King’s Speech

Baroness Bray of Coln Excerpts

Wednesday 20th May 2026 Lords Chamber

[Baroness Bray of Coln (Con)]

My Lords, it is a pleasure to follow the noble Lord, Lord Kakkar. The health measures outlined in the gracious Speech raise profound questions about the future direction of the National Health Service. Much of the focus of the proposed NHS modernisation Bill appears to centre on the abolition of NHS England and the transfer of its powers directly to the Department of Health and Social Care and, ultimately, to the Secretary of State. This is presented as a move to simplify decision-making and improve accountability. Ministers argue that, if the public are dissatisfied with the performance of the NHS, there should be no ambiguity about who is responsible. In theory, a more direct chain of command could reduce duplication and speed up reform.

But there are serious concerns that cannot be ignored. NHS England is not simply another layer of bureaucracy; it was created to provide a degree of operational independence from day-to-day political control and, importantly, to help ensure that the voice of patients remained central to how services were designed and delivered. There is also concern about the future of local Healthwatch organisations, which play an important role in representing patients and communities at a local level. If these bodies are weakened or removed along with NHS England, as is proposed in the Bill, there is a real risk that local accountability and patient representation will be diminished even further. Removing these structures risks concentrating too much power in the hands of Ministers while weakening independent advocacy for patients.

At a time when waiting lists remain long, staff morale is under strain and many patients struggle to access timely care, this reorganisation feels disconnected from the real pressures facing the NHS. Structural reform in itself does not shorten ambulance delays, increase GP appointments, recruit more nurses or improve social care provision. There is a danger that yet another major reorganisation consumes time, money and energy that should instead be directed towards improving front-line services.

The NHS has already undergone repeated restructurings over the past two decades. Each one has promised efficiency and better outcomes, yet the core challenges remain remarkably similar: workforce shortages, uneven access to care, rising demand, and chronic underinvestment in prevention and community services. Many people will therefore ask whether abolishing one organisation and transferring powers elsewhere is truly reform or simply rearrangement.

There is, however, one potentially positive proposal within these plans, which has been mentioned widely this evening: the ambition to create a single patient record across the NHS. If implemented properly, this could make a real difference. Too often, patients must repeat the same information to different parts of the system because records are fragmented and incompatible. A shared patient record could improve communication between hospitals, GPs, mental health services and social care, reducing delays and improving safety.

Equally important, giving patients direct access to their own records could empower people to take a greater role in managing their own health, but even here the detail matters enormously. Public trust will depend on strong safeguards around privacy, data security and consent. Patients must be confident that their information is protected and used appropriately. Technology should support care, not undermine confidence in it.

The key question is this: will these reforms genuinely improve patient outcomes? The NHS does not simply need another structural overhaul; it needs investment in staff, modernisation of services, stronger primary care, better integration with social care, and a relentless focus on performance, productivity and patient experience. Without that, changing organisational charts risks becoming a distraction from the urgent work that patients and healthcare professionals need most. The public judge the NHS not by who holds authority in Whitehall but by whether they can see a GP when they need one, whether ambulances arrive on time, and whether treatment is delivered safely and promptly. That is where the real test of these proposals will lie.