The National Health Service (NHS) remains a cornerstone of British society, yet it faces ongoing scrutiny over governance and democratic accountability. Recent reforms introduced by the Health and Care Act 2022, including Integrated Care Systems (ICSs) and enhanced ministerial oversight, were intended to improve healthcare delivery, but have also raised concerns about excessive centralisation, transparency, and responsiveness to local needs. The abolition of NHS England in 2025 further consolidated ministerial powers and reshaped lines of accountability, intensifying debate about governance structures amidst increasing financial pressures.
Against this backdrop, and with the NHS 10-Year Plan under development, there is a crucial opportunity for policymakers to strengthen NHS accountability, aligning the service more closely with public expectations and democratic principles. Commissioned by The Constitution Society, this report assesses current NHS accountability arrangements and proposes actionable recommendations to enhance transparency, responsiveness, and public engagement.
This publication presents the personal views of the author and not those of The Constitution Society, which publishes it as a contribution to debate on this important subject.