The Westminster government's Health Bill is moving through Parliament and could bring significant changes to how parts of the NHS in England are run, how workforce planning is delivered, and how patient safety investigations are carried out.
The RCN has been closely monitoring the legislation and has already secured an important amendment to protect nursing leadership at the highest levels of NHS decision making.
Here's what nursing staff need to know.
What is the Health Bill?
The Health Bill is a major piece of proposed legislation that would introduce some of the biggest changes to the NHS in England for more than a decade.
The Westminster government says it will improve patient care through a new single patient record and create clearer accountability across the health service.
Why does this matter for nursing staff?
The bill deals with issues that could have a direct impact on nursing staff and patient care, including:
- nursing representation in NHS leadership
- workforce planning
- patient safety investigations
- the sharing of patient information through the proposed single patient record
- governance and accountability within NHS organisations.
This legislation could influence how nursing expertise is represented in key decisions affecting patients, services and the workforce for years to come.
What is the single patient record and why does it matter?
One of the bill's most significant proposals is the creation of a single patient record for England, bringing together information currently held across separate health and social care systems.
The government says this would improve information sharing, reduce duplication and support more joined-up care.
What could this mean for nursing staff?
The proposal could mean faster access to important patient information, fewer administrative barriers when working across different systems, and improved coordination between services.
The plans could be particularly relevant for nursing staff working across community, primary, secondary and social care settings, where incomplete records can make it harder to coordinate care and identify risks early.
What other changes does the bill include?
Alongside the creation of a single patient record, the bill would introduce wider changes to how the NHS is organised and governed.
The government plans to absorb NHS England (NHSE) into the Department for Health and Social Care and other NHS organisations. Ministers argue this will reduce duplication, cut bureaucracy and put more resources into frontline services.
The legislation would also make changes to integrated care boards (ICBs), which are responsible for planning NHS services locally.
What has the RCN been doing?
We’ve submitted evidence to parliament and engaged ministers, MPs and peers throughout the bill's passage. We’ve focused on protecting nursing leadership, strengthening workforce planning and safeguarding independent patient safety investigations.
What’s the RCN's biggest success so far?
We secured a government amendment preserving the statutory requirement for NHS foundation trusts to have a registered nurse or midwife serving as an executive director.
The original bill omitted this existing legal safeguard, which would have removed the guaranteed nursing or midwifery voice from foundation trust boards. Following RCN lobbying, ministers tabled Amendment 19 to restore the requirement, ensuring the protection remains in law.
Why is this significant?
The amendment may sound technical, but its consequences are far-reaching.
Executive directors help make decisions on patient safety, care quality, workforce issues and organisational strategy. Ensuring a registered nurse or midwife sits at that table means decisions continue to be informed by clinical expertise and frontline experience.
The amendment requires at least one executive director to be a registered nurse or midwife, though not necessarily with the title of chief nurse. We’ll continue to monitor this closely.
What has the RCN said about workforce planning and the bill?
We’ve used the bill to highlight wider concerns about nursing workforce supply and long-term staffing plans.
During parliamentary debates, MPs cited RCN evidence showing nursing workforce growth had fallen to its lowest level in eight years.
The RCN has helped draft a new amendment, tabled by the Liberal Democrats, to improve NHS workforce planning in England.
It would require the government to work out how many staff are needed now and in the future, and publish a plan to close any gaps.
This would help ensure there are enough nursing staff to provide safe care, and hold ministers accountable for delivering them. We see this an important step, and will continue working on this issue regardless of the outcome at report stage.
What are the concerns about patient safety investigations?
The bill includes proposals that would see functions currently carried out by the Health Services Safety Investigations Body (HSSIB) transferred elsewhere.
We argued that there must remain a clear distinction between investigations intended to support learning and improvement, and processes linked to regulation and enforcement.
The concern is that staff may be less likely to speak openly about safety incidents if they believe investigations could lead directly to regulatory or disciplinary consequences.
The Royal College of Emergency Medicine subsequently endorsed the RCN's position in its own written evidence to parliament, echoing concerns that blurring these functions could undermine learning and staff confidence.
What's next for the Health Bill?
The bill will now move through several further stages.
- Report stage: all MPs can debate and vote on further amendments.
- Third reading: MPs will decide whether to approve the bill in its final House of Commons form.
- House of Lords scrutiny: peers consider the bill at second reading, detailed Committee stage, report stage and third reading. The Lords Committee stage will be a particularly important opportunity for further amendments.
- Consideration of amendments: the House of Commons and House of Lords resolve any differences between their versions of the bill.
- Royal assent: once both houses agree the same text, the bill becomes an act.
Although the amendment on nursing leadership has been secured, our work is far from over. We’ll continue to press policymakers on several issues, including:
- protecting nursing leadership in practice as well as in law
- strengthening workforce planning to address staffing shortages
- ensuring patient safety investigations remain independent and focused on learning
- scrutinising any proposed exemptions to the requirement for a registered nurse or midwife on foundation trust boards
- retaining NHSE’s existing statutory duties on climate change and environmental targets
- ensuring better accountability in relation to children's health.
The House of Lords may be particularly important in the next phase of scrutiny, where peers can examine the bill line by line and propose further changes.
Further information
In June 2026, lobbying by the RCN resulted in the Westminster government reinstating the requirement for nursing leadership on foundation trust boards in England in the Health Bill.
RCN General Secretary and Chief Executive Professor Nicola Ranger said: "Chief nurses deserve their expertise and leadership to be recognised and their place guaranteed so they can advocate on behalf of patients and for the nursing workforce.”
We previously described this proposal as “a brazen attack on patient safety.”
Read more about the Health Bill.
