Health Bill: impact assessments summary

Summary of policies and intended aims

On 13 March 2025, the government announced plans to abolish NHS England and merge its functions into the Department of Health and Social Care (DHSC) by March 2027, subject to Parliamentary approval. This decision reflected the need for a new structure capable of delivering the scale of reform and ambition set out in the government’s health mission, Plan for Change, and was reinforced by the 10 Year Health Plan for England.

The 10 Year Health Plan set out the need for a radical change to address both:

• the immediate challenges the NHS faces
• longer-term demographic change, technological opportunity and an evolving workforce

It was formed around a large-scale public conversation, Change NHS, that involved thousands of staff and members of the public.

The Health Bill (‘the bill’) is a critical part of this government’s health agenda, and it is an important step in enabling the required change in line with the 10 Year Health Plan and abolishing NHS England.

The bill is supporting 2 overarching aims:

• improve patient safety and experience through a new single patient record (SPR), enabling joined-up, proactive care and empowering patients
• put power and resources in the hands of NHS organisations providing direct patient care by abolishing NHS England and stripping back national bureaucracy

Improve patient safety and experience through a new SPR, enabling joined-up, proactive care and empowering patients

This overarching aim covers the creation of a legal basis for an SPR.

The bill proposes to allow the NHS to bring together patients’ health and social care records in one place through the SPR - a single, secure and authoritative account of patient data. This will enable people to see their own health record, securely, on the NHS App - empowering them to take informed decisions about their own health. Healthcare professionals will access the patient information they need from one single place too, supporting safer, quicker and more accurate care. 

Often patients’ experience of care is not joined up, and they must tell their story repeatedly each time they meet a new clinician. This 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. By moving to a more personalised and proactive health and care system, we are giving people a bit more control over their lives. The NHS will revolve around patients, rather than patients revolving around the NHS.

Put power and resources in the hands of NHS organisations providing direct patient care by abolishing NHS England and stripping back national bureaucracy

This overarching aim covers abolishing NHS England and implementing the recommendations of the Review of patient safety across the health and care landscape (the Dash review) to:

• improve accountability and efficacy
• provide a better service to patients

The recommendations of the Dash review relate to:

• abolishing Healthwatch England (HWE) and local Healthwatch
• the role of the Health Services Safety and Investigations Body (HSSIB)

This aim also covers a range of measures to support clarity in relation to the new operating model for integrated care boards (ICBs) and NHS foundation trusts (FTs) to support devolving decision-making to the local level.

Lord Darzi’s findings in the Independent investigation of the NHS in England were clear that the Health and Social Care Act 2012 has made the NHS rigid, overly centralised and bureaucratic. This can draw resources from where they are most needed - NHS organisations providing direct patient care - and slow down change to modernise the NHS.

Abolishing NHS England intends to cut bureaucracy and increase efficiency to support us in reinvesting resources in the NHS organisations providing direct patient care and restoring democratic ministerial accountability for national decision-making.

Through implementing the Dash review recommendations, the bill proposes to simplify the confusing landscape of arm’s length bodies (ALBs) with unclear and often overlapping roles, that ultimately do not best serve the public. This includes transferring the functions of HSSIB to the Care Quality Commission (CQC).

The bill proposes to abolish HWE and embed the voice of patients back into central government’s work, with a dedicated national director of patient experience. Additionally, the work of local Healthwatch will be transferred into ICB and local authority engagement functions, putting accountability closer to clinical teams and clinicians.

Empowering ICBs as strategic commissioners will support putting patients at the centre of care by devolving decisions to a local level where different services can better integrate. The bill proposes transferring responsibilities for all but the most specialised commissioning functions to ICBs. ICBs as local strategic commissioners are best placed to integrate health services such as primary care, dentistry, ophthalmology and pharmacy. This measure will refine the requirements for ICB memberships to better support strategic planning opportunities.

Strategic authority mayors rather than local authority representatives will be included as members and provider organisations (such as NHS trusts, NHS FTs and primary medical care providers) will no longer sit as members on ICBs. The bill also proposes to remove the requirement to set up integrated care partnerships to allow for local decisions on how to most effectively put in place partnership working.

In addition, empowering ICBs as commissioners will be supported by financial accountability changes allowing ICBs to move away from performance managing to act as strategic commissioners.

Reforms to the NHS FT model will give providers more flexibility to design and deliver healthcare around local needs. The reforms will introduce the basis for the criteria to convert failing NHS FTs into NHS trusts, supporting the principle of earned autonomy with a higher price for failure for those FTs that do not meet the necessary standard. They will also remove the requirement for NHS FTs to have governors, allowing them to put in place more dynamic arrangements that best serve their patients and staff.

