Impact assessment

Health Bill: abolishing NHS England - equality impact assessment

Published 14 May 2026

Applies to England

Introduction

The general equality duty that is set out in the Equality Act 2010 requires public authorities, in the exercise of their functions, to have due regard to the need to:

• eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the act (equality aim 1)
• advance equality of opportunity between people who share a relevant protected characteristic and those who do not (equality aim 2)
• foster good relations between people who share a relevant protected characteristic and those who do not (equality aim 3)

The general equality duty does not specify how public authorities should analyse the effect of their existing and new policies and practices on equality but doing so is an important part of complying with the general equality duty.

In addition, the Secretary of State for Health and Social Care has a duty under the NHS Act 2006 to have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service.

This document therefore considers the impact of the Health Bill on people who share each of the 9 protected characteristics, as well as additional factors that have been strongly linked to inequalities related to the health service.

Summary of policy

On 13 March 2025, the government announced plans to abolish NHS England and merge its functions into the Department of Health and Social Care (DHSC) by March 2027, subject to Parliamentary approval. The government also announced plans to reduce the combined headcount of staff across both organisations by 50% by March 2028. This decision followed Lord Darzi’s independent investigation into the National Health Service.

The Secretary of State said in the March 2025 announcement that Lord Darzi had traced the “current crisis” back, in part, to the reorganisation of the NHS by the Health and Social Care Act 2012 which “created a complex and fragmented web of bureaucracy”. This ‘web of bureaucracy’ was also creating significant extra cost, duplication of effort, and an unhelpful decision-making tension between the 2 organisations. 

To enact these plans, 2 programmes of work are required:

• primary legislation to confer NHS England’s functions on the Secretary of State or other parts of the system, as well as to enable appropriate transfers of staff, assets and liabilities
• non-legislative transformation policies to design the restructured DHSC and reach the desired headcount across both organisations (the Transformation programme)

The Health Bill (‘the bill’) is required to abolish NHS England and establish the legislative basis for the restructured healthcare system. The bill proposes to confer NHS England’s existing functions on the Secretary of State or on other parts of the system, such as integrated care boards (ICBs) - where there is a clear case for doing so. This assessment of equality impacts is concerned with primary legislation in the bill, looking at functions being conferred on the Secretary of State to create a restructured DHSC. A separate primary legislation equality impact assessment looks at functions being conferred on ICBs in relation to empowering ICBs as strategic commissioners.

Transformation programme decisions, such as organisation design of the restructured DHSC and headcount reductions, are happening at a slower pace and will be implemented after the bill receives Royal Assent (subject to Parliamentary approval). These equality impacts will be assessed separately. However, this assessment notes that the impact of primary legislation changes is interdependent with the success of the Transformation programme.

In addition, there is an NHS England regional change programme, with initial plans, subject to consultation, showing a reduction of overall staffing numbers in line with the government ambition to reduce the combined headcount across both NHS England and DHSC by 50% by March 2028. Given the regional variations in the NHS England workforce, a separate assessment will be carried out on the impact of these changes on various protected groups for each region. NHS England will work with trade unions and subject matter experts to look at ways to mitigate any adverse impact on any particular demographic, in any particular area, as well as the overall impact.

Health system management functions

The aim of the policy is to create the restructured DHSC without changing the fundamental division of roles and relationship between commissioners and providers in the NHS system. The bill proposes to confer NHS England functions on the Secretary of State and on ICBs or to repeal them if the function is no longer required, such as where the function is duplicating an existing Secretary of State function.

In line with this policy aim, the Secretary of State is expected to take on NHS England’s current role and associated legal functions in managing the health system through:

• allocating resources to ICBs and exercising financial control powers over ICBs and providers
• making arrangements for any NHS England - and, in the future, Secretary of State - health functions to be delegated to (or exercised jointly with) an ICB, an NHS trust, an NHS foundation trust, a local authority or a combined authority
• holding ICBs accountable for their performance and intervening where necessary, including through issuing guidance
• managing NHS trusts and foundation trusts through the provider licensing process and failure regimes, such as the trust special administration regime to improve performance
• developing and publishing the details of the NHS Payment Scheme and negotiating the NHS Standard Contracts with general practice, dentistry, optometry and pharmacy, as well as managing the Performers List for these

Wider healthcare functions

Where NHS England has other legal functions wider in scope than managing the health system and where these are not already covered by existing Secretary of State functions, the bill provides that they become either the legal responsibility of the Secretary of State or of ICBs where exercise at a local level is more appropriate. The aim of the policy is to preserve continuity of these functions and their scope and mitigate against any disruption while DHSC is restructured.

