One of the bits of business for the reconvened Commons left-over from the shambolic Starmer period of government is the Health Bill (aka NHS Modernisation Bill 2026). Lowdown readers can be excused for having forgotten this ragbag of odds and ends, hatched up when Wes Streeting and Alan Milburn ruled the roost in the DHSC.
The DHSC’s official summary of the Bill now carries the health warning: “This was published under the 2024 to 2026 Starmer Labour government.”
That raises an obvious question: why on earth does Andy Burnham want to push through this legislation, which drives in the very opposite direction from his USP of promising to restore “local” control – and to offer change “to every postcode”.
Ministers have already had to amend by U-turning on the Bill, most recently a U-turn to scrap its proposals to remove mandatory council representation from integrated care boards. It will now say ICBs (soon to be fewer and larger in number and less local) should have “at least one member nominated jointly” by the local authorities it covers, in addition to the original proposal of “a member nominated from each mayor of a mayoral strategic authority covered in the ICB’s area”.
How local will that representation really be? North East and North Cumbria ICB, for example, covers three sub-areas and 14 very different local authorities – from coast to coast: North area: County Durham, Gateshead, Newcastle, North Tyneside, Northumberland, Sunderland, and South Tyneside; Tees Valley area: Darlington, Hartlepool, Middlesbrough, Redcar & Cleveland, and Stockton-on-Tees; and North Cumbria area: Cumberland and part of Westmorland & Furness.
Which one of these councils would be the lucky one chosen to raise a “local voice” on behalf of its own residents and the other 13 at ICB meetings? How could that even be done without some form of organised meeting?
The succession of service failures, cash crises and unresolved problems in the North West, where Andy Burnham was Mayor of Greater Manchester and Labour also has the Mayor in Liverpool City Region, tends to suggest that there is little evidence of Mayors or their nominees successfully steering large ICBs.
Weaker local participation
How significant is the concession on council involvement compared with the Bill’s proposal to scrap the ‘Integrated Care Partnerships’, the bodies that were set up alongside ICBs to give local authorities some form of a role in local health care planning – even if there is also a token commitment to strengthen the often weak Health and Wellbeing Boards?
There has also been experience over the years of potentially disastrous hospital closure plans being driven forward by remote NHS bodies and having to be blocked by local councils, responding to local campaigns (Lewisham Hospital closure, North West London’s ‘Shaping a Healthier Future’, and more). How would this latest change help one or more communities within any of the council areas get their point of view across to an ICB on an issue that affects them, but perhaps few or none of the other areas?
Moreover, since the most deprived areas are almost inevitably the ones with the least voice, how can this new system open up any serious work to eradicate inequalities in health?
The latest amendment follows an earlier about-turn – to drop the proposal that Foundation Trust boards would no longer be required to include a nurse and a doctor member. However, the Bill is still proposing to reduce FT accountability by stripping away the need for them to have an elected Board of Governors, a plan which is vaguely summarised as:
“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.”
This makes no sense. No examples can be found of a council of governors anywhere preventing a foundation trust from designing or delivering healthcare around local needs. The problem did not exist. The only effect of the change is that even fewer people would be brought into engagement with their local NHS, and information on the plans and decisions of FTs would be shared and discussed by ever-fewer people, with little if any public awareness until decisions have been made (often in closed session) and policies are pushed through.
Local scrutiny scrapped
The Bill also aims to scrap Healthwatch nationally, along with the puny, deliberately toothless and often ineffective local remnants of the old Community Health Councils (which once held statutory powers to speak up for communities and patients).
Instead, the Bill would bring in an even more ridiculous system in which the Department and ICBs would effectively be allowed to mark their own homework and select which “patient voices” they choose to listen to. The summary claims the new system in the Bill would:
“embed patient voice in the heart of national decision-making by transferring the functions of Healthwatch England to DHSC, and developing a new patient experience directorate in the department to make the public’s voice more directly relevant to the formulation of policy …
and “ensure the voices of patients, service users and local people feeds 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.”