The bill is only one part of a wider modernisation agenda. While the bill is a critical part of government reform, several proposals in the 10 Year Health Plan do not need legislation. Work is already underway to support implementation of neighbourhood health, reducing waiting times and improving health outcomes, among other areas. In addition, a Transformation programme will lead the design of a restructured DHSC to take on NHS England functions, with responsibility for policy decisions on the design and size of the new organisation.

Impact assessments

The bill legislates for multiple policy objectives and therefore brings forward several different measures. Following engagement and policy development undertaken during the 10 Year Health Plan process, the proposals presented in these impact assessments (IAs) were deemed preferred and were subsequently included in the 10 Year Health Plan. Therefore, most IAs only present the business as usual and preferred options, with some IAs including other options considered where appropriate. An assessment of impacts for the 10 Year Health Plan proposals was also provided as part of the 10 Year Health Plan impact statement.

All the policies where costs and benefits have been identified have an IA which discusses the objectives, rationale, costs and benefits in detail. The IAs will also highlight where the policy meets the overarching aims listed in the introduction.

A proportionate assessment of impacts for each proposal has been developed in line with HM Treasury Green Book guidance. Several of the policies relate to enabling powers which do not have quantifiable benefits or costs, as the impact of the policy will ultimately depend upon how the powers are used. Therefore, in most cases a qualitative assessment of the potential costs, benefits, risks and mitigations has been included as part of this package of IAs.

For each of the policies, the IA presents the identified costs and benefits. It is assumed that the benefits outlined are expected to outweigh the costs, but this assumption is uncertain because the scale of benefits and costs is dependent on future policy decisions.

Furthermore, given that there are multiple policies, several of which do not have quantifiable benefits, it was not deemed appropriate to calculate an overall net present value (NPV) for the relative costs and benefits across the entirety of the bill measures. Rather, if costs and benefits have been quantified, then an NPV is included in that policy’s respective IA and will be considered in isolation.

The analytical approach to IAs is consistent with Green Book guidance and the principle of proportionality. Therefore, some IAs contain more detailed analyses based on the information available and specific requirements. For example, the SPR and information sharing proposals affect businesses, so that IA:

• must adhere to regulatory IA standards in line with the Better Regulation Framework (such as more detailed cost estimates than a discretionary IA)
• has undergone scrutiny by the Regulatory Policy Committee

Also, the IAs covering HSSIB and abolishing NHS England and Healthwatch involve their functions either merging with other organisations or being conferred on the Secretary of State or other organisations. The level of detail available about policy decisions, such as redundancies, differ for each proposal. Therefore, the approach is tailored to that level of detail in each case.

The IAs have been grouped together in some cases so that policies with a similar theme can be considered together. We are publishing 4 IA documents:

• Health Bill: abolishing NHS England - impact assessment
• Health Bill: structural measures to ICBs and FTs - impact assessments
• Health Bill: patient safety measures - impact assessments
• Health Bill: single patient record and information sharing - impact assessment

Summary of policies and their respective IAs

Policy: abolishing NHS England and creating a more efficient, agile, restructured DHSC

IAs:

• ‘Health Bill: abolishing NHS England - impact assessment’
• ‘Transfer of Health Services Safety Investigation Board (HSSIB) functions into the Care Quality Commission (CQC)’ (published in ‘Health Bill: patient safety measures - impact assessments’)

Policy: reforming the NHS FT model

IAs:

• ‘Reform to the foundation trust model’ (published in ‘Health Bill: structural measures to ICBs and foundation trusts - impact assessments’)
• ‘Financial accountability reform’ (published in ‘Health Bill: structural measures to ICBs and foundation trusts - impact assessments’)

Policy: empowering ICBs as strategic commissioners

IAs:

• ‘Health Bill: abolishing NHS England - impact assessment’
• ‘Reform to the integrated care board (ICB) model’ (published in ‘Health Bill: structural measures to ICBs and foundation trusts - impact assessments’)
• ‘Removing the requirement to set up integrated care partnerships’ (published in ‘Health Bill: structural measures to ICBs and foundation trusts - impact assessments’)
• ‘Financial accountability reform’ (published in ‘Health Bill: structural measures to ICBs and foundation trusts - impact assessments’)

Policy: creating a legal basis for an SPR

IA: ‘Health Bill: single patient record and information sharing - impact assessment’

Policy: abolishing HWE and local Healthwatch

IA: ‘Abolishing Healthwatch England and local Healthwatch’ (published in ‘Health Bill: patient safety measures - impact assessments’)

Policy: strengthening regulatory enforcement for CQC

IA: ‘Care Quality Commission (CQC): extending the statute of limitations’ (published in ‘Health Bill: patient safety measures - impact assessments’)

Interaction between policies

The policies in the bill should be seen as mutually reinforcing, rather than policies to be viewed in isolation. There is a close interdependency between the bill provisions, such as where empowering ICBs as strategic commissioners relies in part on creating a more efficient, agile, restructured DHSC, and both policies relate to the effective transfer of NHS England functions in the process of its abolition.

