The NHS Modernisation Bill was formally introduced to parliament on Wednesday as part of the King's Speech, marking the most substantial reorganisation of England's health service since the Health and Social Care Act of 2012. At its centre is the abolition of NHS England, the arm's-length body that has overseen the health service since its creation under the coalition government. Ministers say the changes are necessary to cut bureaucracy and make the NHS fit for the future. Others are less certain the Bill will achieve that.

The legislation would return many of NHS England's functions directly to the Secretary of State for Health and Social Care. The government has presented this as part of a wider drive to devolve power and give patients greater control over their care. Sarah Woolnough, Chief Executive of The King's Fund, said the Bill risks creating "the opposite impression, of a government pulling power back to the centre." The tension between those two characterisations will likely define the Bill's parliamentary passage.

Among the Bill's provisions, the proposal for a Single Patient Record has drawn the most interest from clinicians and patient groups. The plan would join up records across primary care, secondary care and social care into one shared digital record accessible to patients and the professionals treating them. Previous governments have attempted similar reforms and failed, largely due to concerns about data privacy and resistance from health professionals uncertain about where responsibility for that data would lie. The current government faces the same obstacles. Woolnough acknowledged that winning the argument in parliament, that individual privacy can be protected while also meeting the concerns of health workers, is essential for this element of the Bill to succeed.

The practical consequences of fragmented records are well documented. Patients and carers routinely report being kept in the dark about their own care, sometimes receiving no communication between appointments or following discharge from hospital. Research published earlier this year found that poor NHS administration puts some patients off seeking care altogether. A single shared record would, in principle, reduce duplicated referrals, avoid repeated tests and give patients visibility of their own information in real time. Whether the government can deliver what successive administrations have promised remains to be seen.

What the Bill does not contain has attracted as much comment as what it does. The government came to office promising a prevention revolution, citing action on obesity, alcohol misuse and air quality as priorities. None of those ambitions feature in this legislation in any meaningful form. The passage of the Tobacco and Vapes Act demonstrated that bold public health legislation can attract public support even when it is politically contentious. Health policy analysts have noted that the government appears to have chosen structural reform over the harder work of changing behaviour and reducing demand on the NHS before people become seriously ill.

NHS reorganisation bills have a poor record in parliament. The 2012 Act, introduced by the coalition government, took two years to pass and consumed enormous political capital while delivering limited improvements to patient care. The King's Fund has previously noted that structural change tends to distract NHS leadership from service delivery during transition periods. The NHS manages a budget comparable to the economy of a mid-sized European country and any sustained period of organisational uncertainty carries real operational risk. The government will need to move the Bill through parliament quickly if it is to avoid that pattern repeating.

The Bill also proposes abolishing Healthwatch, the independent body responsible for gathering and representing patient experience across health and care services, along with other organisations set up to provide scrutiny independent of government. No clear replacement mechanism has been announced. The King's Fund has called for a new Director of Patient Experience to be given sufficient authority to hold the NHS and ministers to account. Without that, there is a straightforward risk that the organisation responsible for the largest portion of public spending in England will be left, as Woolnough put it, "marking its own homework." Whether parliament accepts that arrangement is another question the Bill will have to answer.