We can almost smell the predictable waft of bullsh*t even before the DHSC sets up its Patient Experience Directorate (PED), with a team of smart, well-paid bureaucrats, a shredding machine at the ready for any communications which do not fit in with the happy-clappy rhetoric that will be churned out by well-staffed comms teams: perhaps occasional tokenistic gatherings might be held of carefully selected members of the public to take tea, finger sandwiches and vol-au-vents and exchange polite – but pointless – conversation with PED functionaries, or even a junior minister.
ICBs, whose staffing is being extensively cut back as part of the ongoing NHS financial squeeze, are not even obliged to go through the rigmarole of setting up PEDs: all they need is a large bin to receive any messages communicated by patients.
This type of ‘patient voice’ was abandoned back in 1974, when governments of both main parties agreed that there was a need for a genuine patient voice – and CHCs were established. The current plan to turn back the clock was nonsense when it was first published, and it makes even less sense given Andy Burnham’s promise of change at really local level.
But what of the rest of the Bill? After Wes Streeting did a runner from the Secretary of State position (only to find out how hopeless were his chances of winning a leadership vote) Lowdown summed up what he had left behind:
“All Streeting offered was a belated word salad of a ‘Ten Year Plan’, which a year later is still devoid of any clear implementation, workforce or finance plan. It threatens to recreate the NHS competitive ‘market’ of the 2000s and further weaken the already minimal public accountability of NHS bodies ….
“Legislation, to rubber stamp the plan (and throw the NHS into turmoil through another top-down reorganisation and wholesale loss of top-level jobs as NHS England is abolished and rolled into the DHSC) is still going through parliament with pathetically minimal scrutiny or debate.”
The official summary of the Bill begins with the abolition of NHS England (which for all its faults, did at least hold some Board meetings in public and publish board papers) and its merger into the DHSC, which has no equivalent public board or system of published board papers, removing one existing window through which the public can scrutinise national NHS decision-making.
The Bill also follows the line of the Ten Year Plan in redefining ICBs as “strategic commissioners” of services, holding the budgets – eventually around 93% of NHS healthcare commissioning budgets – and therefore reinforcing the divide between commissioners and providers that was central to the costly and wasteful market system developed under New Labour from 2000 and Andrew Lansley’s disastrous top-down reorganisation for the Tory-Lib Dem coalition in 2012.
Andy Burnham, as Health Secretary, brought the drive towards marketisation of the NHS to a halt in 2009 by declaring that the NHS should be the ‘preferred provider’ for the community services that were being outsourced to private and non-profit providers. He successfully defended that position in Gordon Brown’s cabinet, and it was only reversed after Labour’s defeat in 2010.
The notion that competition improves services or delivers genuine savings for the NHS has been comprehensively discredited since then by all the efforts to make a market-style system work.
It’s not clear why Andy Burnham should now want to push through legislation taking us back down the same old track again.
And of course, the government’s wider programme surrounding the Bill, following the logic of the Ten Year Plan, also has a consistent line of rhetoric on “shifting care from the hospital to community, through the development of neighbourhood health services which organise services around people and the creation of integrated health organisations (IHOs), which will eventually have control over the whole health budget for their local areas.”
But now doubts are being raised over the extent to which as yet untested IHOs might be the answer to all the problems they are supposed to solve: the Health Service Journal reports that Birju Bartoli, the CEO of Northumbria Healthcare Foundation Trust, one of the first trusts designated to develop the IHO model, is warning already that the model should not be expected to “fix the ills of everything,” and that in particular they should not take over Adult Social Care, where councils, not NHS organisations, have the expertise and statutory responsibilities.
Another HSJ report highlights the problems now confronting some of the longest-running experiments in integrating health and social care, including arrangements in Salford and Torbay. These are not IHOs in the new sense, but their experience is highly relevant to the claims now being made for the model. In Torbay, where health and adult social care have been integrated for almost two decades, the NHS trust has decided to end the existing arrangement from April 2027 after concluding that the financial risk had become unsustainable, with costs exceeding available funding by around £35m a year. The experience raises questions over whether the new IHO model can overcome the financial pressures that have destabilised previous attempts to integrate budgets and services.
So what about Neighbourhood Health Services? The claim that these much more local services would be available “on the doorstep” to “ordinary, hard-working communities across England” is not matched by the total numbers of Neighbourhood Health Centres (NHCs) planned, let alone the small number (27) of first-wave NHCs due to open by 2027 (not even one for each of the 43 ‘priority areas’ for the roll-out) with the remainder of the first 120 not promised until 2030 – after the election.