Further potential interdependencies are outlined below, although this list is not exhaustive and details can be found in the accompanying IAs for each policy:

1. New financial provisions (such as a new ‘backstop’ power for the Secretary of State to set limits on revenue spending) and empowering ICBs as strategic commissioners (by ensuring financial accountability firmly sits with the Secretary of State following the abolition of NHS England) both relate to the setting out of financial accountability in the health and care system.

2. Abolishing HWE and local Healthwatch and transferring HSSIB functions to CQC both relate to the governance of patient safety, and both interact with the creation of a more efficient, agile, restructured DHSC with respect to improving the standards of care for patients.

3. Reforms to ICB membership also relate to the changes being introduced as part of the English Devolution and Community Empowerment Act 2026.

Many of the policies in the bill provide enabling powers and as such are related to secondary legislation or non-legislative decisions, which will be required to deliver the changes set out in the 10 Year Health Plan. The accompanying IAs outline where powers are enabling and where further decisions will be assessed separately. The IAs do not set out how such decisions will be made or attempt to assess them pre-emptively.

Cumulative impacts on the health and care system

Although the proposals are outlined in separate IAs to clarify the specific objectives of each, it is important to note their cumulative effects on ICBs and FTs. An overview of these effects is provided below.

Cumulative impacts on ICBs

The changes for ICBs are intended to support ICBs to become strategic commissioners by clarifying their role and reducing their administrative burden, such as through streamlining strategic planning. Working more closely with mayoral strategic authorities also supports with 10 Year Health Plan ambitions to align strategic planning between the NHS and local government. It will also ensure that ICBs take more account of patients’ views in their decision-making, to serve their local populations better.

The scale and complexity of these legislative changes, together with ongoing ICB reforms such as boundary adjustments and cost reductions, introduce short-term delivery risks as ICBs adapt to new working practices. The model ICB blueprint and the Strategic commissioning framework (including the strategic commissioning development programme) mitigate this risk, by providing guidance and support to ICBs to achieve these changes.

Cumulative impacts on FTs

The 10 Year Health Plan aims to increase FT freedoms, through an ambition to:

reinvent the NHS FT model for a modern age. By 2035, our ambition is that every NHS provider should be an FT with freedoms including the ability to retain surpluses and reinvest them and borrowing for capital investment. FTs will use these freedoms and flexibilities to improve population health, not just increase activity.

As freedoms are granted to FTs through non-legislative means (like the introduction of advanced FT status), expectations are being put in place to ensure they meet national standards. Also, some of these legislative changes are safeguards to avoid unintended consequences for patients from these expanded freedoms, by ensuring the Secretary of State can intervene to support FTs when required.

Summary of policy proposals affecting ICBs and FTs

1. Changes affecting ICBs

These changes are:

• abolishing NHS England: new commissioning responsibilities, UK devolution duties and integration duties will be conferred on ICBs. New Secretary of State powers of direction will also apply to ICBs (changing the way requirements are set on ICBs)
• ICB reforms: changes to the required nominations for ICB membership and the strategic planning landscape
• removing the requirement to set up integrated care partnerships - these are committees where ICBs work with local authorities and other partners
• HWE and local Healthwatch: the health functions of local Healthwatch will be conferred on ICBs

2. Changes affecting FTs

These changes are:

• abolishing NHS England: we will streamline the trust special administrator process. However, this process is only required in cases of failure at the provider level. Changes will also strengthen the provider licence as a mechanism for ensuring compliance with existing legislation

• FT reforms: these changes are:
  • removing the requirement for FTs to have a council of governors - this will enable these functions to be provided in a national, consistent way by the Secretary of State
  • introducing powers for the Secretary of State to de-authorise an FT back to an NHS trust, providing safeguards in serious cases of failure
• financial accountability: we will expand existing financial control powers to include FT revenue spending (not just capital spending), to safeguard financial balance at the national level
• ICB reforms: FTs (along with other providers) will no longer be required to be nominated to be members of ICBs

Specific impact tests

This section summarises where specific impact tests have been deemed relevant to the policies within the bill.

Equality

DHSC has undertaken equalities assessments for the policy measures that are covered in the accompanying IAs, as appropriate. These are published alongside the bill’s IAs.

Economic growth

DHSC is undertaking assessments on the impact of proposals on economic growth as appropriate. It is unlikely that these proposals will have a direct impact on economic growth. However, the SPR may have an indirectly positive impact on economic growth through improved health outcomes, although this is uncertain.

Privacy

Security and privacy are fundamental to the design of the SPR. Permission to access patient information will be restricted to authorised users only - with an audit trail of who has accessed the patient’s data.

