Last week, MPs debated the UK Government’s new Health Bill, also known as the NHS Modernisation Bill. After an unusual start (introduced just before the former Health Secretary Wes Streeting MP resigned) it is now progressing through Parliament under the new Health Secretary.
The Bill has been framed as largely technical legislation to enact reforms already announced by the Government – such as the abolition of NHS England, and introduction of the . But the bill marks one of the most significant changes to how the NHS in England is run in recent years with potential to reshape how child health policy is developed; how children’s services are delivered; how workforce and service priorities are set; and how children and young people’s voices are heard.
But we know from experience, that too often the unique needs of children and young people are not considered from the outset when policy is made, or when systems are designed. So, as this legislation moves through parliament, we’ll be closely monitoring the bill and working to ensure that, through both the legislation and subsequent guidance, it delivers for children, young people and the paediatric workforce.
Key measures in the Bill
- Abolition of NHS England, transferring its functions to the Department of Health and Social Care (DHSC) and increasing direct accountability for the Secretary of State.
- Expansion of powers for the Health Secretary, including the ability to direct Integrated Care Board (ICBs) on issues such as waiting times and patient experience.
- Reform of Integrated Care Boards (ICBs), giving them responsibility for commissioning primary care services (including dentistry, ophthalmology and pharmacy), alongside changes to membership and planning arrangements, scrapping requirements for members from local authorities, primary care or NHS trusts, instead requiring nominated representative from mayoral authorities (where these exist).
- Enabling the introduction of a Single Patient Record, introducing legislation needed to bring data together from across health and social care in to one system to be accessed by healthcare professionals, and for patients via the NHS App.
- Abolition of Healthwatch England and Local Healthwatch, with a new Patient Experience Directorate in DHSC, alongside expectations for ICBs to deliver local patient voice arrangements.
- Merging Health Services Safety Investigations body into the Care Quality Commission
What does this mean for children, young people and paediatrics?
These reforms represent a significant reshaping of how decisions are made, services are delivered, and patient voice is heard across the NHS. As such, they have the potential to profoundly impact the work of paediatricians, the delivery of children’s health services, and ultimately whether the UK Government’s own ambition to create the healthiest generation of children ever will be realised.
That is why we have briefed MPs on five key principles that should guide NHS reform under this Bill, alongside the critical questions that must be addressed as it progresses, to ensure the system genuinely meets the needs of children and young people.
The needs of children and young people, and the paediatric workforce are central to national health and care policy decisions.
We know that too often the UK health system is not required or encouraged to “think child”. As responsibilities shift to DHSC, and given the government’s ambitions to raise the healthiest generation ever – how will children’s health will be prioritised within national decision-making?
The Bill also gives accountability to the Secretary of State over workforce, performance and reducing health inequalities – how will these duties be used in practice to improve child health outcomes, reduce inequalities and address challenges facing the paediatric workforce?
Services are designed with and for children, young people and their families / carers and there are suitable mechanisms and opportunities for feedback.
Children and young people have a right to be included the decisions about their care, and so Bill plans to abolish Healthwatch England and Local Healthwatch are of particular concern. Since their creation in the 2012 Health and Social Care Act, local Healthwatch has had duties to engage with children and young people. With ICBs taking on local patient voice, how will they ensure meaningful participation from children and young people?
Children’s health services are prioritised and funded within Integrated Care Board plans, with national oversight and accountability to improve child health outcomes.
Reforms to Integrated Care Boards (ICBs), both in the Bill and already underway, raise significant questions about how children’s services will be delivered in the future. Members are already reporting challenges linked to mergers and wider uncertainty around staffing, funding and structures, affecting both recruitment and service delivery.
As these reforms progress, how will the Government ensure that ICBs consistently prioritise and adequately fund children’s health? Will the executive children’s leads within ICBs – roles RCPCH successfully fought for in the last major Health Act – be protected? More broadly, how will changes to ICB membership ensure there is strong and effective clinical ĢƵ for children’s services at both system and place level?
At the same time, there are opportunities we would want to see realised. The Bill introduces new powers for the Secretary of State over waiting times – how will these be used in practice? Could they be used to direct ICBs to tackle the unacceptably long waits facing children in elective and community services?
Children and young people have timely access to appropriate information about their condition and care.
Better information sharing could support earlier identification of need and more joined-up care, while reducing the need for families to repeat their stories and helping prevent gaps between services. As the Single Patient Record is developed, how it will it ensure appropriate access for children and their families to their records? How will it be delivered with transition to adult services in mind? How will it support the wider ambitions around the roll out of the single unique identifier?
Workforce planning must recognise the unique needs of children and young people and address pressures across the child health workforce.
The Bill will give the Secretary of State responsibility over education and training to ensure there are enough staff with the right skills to meet service needs. This comes as we are awaiting the Government’s publication of the 10 Year workforce plan – and presents a clear opportunity for better support the paediatric workforce as they face rising demand and increased complexity. A key question we’ll be continuing to ask Ministers is how these new responsibilities, in the context of the upcoming workforce plan, will be used to tackle workforce shortages, and build and support the paediatric workforce?
Next steps
This debate is just the first step in what will be a long legislative process over the coming months – with more likely to follow in statutory guidance, implementation plans, and alongside the work already happening in parallel to the Bill to enact the UK Government’s plans.
The next stage in Parliament begins on 16 June, when MPs will undertake line-by-line scrutiny of the Bill and table amendments during Committee Stage. RCPCH will continue to engage with parliamentarians, policymakers and system leaders throughout the Bill’s passage and beyond.
Getting involved
We want to hear from members about how these changes could affect your work and the care you provide for children and young people. Your insights will help shape our ongoing work as the Bill progresses through Parliament. You can keep up to date with our work influencing the legislation, and find out how to share your views by signing up to our Paediatric Influencing Network.