The Lowdown has discussed the Neighbourhood Health idea a number of times. We have pointed out that with a neighbourhood defined as a population of around 50,000 people (equivalent to the population of whole towns such as Durham, Banbury, Leamington Spa or Yeovil):
“It turns out they [NHCs] won’t cover neighbourhoods; most won’t centralise all the services needed for a ‘one stop shop’ (while those that do so will undermine hospital services); and 80% of the new build NHCs will be financed through ‘Public Private Partnerships’ – giving the private sector a fresh profit stream at the expense of the NHS.
“They won’t be as local as claimed because there will be nowhere near enough of them to cover all of the 1,250 neighbourhoods currently covered by Primary Care Networks.”
By contrast there are over 6,200 active GP practices, some sharing premises. GPs are the most local NHS service. Concentrating them into fewer, larger Neighbourhood Health Centres (NHCs) even where they exist won’t make care more local, despite claims from ministers and NHS leaders.
Nor will any changes in the Bill tackle the core problems of the NHS, which are not the organisational structure but the lack of capacity, gaps in staffing, and lack of capital to tackle backlog maintenance, replace crumbling, increasingly unsafe hospital buildings and improve
So we come back to the question: since the Bill makes the NHS LESS accountable, LESS democratic, and LESS integrated (if commissioners are split from providers, and contracts are once more opened up to competition), and since the main new organisational forms (IHOs) already seem unlikely to deliver, and only a handful of NHCs will be scattered across the country by the next election, why doesn’t Andy Burnham cut his losses and scrap the bulk of the Bill now?
Why doesn’t he focus ministers’ and NHS management’s energy instead on delivering real and tangible improvements as quickly as possible, by targeting action on hot-spots for delayed discharge from hospitals, to free up vital beds and end chronic problems of trolley-waits and corridor care for emergency admissions, and help cut the waiting lists which are still stubbornly above 7 million?
Why not task ministers with ensuring that General Practice is funded to employ all of the qualified GPs seeking jobs, especially in areas where the delays in appointments are most severe?
Why not tell Yvette Cooper to target action on the gaping holes in mental health services for adults and children?
These are the things that could reach every post code in England: and whether the Bill passes or not, these are the issues that need to be resolved. If they cost money now, they would also cost money after the Bill was passed: that nettle has to be grasped if Burnham does not want disgruntlement over the decline of the NHS to be one of the key issues in the next election.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
One of the bits of business for the reconvened Commons left-over from the shambolic Starmer period of government is the Health Bill (aka NHS Modernisation Bill 2026). Lowdown readers can be excused for having forgotten this ragbag of odds and ends, hatched up when Wes Streeting and Alan Milburn ruled the roost in the DHSC.
The DHSC’s official summary of the Bill now carries the health warning: “This was published under the 2024 to 2026 Starmer Labour government.”
That raises an obvious question: why on earth does Andy Burnham want to push through this legislation, which drives in the very opposite direction from his USP of promising to restore “local” control – and to offer change “to every postcode”.
Ministers have already had to amend by U-turning on the Bill, most recently a U-turn to scrap its proposals to remove mandatory council representation from integrated care boards. It will now say ICBs (soon to be fewer and larger in number and less local) should have “at least one member nominated jointly” by the local authorities it covers, in addition to the original proposal of “a member nominated from each mayor of a mayoral strategic authority covered in the ICB’s area”.
How local will that representation really be? North East and North Cumbria ICB, for example, covers three sub-areas and 14 very different local authorities – from coast to coast: North area: County Durham, Gateshead, Newcastle, North Tyneside, Northumberland, Sunderland, and South Tyneside; Tees Valley area: Darlington, Hartlepool, Middlesbrough, Redcar & Cleveland, and Stockton-on-Tees; and North Cumbria area: Cumberland and part of Westmorland & Furness.
Which one of these councils would be the lucky one chosen to raise a “local voice” on behalf of its own residents and the other 13 at ICB meetings? How could that even be done without some form of organised meeting?