The new powers will facilitate the development of the SPR by enabling regulations to require or authorise processing of data for the purpose of making it available to patients. Any requests that relate to identifiable patient information will be subject to existing data protection law and individual privacy tests.

Justice system

Justice impacts are anticipated for the proposal to strengthen the regulatory enforcement for CQC by changing the time limit for CQC to bring legal action against a provider from 3 to 5 years.

There may be further justice system impacts related to future decisions and processes, enabled by this bill, such as through making regulations or issuing guidance. These will be assessed separately to primary legislation, as appropriate.

New burdens for local government

New burdens for local government are expected in relation to local authorities complying with requirements in relation to the SPR, which the bill will enable through regulation-making powers. This is because local authorities will need to familiarise themselves with the regulations and may incur administration costs to support successful completion of new obligations.

New burdens for local government may arise in relation to the proposal to abolish local Healthwatch, as local authorities will need to establish new service user engagement and feedback functions. This will depend on future funding and grants agreements.

Competition and innovation

The impact of SPR legislation on market competition is uncertain, as while an increased compliance burden could deter entry into the market, improved data sharing processes and an increase in clarity on the management of patient data might encourage entry and investment into the sector. Beyond this, there are no expected impacts of this legislation on competition and innovation.

Small and micro business assessment (SaMBA)

The proposed legislation enables the establishment, through regulations, of a legal basis for an SPR which will affect businesses, and the accompanying IA includes a SaMBA.

Monitoring and evaluation framework

We intend to undertake an evaluation of the bill to provide objective and robust evidence for both learning and accountability. The learning element will feed directly into the development of services and creating an evidence base. The accountability element will support further decisions and approaches to implementing services.

Any costs associated with monitoring and evaluation, including new data collections, have not been quantified at this stage. A more detailed monitoring and evaluation plan will be developed as the bill progresses through Parliament.

The monitoring and evaluation of the bill will need to encompass a uniquely large and complex policy landscape, much of which is still subject to policy refinement. The intention is that each individual bill measure will be considered as part of the monitoring and evaluation strategy.

It is anticipated that measures will be grouped where possible, with the groupings directed by shared objectives. For example, one evaluation is likely to encompass the range of structural reform measures including:

• removing the requirement for integrated care partnerships
• changes to ICB membership

There will also be several policy proposals encompassed by standalone evaluations, such as the Dash review measures (HSSIB and Healthwatch) and the SPR measure.

The evaluations will seek to cover similar research questions and would involve similar methodologies. Precise details of how each bill measure will be handled will be developed in more detail should the bill receive Royal Assent. As such, this proposal sets out the intended aims of the programme and the high-level approaches the department may take towards determining the impact of the bill.

The primary success indicator that the department must monitor is the extent to which the bill successfully meets its aim of enabling the department and the wider health and care system to operate more efficiently and effectively. Should the bill receive Royal Assent, it would be important to undertake a mixed-method evaluation. The evaluation should include elements of impact and process evaluations. This would be needed to understand:

• how the bill has been enacted
• whether there have been any unforeseen barriers
• what impact the bill has had on implementing the 10 Year Health Plan ambitions

This evaluation would aim to answer research questions such as these on impact:

• What impact have bill initiatives had on outcomes in each year after implementation?
• To what extent have the bill initiatives enabled the goals of the policy proposals to be met in each year after implementation?
• What unintended consequences has the reform programme had?
• What impact have bill initiatives had on external stakeholders and businesses?

And these questions on process:

• At a national level, how has the bill been implemented? What barriers or issues has the reform programme encountered during its delivery?
• Has the bill been implemented equitably across the country, patient and staff demographic groups?
• At a health and care system level, how has the bill been implemented? What barriers or issues has the bill encountered during its delivery?
• What workforce, contractual, technology or other resources need to be put in place for delivery?

Existing data collections would need to be reviewed to assess to what extent monitoring and evaluation could be accommodated by current data collections and what additional data would need to be collected. Should the bill receive Royal Assent, the government would ensure adequate baseline data is captured to facilitate the evaluations.

One option being considered is commissioning a research partner to undertake a mixed-method evaluation (or multiple, separate evaluations) to explore the questions set out above. For example, DHSC would consider commissioning using the Policy Research Programme (PRP) open-competition method, through the National Institute for Health and Care Research (NIHR). The precise timing schedule for publication of results would be negotiated when a research partner is in place.

An evaluation of this scale is expected to take between 2 to 3 years from commissioning to completion. However, research outputs would be produced and shared where appropriate before completion. This will allow lessons learned and best practice to be shared within the health and care system. In addition, DHSC would expect that full benefit realisation may stretch beyond the timeframe of a commissioned evaluation. As such, the department would also expect an evaluation partner to propose or develop robust collection mechanisms to enable the department to continue to monitor the impact of the proposals.