A fine balance: can the Health Bill improve neurological care?
04/06/2026
Our Chief Executive, Georgina Carr, considers the risks and opportunities the Health Bill presents for people affected by neurological conditions.
The Government’s Health Bill proposes some of the biggest structural changes to the NHS in a generation. Supporters argue the reforms will reduce bureaucracy and support more integrated care. Critics warn they risk creating disruption when services are already under significant pressure.
For people affected by neurological conditions, both may be true.
Witnesses from The King’s Fund, the Health Foundation and the Nuffield Trust also told the Health and Social Care Committee that structural reform creates opportunities, but also carries real risks. Their evidence repeatedly returned to familiar themes: accountability, implementation, retention of expertise and whether already stretched systems can absorb major change.
For neurological services, those questions matter enormously.
Neuro reveals whether reform works
At least 1 in 6 people in England have a neurological conditions. Many neurological conditions are complex, lifelong and require coordinated support spanning primary care, specialist services, rehabilitation, mental health and social care. Yet people continue to face long waits, inconsistent access and stark variation depending on where they live. Neurology and neurosurgery remain among the worst-performing specialties against NHS waiting time standards. Nearly half of adults with neurological conditions do not feel supported by the health system.
Neurological pathways routinely cross organisational boundaries. People may move between GPs, hospital teams, specialist centres, rehabilitation services, community providers and social care, often repeatedly.
If integrated care works for neurological services, it is more likely to work elsewhere too.
The opportunities are real
Even the Secretary of State in his opening remarks at the Bill’s second reading acknowledged what good neurological care actually requires: specialist expertise, coordinated pathways and access to multidisciplinary services. That is a meaningful statement of intent. The question is whether the reforms deliver it.
There are aspects of the Bill that could support better care. The proposed Single Patient Record has the potential to improve continuity and coordination for people who currently navigate multiple providers and repeatedly tell their story. Better integration between services could improve access and reduce fragmentation. Simpler structures may create clearer routes for improvement.
Done well, these reforms could help create a system that feels less fragmented and more joined up for people affected by neurological conditions..
But so are the risks
Structural reform does not automatically improve care. Recent parliamentary debate and scrutiny have repeatedly returned to important questions.
MPs at the Bill’s Second Reading, and witnesses from The King’s Fund, the Health Foundation and the Nuffield Trust told the Health and Care Select Committee said that structural reform creates real opportunities but also carries real risks. Their remarks repeatedly returned to themes we know well: accountability, retention of expertise and whether already stretched systems can absorb major change. These are not niche concerns. They are central to the broader debate about this Bill, and they matter acutely for neurological services.
Who will be accountable for neurological services once NHS England is abolished? How will specialist expertise be retained during transition? Will Integrated Care Boards have the capacity to take on expanded responsibilities? How will people challenge poor care or poor commissioning decisions?
Without strong safeguards, reform risks worsening existing variation rather than reducing it.
Getting the balance right
Local flexibility matters, but so does national leadership. Integration matters, but so does accountability and transparency. Digital transformation matters, but so does patient trust.
We believe reform must be accompanied by stronger safeguards: clear national leadership for neurological services, protection of specialist expertise, transparent and accessible data, meaningful involvement of people affected by neurological conditions, and a stronger framework for improving care.
We have already briefed parliamentarians ahead of the Bill’s second reading and are engaging with MPs and peers as the legislation progresses. We are working with partners including National Voices on the Single Patient Record, patient voice, scrutiny arrangements and the proposed abolition of Healthwatch.
Throughout, we continue to call for a dedicated Modern Service Framework for neurological conditions to provide the direction, accountability and national focus neurological services currently lack.
Because while legislation creates opportunities, improving care depends on what happens next.
