The Health Bill 2026: 10 things you need to know

The Health Bill 2026 represents a deliberate reversal of the institutional architecture created by the Health and Social Care Act 2012, pivoting from an arm’s-length model towards direct ministerial control.

Whereas the Lansley reforms sought to depoliticise operational decision-making by embedding NHS England as an independent commissioning body, the current Bill dismantles that structure by abolishing NHS England and transferring its functions to the Secretary of State. In doing so, it reasserts central accountability while simultaneously granting the Secretary of State significantly broader intervention powers over commissioning, provider governance and system performance.

Whilst this could be characterised as one of the most significant NHS restructures in over a decade, this isn't a Bill that creates a raft of new NHS organisations (if anything, it creates fewer). There is, however, a fundamental recasting of who holds decision-making authority across the system and some subtle tweaks to the governance arrangements both at provider and local commissioner level, all designed to enable the NHS 10 Year Plan.

A distinctive feature of this Bill is not just the direction of travel but the legislative technique: in contrast to the highly prescriptive detail of the 2012 Act, the current approach is intentionally skeletal, setting broad enabling powers in primary legislation and leaving much of the operational substance to be defined through secondary legislation, policy and guidance.

The requirement for Foundation Trust ('FT') Councils of Governors ('Council'), constituencies, and members will be removed completely.

Part of the rationale is to allow more dynamic and flexible arrangements to take account of patient, staff and stakeholder insights. FTs could choose to retain their Councils in some form, perhaps as a public/patient engagement forum, but it will have no legal status or powers.

FTs should now ask themselves: is there any role for the Council in our organisation? In most cases, the answer is probably "no", which will lead FTs to consider the practical implications in the interim period until the Health Bill is passed. How can FTs ensure that governors remain engaged enough to take critical decisions? What are the options for managing vacancies and elections, knowing that any arrangements will be short lived. And how can the FT make the best use of the Council in the remaining time?

Once Councils are removed, their powers to appoint and remove FT Chairs and NEDs will vest in the Secretary of State. This puts the choice of FT leaders on par with NHS Trusts, and under direct Ministerial control. In consequence, the Secretary of State will also be able to determine (block?) joint leadership appointments which underpin many Group Models. Neighbouring FTs and NHS Trusts should consider the impact on strategic collaborations and should be aware that formal mergers and acquisitions will be granted by the Secretary of State in future.

Trust secretaries will be particularly keen to note that Secretary of State approval will be needed for constitutional changes. While this seems straightforward on the surface, it could mean navigating a new DHSC constitution review process. Given the practical uncertainty, FTs may want to consider what can be done now to future-proof the need for changes. More fundamentally, the Secretary of State will have power to approve the size and configuration of FT boards over and above the minimum requirements of Schedule 7 (FT constitutions) in a roll-back of one of the core benefits and freedoms enjoyed by FTs so far.

The rarely-used Trust Special Administration survives. In a further step, failing FTs could be converted back to NHS Trusts by the Secretary of State. It is expected that conversion will only happen in cases of serious failure and involves a detailed process including a statutory order. It seems to be as much about maintaining the FT status/brand as it is about direct control over individual FT poor performance. FTs under close NHS England scrutiny will want to understand the likelihood and implications of this level of intervention, particularly on the FT's directors.

Leaving aside reputational kudos, FTs may question whether being an NHS trust makes any practical difference to what they can do and how they are regulated. That's a reality we suspect is dawning on many of our FT clients across numerous areas impacted by the Bill. 

As expected, the Bill will have a further significant impact on ICBs. From the Secretary of State gaining powers to intervene in a failing ICB to the ability for Regulations to impose duties on ICBs in respect of missed waiting time targets, the Bill cements the ability for direct central control of local commissioners.

The role of ICBs as strategic local commissioners is given legislative traction. ICB membership is overhauled - gone is the requirement for local NHS Trust, FT, primary medical provider and Local Authority membership. There remains a need for a mental health representative and representation from any mayoral Authorities in their local areas. The Bill removes the requirement for integrated care partnerships - statutory committees bring together the ICB and local authorities - and associated plans. Although this removal could be perceived as counter-intuitive to a more strategic role, joint working is retained through Joint Strategic Needs Assessments and the newly introduced Neighbourhood Health Plans.

Many ICBs have struggled to meet the reduced running costs targets and the Bill certainly reduces operating costs with fewer committees, plans and members but it risks less collaboration and potentially a loss of feeling of inclusion by Local Authorities and primary and secondary care NHS providers. It will be a question of time whether ICBs find this reduced operating structure more nimble to perform their more clearly defined role as strategic commissioners.