The succession of service failures, cash crises and unresolved problems in the North West, where Andy Burnham was Mayor of Greater Manchester and Labour also has the Mayor in Liverpool City Region, tends to suggest that there is little evidence of Mayors or their nominees successfully steering large ICBs.
Weaker local participation
How significant is the concession on council involvement compared with the Bill’s proposal to scrap the ‘Integrated Care Partnerships’, the bodies that were set up alongside ICBs to give local authorities some form of a role in local health care planning – even if there is also a token commitment to strengthen the often weak Health and Wellbeing Boards?
There has also been experience over the years of potentially disastrous hospital closure plans being driven forward by remote NHS bodies and having to be blocked by local councils, responding to local campaigns (Lewisham Hospital closure, North West London’s ‘Shaping a Healthier Future’, and more). How would this latest change help one or more communities within any of the council areas get their point of view across to an ICB on an issue that affects them, but perhaps few or none of the other areas?
Moreover, since the most deprived areas are almost inevitably the ones with the least voice, how can this new system open up any serious work to eradicate inequalities in health?
The latest amendment follows an earlier about-turn – to drop the proposal that Foundation Trust boards would no longer be required to include a nurse and a doctor member. However, the Bill is still proposing to reduce FT accountability by stripping away the need for them to have an elected Board of Governors, a plan which is vaguely summarised as:
This makes no sense. No examples can be found of a council of governors anywhere preventing a foundation trust from designing or delivering healthcare around local needs. The problem did not exist. The only effect of the change is that even fewer people would be brought into engagement with their local NHS, and information on the plans and decisions of FTs would be shared and discussed by ever-fewer people, with little if any public awareness until decisions have been made (often in closed session) and policies are pushed through.
Local scrutiny scrapped
The Bill also aims to scrap Healthwatch nationally, along with the puny, deliberately toothless and often ineffective local remnants of the old Community Health Councils (which once held statutory powers to speak up for communities and patients).
Instead, the Bill would bring in an even more ridiculous system in which the Department and ICBs would effectively be allowed to mark their own homework and select which “patient voices” they choose to listen to. The summary claims the new system in the Bill would:
“embed patient voice in the heart of national decision-making by transferring the functions of Healthwatch England to DHSC, and developing a new patient experience directorate in the department to make the public’s voice more directly relevant to the formulation of policy …
and “ensure the voices of patients, service users and local people feeds 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.”
We can almost smell the predictable waft of bullsh*t even before the DHSC sets up its Patient Experience Directorate (PED), with a team of smart, well-paid bureaucrats, a shredding machine at the ready for any communications which do not fit in with the happy-clappy rhetoric that will be churned out by well-staffed comms teams: perhaps occasional tokenistic gatherings might be held of carefully selected members of the public to take tea, finger sandwiches and vol-au-vents and exchange polite – but pointless – conversation with PED functionaries, or even a junior minister.
ICBs, whose staffing is being extensively cut back as part of the ongoing NHS financial squeeze, are not even obliged to go through the rigmarole of setting up PEDs: all they need is a large bin to receive any messages communicated by patients.
This type of ‘patient voice’ was abandoned back in 1974, when governments of both main parties agreed that there was a need for a genuine patient voice – and CHCs were established. The current plan to turn back the clock was nonsense when it was first published, and it makes even less sense given Andy Burnham’s promise of change at really local level.
But what of the rest of the Bill? After Wes Streeting did a runner from the Secretary of State position (only to find out how hopeless were his chances of winning a leadership vote) Lowdown summed up what he had left behind:
The official summary of the Bill begins with the abolition of NHS England (which for all its faults, did at least hold some Board meetings in public and publish board papers) and its merger into the DHSC, which has no equivalent public board or system of published board papers, removing one existing window through which the public can scrutinise national NHS decision-making.
The Bill also follows the line of the Ten Year Plan in redefining ICBs as “strategic commissioners” of services, holding the budgets – eventually around 93% of NHS healthcare commissioning budgets – and therefore reinforcing the divide between commissioners and providers that was central to the costly and wasteful market system developed under New Labour from 2000 and Andrew Lansley’s disastrous top-down reorganisation for the Tory-Lib Dem coalition in 2012.
