King's Speech 2026: NHS Modernisation Bill

NHS Modernisation Bill

“My Ministers will push forward with significant reforms to… the National Health
Service”

● The NHS Modernisation Bill is integral to the Government’s plans to improve
care for patients through investment and modernisation. It will enhance
patient safety and experience through a new Single Patient Record, enabling
joined-up, proactive care and empowering patients. The Bill puts power and
resources in the hands of frontline NHS organisations by abolishing NHS
England and stripping back national bureaucracy.

● These are necessary steps to reduce inefficiency, drive innovation, and
support early intervention to help people stay well for longer. This will help put
the NHS back on its feet so it’s there for patients when they need it, a better
place for staff to work and better value for taxpayers.

What does the Bill do?

● Lord Darzi’s 2024 Review of the NHS in England found the NHS in a critical
condition. A system too rigid and complex, over-centralised and with unclear
accountability, using fragmented and outdated information systems resulting
in poor patient care and experience.

● The 10 Year Health Plan for England sets out the Government’s vision to
deliver high-quality healthcare for the public. An NHS that harnesses digital
technologies, unlocks the value of health data, empowers patients and
clinicians, embeds patient voice in decision-making, and gives greater power
to local leaders, supported by a streamlined and accountable national centre.

● The Bill will:

○ Build the Single Patient Record - by enabling the NHS to bring
together patients health and social care records into one place to
improve patient safety and experience. It will enable people to see their
own health records securely on the NHS App, empowering them to
make informed decisions about their own health. This will apply to
those receiving maternity and frailty care by 2028, with learning from
this applied to the wider rollout.

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○ Abolish NHS England - by transferring NHS England’s functions into
the Department of Health and Social Care or the wider system, it will
reduce bureaucracy, freeing up resources to be reinvested in the
frontline – and in doing so will restore democratic ministerial
accountability for national decision-making.

○ Strengthen local democratic accountability in health systems - by
placing new requirements for mayoral nominees to be on Integrated
Care Boards (ICBs).

○ Streamline the patient safety landscape and ensure better outcomes
for patients and staff by transferring the Health Services Safety and
Investigations Body functions to the Care Quality Commission. It will
also help bring confidence that the Government has learnt from
previous experiences by extending the time limit for the Care Quality
Commission to bring legal action against a provider.

○ Embed patient voice in national decision-making by transferring the
functions of Healthwatch England to the Department of Health and
Social Care, and developing a new Patient Experience Directorate in
the department to make the public's voice more directly involved in the
formulation of policy.

○ Support ICBs to become strategic commissioners by transferring
responsibilities for all but the most specialised commissioning functions
to ICBs, including primary care, dentistry, ophthalmology and
pharmacy.

○ Give ICBs the flexibility in how to manage their local systems by
refining the membership of their boards. The Bill will also streamline
the planning process to ensure there are ICB plans at neighbourhood
and strategic level, eliminating the requirement on a local area to have
an Integrated Care Partnership and allowing for greater flexibility.

○ Empower providers through Foundation Trust reform, giving them
more flexibility to design and deliver healthcare around local needs by
removing the requirement for a Council of Governors. The power to
deauthorise Foundation Trusts as a last resort option will also return to
Ministers.

○ Ensure the voices of patients, service users and local people feed
directly into the services they receive, by transferring the functions
of Local Healthwatch to where local decisions are made. The functions
relating to healthcare will transfer into ICBs, while the functions relating
to social care move to local authorities. Putting patients at the heart of

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 care means devolving decisions to a local level, so those who truly
understand the needs of their communities are trusted to shape and
integrate services more effectively.

Territorial extent and application

● The majority of the Bill will extend to England and Wales, with some
provisions extending to the whole of the UK. The majority of provisions will
apply to England only.

Key facts

● Accountability has been lost in layers of bureaucracy. Since NHS
England’s creation in 2013, the number of staff working in NHS England
(including previously independent digital, workforce and trust regulator bodies)
and the Department of Health and Social Care has risen by 50 per cent. Local
leaders have complained of “two centres”, creating confusion and inertia, and
diluting democratic accountability for the NHS. The public rightly expects to
hold politicians to account directly for the quality of the services they are
paying for.

● The reintegration of NHS England and the restructuring of ICBs is expected to
save £1 billion a year by the end of this Parliament.

● The wider national health and care landscape includes 23 arm’s length
bodies, some of which have overlapping responsibilities, creating confusion
and slowing decision-making. This Bill will clarify the role of local health
bodies, giving them real flexibility to design and deliver health services to best
meet the needs of their local populations.

● The Hewitt Review of integrated care systems, published April 2023,
highlighted challenges to the system from competing requests for information
from both NHS England and the Department of Health and Social Care. For
example: “... in December 2022, in one instance one integrated care system
received 97 ad-hoc requests from DHSC and NHSE, in addition to the 6 key
monthly, 11 weekly and 3 daily data returns.”

● There are more than 70 different channels or organisations that offer a
place for patients or users to share feedback. The Dash Review of patient
safety across the health and care landscape, published July 2025, concluded
that even though there are multiple organisations representing the voice
of the user (including local Healthwatch), patient experience has not been
given the attention that it deserves.

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● A cluttered patient safety landscape has resulted in an overwhelming
number of recommendations, varying in quality and value with
recommendations overlapping or contradicting others. The Thirlwall
Inquiry found that there have been over 1,400 recommendations from 30
inquiries that have taken place in England and Wales in the last 30 years,
related to its Terms of Reference alone. The various inquiries and reviews into
maternity care over the last five years resulted in over 450 recommendations.

● Information silos across hospitals, GPs and community care force
patients to repeat their stories and clinicians to work with incomplete
data. This is not just an inconvenience: it puts patient safety at risk. When
clinicians do not have all the relevant facts available, they cannot make the
best decisions, and patients lose out. A lack of joined up care records also
means that the NHS misses opportunities to diagnose and treat people early.

● According to Healthwatch England’s May 2025 Report, nearly one in four
adults have noticed inaccuracies or missing details in their medical
records, such as incorrect personal details, inaccurate records of medication,
diagnoses, treatments, and conditions. Over one in four of those who have
noticed inaccuracies say they have had to repeat their patient history.

● Independent public deliberations showed support for the Single Patient
Record was strong and wide. It was described as a “long overdue fix to
fragmented care” and 76 per cent were in support of a single patient record.

● A survey of 1,888 English adults (aged 18-75), by the King’s Fund in
February 2025, found that nearly two in three patients and carers have
experienced at least one problem over the last year with their care, such
as having to chase for test results, attending an appointment but the right
information was not available, or inability to change or cancel appointments.
The survey concluded that this is leading to patient frustration, with four in 10
who faced administration problems less likely to seek care in the future.

● In the year up to April 2018, there were over 11 million occasions of a
patient presenting to a hospital using a different Electronic Patient
Record system to their previous attendance (Warren et al, ‘Measuring the
Scale of Hospital Health Record System Fragmentation in England’, August
2020).

● In the year up to April 2018, nearly 4 million patients accessed care at
two or more NHS hospitals trusts, highlighting the demand for effective
inter-hospital data sharing. 65 per cent of maternity complaints to the
Parliamentary and Health Service Ombudsman between 2020 to 2022 related
to communication failures.

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