Most NHS patients never think about who has legal responsibility for the health service. They notice waiting times, whether local services disappear and whether they can get treatment when they need it. But Wes Streeting’s new health bill changes who has the ultimate power to make those decisions, and may make the NHS far more vulnerable to future political swings across the UK.

A key aspect of Streeting’s bill is to abolish NHS England and bring NHS management “back into democratic control”, as announced by Keir Starmer in March 2025. Since 2013, NHS England has been responsible for the day-to-day running of the NHS, acting as a buffer between ministers and frontline care. Removing it amounts to a top-down reorganisation of the NHS in England.

NHS England was introduced in a previous controversial top-down reorganisation by the Conservative-led coalition government, which also generated fears that the Competition and Markets Authority would allow more private sector involvement in the NHS.

Even before NHS England’s launch, Andy Burnham, as health secretary in 2009, had referred to it as “the world’s biggest quango”, adding to fears that there would be limited political accountability.

It is true........

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