While the Bill does not create new Neighbourhood concepts through organisational change as we might have expected to see in the highly prescriptive legislation of past governments, it is certainly an enabling Bill which will support the delivery of care in the community. This is evident through intentions to develop the Single Patient Record accessible across all NHS data controllers and patients, to pursue strategic commissioning by ICBs, the requirement for representation from mayoral Authorities on ICBs, and the development of Neighbourhood Health Plans. This, of course, sits alongside the recently published Neighbourhood Health Framework where considerable further detail was set out in relation to neighbourhood services.

The 'left shift' from hospitals to community has long been government ambition, sought by patients and the public. The test will be whether Neighbourhoods can develop from the NHS 10 Year plan concepts (and the announcement of two new contracts for single neighbourhood providers and multi-neighbourhood providers), through to the Neighbourhood Health Framework and now the Bill, at speed to reduce inequalities in respect of access to health services and to outcomes achieved by the provision of health services. From the work that our teams are involved in, the Neighbourhood ambition is evident and the Bill provides a further nudge in the right direction, enabling commissioners and providers without further disruptive organisational change.

ICBs have been commissioning primary care services under delegated authority from NHS England for several years. The Bill now formally transfers these functions to ICBs to enable local tailoring of primary care commissioning. This fits with the approach to Neighbourhood health with each local area adopting an approach that makes sense locally.

GPs will be affected by the membership changes to ICBs - their representation as members of an ICB will no longer be a statutory requirement. Explained as a supportive measure as ICBs move to become more strategic commissioners, there is a risk of less collaboration with primary (and secondary) providers at the commissioning level.

The more controversial aspect of the Bill for GPs is the requirement to share patient data as part of the Single Patient Record. At the date of writing, the BMA is encouraging collective action in relation to new voluntary data sharing arrangements and new obligations requiring data sharing will likely attract considerable comment on security and confidentiality grounds. We have set out within our 'Devil's in the detail' comments, the protections where the Bill expressly acknowledges concerns around data security and requires the Secretary of State when making Regulations to have regard to the need for safeguards to prevent improper use of the information.

The Single Patient Record (SPR) is a central enabler of the NHS 10 Year Plan. While significant progress has been made in digitising patient records, the focus has largely been on moving from paper to digital systems rather than ensuring those systems are interconnected. As a result, records often remain siloed and are not easily accessible to patients or shared across care providers, limiting the benefits of a digital health system.

The SPR programme seeks to address this by enabling secure, practical, and legally compliant data sharing across health and social care. The Health Bill supports this by introducing the SPR into legislation and establishing a framework, through regulations, to ensure patient information is accessible to both patients and those involved in their care. This will support more coordinated, neighbourhood-based care by allowing multiple providers to contribute to a shared record.

The Bill also includes provisions to enforce compliance with future regulations, including the potential introduction of a penalty regime, reinforcing the importance of adherence for both providers and patient confidence.

The HSSIB is being abolished, and its investigative functions folded into a new arm of the CQC. The HSSIB carries out independent patient safety investigations. The investigations are intended to provide an independent safe space for individuals to raise issues. They identify risks to the safety of patients and make recommendations to address those risks.

This builds on Penny Dash's recommendations in 2025 that the patient safety landscape should be streamlined, simplified and consolidated, and specifically implements her recommendation that investigatory functions should transfer from HSSIB to CQC. The key aim is to reduce duplication and improve coordination between investigations (HSSIB) and oversight (CQC). 

HSSIB has had a short life as a standalone public body, having lived as the HSIB within NHS England from 2017 to 2022, and only being spun out into a separate body following the 2022 Act.

The shift follows the trend of reducing the number of separate arm's-length bodies in the NHS landscape. The justification for creating HSSIB as a separate entity in the first place was to ensure a distinct and protected safe space for its investigations and patients raising issues with them. The Bill seeks to preserve the safe space by prohibiting disclosure of protected investigation-related material outside CQC's new investigation function.

The change is likely to see a renewed focus on the quality of recommendations produced, and it will be interesting to see the impact of the new National Quality Board on that. It will also be interesting to track the level of coordination between CQC's investigation and oversight arms, and the extent to which the two are able to dovetail.

Regulations will flesh out the operational details needed on some of the key issues in the Bill. As we have described above, this is not a highly prescriptive Bill and we expect much to be established through secondary legislation, policy and guidance. 

