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Sarah Woolnough, Chief Executive of The King's Fund responds to the King's Speech and the government's announced intention to pass the NHS Modernisation Bill in this parliamentary session

'The NHS Modernisation Bill will put on a legal footing the government's plan to embark on the largest reorganisation of the NHS in more than a decade. This includes the formal abolition of NHS England, with many powers returning to the Secretary of State for Health and Social Care.

‘The government has said it wants to devolve power from Whitehall and give patients more control over their care. There is a danger that the Bill creates the opposite impression, of a government pulling power back to the centre and disbanding the independent organisations set up to listen to patients and ensure their voices are heard across health and care services. Many of the Bill’s provisions won’t make much difference to patients day to day, because they focus on how the NHS is organised rather than on care itself. 

‘Potentially the greatest opportunity it offers to improve patient experience is the intention to create a Single Patient Record by joining up health and care records, something successive governments have promised but struggled to deliver. With the right safeguards in place, patients and staff are supportive of this and can’t understand why it doesn’t already exist. This would give patients, and different health and care professionals, access to a single, shared record linking primary and secondary care information and social care data.

‘Time and again, patients and carers are left in the dark when it comes to being updated about their care, with the impact most shockingly being that some patients are put off seeking care in the future. A Single Patient Record could be a real gamechanger, facilitating joined-up communication that will impact how people feel in waiting rooms, at home and in hospitals. But more ambitious action to improve people’s day-to-day experience of NHS admin could significantly boost public satisfaction with the NHS and, in turn, how people judge the government in guiding it.

‘Previous attempts at formalising a Single Patient Record have failed or been delayed, in part due to concerns about privacy, with some health professionals worried about data control responsibilities. The government will need to win the argument in parliament, that they can both protect individual’s health information and allay the fears of those health professionals. It's an argument worth having and one we hope the government wins.

‘The bigger story is perhaps what is not included within this Bill. The successful lessons of the Tobacco and Vapes Act, that the public will celebrate politically brave and transformative action on preventative measures, risk being the final page rather than the start of a new chapter for prevention. The government promised a prevention revolution and there remain opportunities to take bolder action to tackle obesity and alcohol misuse, promote clean air and shift the balance of health spending towards prevention, all in the name of improving the nation’s health.

‘Health legislation focused on changing NHS structures has a history of getting bogged down in parliament and burning through political capital for little gain. The ongoing political uncertainty - when setting out major changes to the structure of an organisation that is responsible for a budget the size of Portugal's economy - could also present difficulties for the Bill’s smooth passage.

‘The test for this Bill is whether it can overcome these obstacles and help make the NHS ‘fit for the future’ in a way that is meaningful for patients.’

Healthwatch and patient voice

‘The Bill sets out a desire to give more power to patients but in the same breath proceeds to abolish the organisations responsible for studying patient experience independently with no clear plan for stopping the NHS and ministers from 'marking their own homework'. To avoid this, ministers should ensure that the new Director of Patient Experience is given the prominence they need with sufficient authority and the ability to hold others to account across government and the health and care system, as The King's Fund set out in our recent Healthwatch report.’

Notes to editors     

The King’s Fund’s previous commentary on NHS restructures: Why Do Politicians Restructure The NHS | The King's Fund.

The King’s Fund’s previous work on Healthwatch: The future of patient voice: learning from the Healthwatch model | The King's Fund.

The King’s Fund, Healthwatch England, National Voices and Ipsos Mori’s recent work on NHS admin: Still Lost In The System: The Urgent Need For Better NHS Admin | The King's Fund and 10 Actions The Government And NHS Leaders Should Take On NHS Admin | The King's Fund.

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