The Health Bill is set for its second reading in the House of Lords on 13 October. However, it is notable that at Labour Party Conference last month, it was barely discussed. Instead, the political focus was on maternity care, neighbourhood health, prevention and, above all, Andy Burnham’s ambition for a national care service.
That absence is notable because the Health Bill is a substantial piece of legislation. It will abolish NHS England, reshape the relationship between the Department of Health and Social Care and the NHS, change the role of ICBs, provide the legislative framework for a single patient record, and reorganise parts of England’s patient safety and patient voice infrastructure. The Bill sent to the Lords also contains new measures affecting medicines and medical devices regulation.
Before Labour’s leadership change, speculation suggested a Burnham administration might use the Bill to distance itself from the previous Government’s NHS reform programme. In particular, the proposed abolition of Healthwatch and HSSIB appeared obvious candidates for reconsideration. However, so far, there is little sign of a reset.
What does the Bill actually do?
At its heart, the Bill is about redistributing responsibility within the NHS.
Its most significant measure is arguably the abolition of NHS England, with functions moving either to ICBs or back into a restructured DHSC. The Government’s argument is that this will remove duplication between NHS England and the department, simplify national leadership, and improve accountability.
The Bill also changes the role of ICBs, reinforcing their position as strategic commissioners and giving the system greater flexibility over local arrangements.
Single patient record
Another point of contention is the single patient record.
The idea is simple: rather than information remaining fragmented across GP practices, hospitals, and other services, relevant patient information would be brought together into one single record. The Government sees it as fundamental to joined-up and preventative healthcare.
There is broad support for the principle; Healthwatch itself has welcomed the ambition, pointing to longstanding patient frustration about having to repeatedly provide the same information.
But questions remain around data access, privacy, interoperability, public confidence, and exactly who will be able to see and use information.
The NHS says the programme remains at an early stage, and HSJ reports that its technology committee said projects like the single patient record are progressing slower than expected, with “limited capacity within providers to implement change”. It’s unclear, therefore, how long it will take to come into force.
Healthwatch
The abolition of Healthwatch England and local Healthwatch arrangements remains one of the Bill’s most contentious points.
Under the Bill, Healthwatch England would be abolished and its functions transferred to DHSC. Local Healthwatch functions would move to ICBs and local authorities.
Critics argue that this creates an obvious accountability problem, with organisations responsible for planning or commissioning services also now responsible for their scrutiny.
Opposition has extended well beyond Healthwatch itself. Written evidence submitted to Parliament pointed to concerns from organisations including the King’s Fund, Nuffield Trust, Health Foundation, National Voices, Patients Association, and Local Government Association.
Furthermore, as mayor of Greater Manchester, Burnham was a defender of Healthwatch. In November 2025, he and Sir Richard Leese opposed plans to absorb Healthwatch functions into ICBs and local authorities, arguing for the importance of an impartial and independent patient voice.
However, since coming into office, there has been no change. That does not rule out amendments in the Lords. Indeed, the issue is likely to attract significant scrutiny. But so far, there is no sign that the Government is actively preparing for a reversal.
HSSIB
The second contentious issue in the Bill is the transfer of HSSIB functions to the CQC, which the Government argues will simplify a crowded patient safety landscape.
Opponents question whether an organisation responsible for independent safety investigations can sit comfortably within the same body that regulates.
That distinction is important because HSSIB’s model is deliberately designed around learning, rather than blame. The Government has said its legislative “safe space” protections will continue and that the investigation function will operate as a discrete unit within the CQC. Despite these assurances, the Health Foundation has questioned whether maintaining that separation inside a single organisation could actually introduce additional complexity rather than remove it.
Continuity rather than a Burnham reset?
That brings us back to Labour conference, which Burnham used to put political weight behind social care and his proposed national care service.
Yet the legislation already travelling through Parliament received little political attention from fringe events or main stage speeches, which could prove significant.
The Government could still accept or introduce amendments as the Lords scrutinises the legislation. Peers are likely to press particularly hard on patient voice, the independence of safety investigations, data governance, and the transfer of powers following the abolition of NHS England.
But there is currently little evidence of the fundamental rewrite that some initially anticipated. Whether ministers show at next week’s Second Reading debate any willingness or agreement to revisit provisions in the Bill will be the thing to watch, following the silence at Labour conference.
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