Andy Burnham, as Health Secretary, brought the drive towards marketisation of the NHS to a halt in 2009 by declaring that the NHS should be the ‘preferred provider’ for the community services that were being outsourced to private and non-profit providers. He successfully defended that position in Gordon Brown’s cabinet, and it was only reversed after Labour’s defeat in 2010.
The notion that competition improves services or delivers genuine savings for the NHS has been comprehensively discredited since then by all the efforts to make a market-style system work.
It’s not clear why Andy Burnham should now want to push through legislation taking us back down the same old track again.
And of course, the government’s wider programme surrounding the Bill, following the logic of the Ten Year Plan, also has a consistent line of rhetoric on “shifting care from the hospital to community, through the development of neighbourhood health services which organise services around people and the creation of integrated health organisations (IHOs), which will eventually have control over the whole health budget for their local areas.”
But now doubts are being raised over the extent to which as yet untested IHOs might be the answer to all the problems they are supposed to solve: the Health Service Journal reports that Birju Bartoli, the CEO of Northumbria Healthcare Foundation Trust, one of the first trusts designated to develop the IHO model, is warning already that the model should not be expected to “fix the ills of everything,” and that in particular they should not take over Adult Social Care, where councils, not NHS organisations, have the expertise and statutory responsibilities.
Another HSJ report highlights the problems now confronting some of the longest-running experiments in integrating health and social care, including arrangements in Salford and Torbay. These are not IHOs in the new sense, but their experience is highly relevant to the claims now being made for the model. In Torbay, where health and adult social care have been integrated for almost two decades, the NHS trust has decided to end the existing arrangement from April 2027 after concluding that the financial risk had become unsustainable, with costs exceeding available funding by around £35m a year. The experience raises questions over whether the new IHO model can overcome the financial pressures that have destabilised previous attempts to integrate budgets and services.
So what about Neighbourhood Health Services? The claim that these much more local services would be available “on the doorstep” to “ordinary, hard-working communities across England” is not matched by the total numbers of Neighbourhood Health Centres (NHCs) planned, let alone the small number (27) of first-wave NHCs due to open by 2027 (not even one for each of the 43 ‘priority areas’ for the roll-out) with the remainder of the first 120 not promised until 2030 – after the election.
The Lowdown has discussed the Neighbourhood Health idea a number of times. We have pointed out that with a neighbourhood defined as a population of around 50,000 people (equivalent to the population of whole towns such as Durham, Banbury, Leamington Spa or Yeovil):
By contrast there are over 6,200 active GP practices, some sharing premises. GPs are the most local NHS service. Concentrating them into fewer, larger Neighbourhood Health Centres (NHCs) even where they exist won’t make care more local, despite claims from ministers and NHS leaders.
Nor will any changes in the Bill tackle the core problems of the NHS, which are not the organisational structure but the lack of capacity, gaps in staffing, and lack of capital to tackle backlog maintenance, replace crumbling, increasingly unsafe hospital buildings and improve
So we come back to the question: since the Bill makes the NHS LESS accountable, LESS democratic, and LESS integrated (if commissioners are split from providers, and contracts are once more opened up to competition), and since the main new organisational forms (IHOs) already seem unlikely to deliver, and only a handful of NHCs will be scattered across the country by the next election, why doesn’t Andy Burnham cut his losses and scrap the bulk of the Bill now?
Why doesn’t he focus ministers’ and NHS management’s energy instead on delivering real and tangible improvements as quickly as possible, by targeting action on hot-spots for delayed discharge from hospitals, to free up vital beds and end chronic problems of trolley-waits and corridor care for emergency admissions, and help cut the waiting lists which are still stubbornly above 7 million?
Why not task ministers with ensuring that General Practice is funded to employ all of the qualified GPs seeking jobs, especially in areas where the delays in appointments are most severe?
Why not tell Yvette Cooper to target action on the gaping holes in mental health services for adults and children?
These are the things that could reach every post code in England: and whether the Bill passes or not, these are the issues that need to be resolved. If they cost money now, they would also cost money after the Bill was passed: that nettle has to be grasped if Burnham does not want disgruntlement over the decline of the NHS to be one of the key issues in the next election.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
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