In contrast to the Bill, the 2012 legislation changes that brought in CCGs contained a wealth of new provisions, directly amending primary legislation. This Bill is relatively short with much of the focus on removing or replacing references to NHS England. The Bill does, however, enable additional secondary legislation, in the form of statutory regulations, on a wide range of subjects. These include:

• Waiting times - where Regulations may impose duties on ICBs mandating actions if treatment is not provided within a specific period.
• Patient choice - where Regulations may require ICBs to make arrangements to enable patients to make choices in relation to specified services. These choices may go beyond the choices set out in the NHS Constitution.
• Appeals against commissioning decisions - where Regulations may give individuals the right of appeal against a decision of an ICB in relation to that individual's treatment. These Regulations could include the establishment of a panel to hear such appeals.
• FT board membership - where Regulations may include eligibility for appointment of a director and the circumstances for appointment and removal of the chair and other NEDs by the Secretary of State.
• Single Patient Record - where Regulations could be used to establish the SPR system, require disclosure of information and impose fines for non-compliance. The Bill expressly acknowledges concerns around data security and requires the Secretary of State when making Regulations to have regard to the need for safeguards to prevent improper use of the information.

For struggling FTs, the Bill sends a strong signal that being an FT is not a 'one-way' street (we consider this further in our 'FT governance changes' comments above). At the other end of the scale, high performing FTs may be thinking that the Bill creates something further to aspire to.

Advanced FT status, set out within the NHS 10 Year Plan, will not be enshrined in legislation, existing in policy instead (and therefore more easily dismantled). Warm words accompanying the Bill suggest that Advanced FTs will continue to feature in the new landscape. Referencing back to the NHS 10 Year Plan, the Bill's provider-based reforms are expected to be a reinvigorated and reinvented FT model embodied by the introduction of Advanced FT status. The status will be the new marker of excellence used for high-performing NHS FTs and NHS Trusts which will need to pass an updated assessment process. 

As a reminder, the process to become an Advanced FT involves an NHS England assessment including in the areas of:

• strategy, leadership and planning
• financial performance and sustainability
• sector collaboration, and people and culture
• services and quality of care
• digital progression

Advanced FTs are promised core freedoms of strategic and operational autonomy, a capability-based regulatory approach and greater financial flexibility, with expectations around greater leadership roles at the local and national level. Since the Bill rolls back some of the core freedoms for all FTs, Advanced FTs will rightly want to know how the two frameworks will work together in practice.

In a further step, Advanced FTs can go on to be assessed and designated as an Integrated Health Organisations (IHO). IHOs would hold the health budget for a defined local population under an IHO contract. The idea is to empower capable FTs to lead system redesign, invest in prevention and undo fragmentation working alongside single and multi-neighbourhood providers.

The IHO model will be a contract-based delivery mechanism, not a new type of organisation. From that perspective, it is unsurprising that there is no direct mention of it in the Bill. According to the Explanatory Notes to the Bill, technical amendments to the NHS Act 2006 have been proposed as enablers of IHOs. Existing delegation and joint working provisions will be amended to allow the Secretary of State to exercise their functions by or jointly with certain bodies. In support of those arrangements, the Secretary of State may also establish joint committees and pool funds. These changes are said to support plans for the Secretary of State to delegate power to IHOs.

Designated IHOs will work with NHS England and commissioners to co-develop the model during 2026 to 2027, with the first IHO contracts set to be awarded in 2027. 

Over the next 12 months, the focus will be on parliamentary scrutiny of the Bill itself, as it progresses through committee stage, amendment and debate before (if passed) becoming an Act. This is the point at which the breadth of the Secretary of State’s proposed powers will be tested and potentially reshaped. There is already noise about the scale of ministerial direction powers and the implications for system independence, making this a central theme for debate in the coming months.

Only once the Bill is enacted will the real operational detail begin to emerge through secondary legislation, Regulations and statutory guidance. The structure of the legislation is deliberately high-level and enabling. This means that many of the most material issues (including commissioning frameworks, data-sharing architecture and the practical operation of new governance models) are deferred. In that sense, the Bill should be seen less as the final settlement and more as the legal framework within which the future system will be designed. For organisations, this creates a two-stage horizon: short-term engagement with the legislative process itself, followed by a much longer period of regulatory development and implementation in which the practical implications will crystallise.

Our team of expert lawyers are running NHS Board briefing sessions about the implications arising from the Health Bill. Please do contact us should you wish to explore this further.