In line with this policy aim, the Secretary of State is expected to take on responsibilities for:

• all NHS workforce education and training functions, including associated planning, implementation and payments
• monitoring and improving the safety of healthcare services
• ensuring that patients can make choices about their healthcare
• promoting the involvement of patients and their carers and/or representatives in decisions about a patient’s illness, care or treatment
• promoting innovation in the provision of health services
• supporting and facilitating integration across public functions - for example, children and young people’s education, health and care provision
• collecting, processing and sharing information in relation to commissioning and providing health and adult social care services in England
• operating national IT systems
• developing quality standards, as well as disseminating advice and guidance, about providing medicines and medical devices in NHS services, and funding treatments recommended by the National Institute for Health and Care Excellence (NICE)
• ensuring the health system is prepared for an emergency
• sharing information needed by courts when hospital orders may be made that could lead to the admission of a person into an NHS mental health hospital (such information could be about available secure beds and facilities)

Direct commissioning functions

NHS England currently has direct legal responsibility for commissioning certain services. While the bill proposes to place the legal responsibility for commissioning most services on ICBs, some require a national approach due to the need for cross-government working at a central level or lower volume of patients and higher complexity of diseases. This means that some services that are commissioned centrally at a national level are expected to continue to be commissioned that way by the Secretary of State in the restructured DHSC. These include:

• high security psychiatric services, where the bill proposes to place the legal responsibility for commissioning on the Secretary of State
• secondary and community care services for members of the armed forces or their families, where the bill proposes a regulation-making power that can be used to set out the services the Secretary of State (rather than ICBs) will be responsible for commissioning
• some specialised services for rare and very rare diseases, where the bill proposes a regulation-making power that can be used to set out the services the Secretary of State (rather than ICBs) will be responsible for commissioning

There are around 150 specialised services for rare and very rare diseases. As of April 2025, ICBs control the commissioning of 70 specialised services through a delegation agreement with NHS England, and NHS England controls the commissioning of the remaining 80. The bill proposes to continue to require ICBs to commission the majority of services but enable regulations to allow responsibility for commissioning specific services to sit with the Secretary of State. This will ensure that very rare and highly complex services may be commissioned centrally, as appropriate. The exact split between which specialised services will be commissioned by ICBs and which will be commissioned by the Secretary of State will be specified in regulations. However, we expect to publish a list of which services are intended be commissioned by the Secretary of State as the bill progresses through Parliament.

In addition, as the Secretary of State is expected to become a commissioner, the bill proposes to broaden the Secretary of State’s duty to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service. The bill proposes to match the existing NHS England inequalities duty such that the Secretary of State will be required to have regard to the need to reduce inequalities between the people of England with respect to their ability to access health services and to the outcomes achieved for them by the provision of health services.

New Secretary of State functions: ICBs

The bill proposes to introduce a new general power on the Secretary of State to direct ICBs to exercise any of the Secretary of State’s functions relating to the health service, including both healthcare and public health functions. Under this proposal, the Secretary of State will have a power to make payments to ICBs in respect of the exercise of these functions and will be required to publish the direction.

The bill also proposes to introduce a new general power on the Secretary of State to direct ICBs in relation to how to exercise any of their functions. This power is expected to be used to direct ICBs to:

• comply with national standards in relation to some services commissioned by ICBs, such as specialised services, where the Secretary of State would want for all ICBs to commission such services consistently (so that all patients receive similar levels of care)
• require ICBs to apply specified assessment and eligibility criteria in relation to certain services they commission to ensure that all ICBs are applying the same approach
• set out the expectations on ICBs in relation to the planning process
• require ICBs to exercise their functions in a particular way to effectively respond to unexpected events or emergencies

This power is not limited to the examples above.

NHS England legal transfer scheme

The bill proposes to introduce a power for the Secretary of State to transfer the property, rights and liabilities of NHS England to the Secretary of State or another NHS or public body.

The transfer scheme may make provision which is the same as or similar to the Transfer of Undertakings (Protection of Employment) (TUPE) Regulations 2006. TUPE regulations mean that on the date of the transfer, employees from one organisation automatically transfer to another organisation along with their length of service and employment contract, including their terms and conditions of employment contract. See further information on TUPE from the Advisory, Conciliation and Arbitration Service (Acas)

Intended aims

The overall objective is to reform the NHS system operating model, where the restructured DHSC sets the strategic direction and empowers ICBs and NHS organisations to provide high-quality, effective care to their local populations.

Abolishing NHS England and creating a more efficient, agile, restructured DHSC aims to:

• reduce excessive bureaucracy
• reduce the burden that central bodies place on ICBs and providers and free up capacity to support the implementation of the reforms set out in the 10 Year Health Plan for England - for example, additional burden due to complexity and the inefficient work processes that arise because of that, such as multiple requests for similar data from across DHSC and NHS England to the health and care system
• make the health and care system more efficient (by changing some functions as they are conferred on the Secretary of State)

DHSC and NHS England officials conducted a comprehensive and thorough review and analysis of legislation underpinning NHS England duties and responsibilities to inform the development of the bill, so that it would clarify and streamline legislation in line with these aims.

The proposed transfer scheme provides a legal mechanism to transfer NHS England employees to DHSC or an NHS body, such as ICBs, or another public body when the functions of NHS England are conferred on the Secretary of State and ICBs.

Non-legislative transformation policies intended to support the creation of the restructured DHSC

Alongside clarified and streamlined primary legislation, the Transformation programme is tasked with operational decisions that are needed to create a more efficient, agile, restructured DHSC that can exercise all Secretary of State functions effectively. These operational decisions include:

• joint executive senior structure: a new joint executive team providing unified leadership across DHSC and NHS England to support the transformation journey
• organisational design of the restructured DHSC: bringing together policy and implementation under one leadership, ensuring all functions are carried out effectively and efficiently
• oversight and accountability of the system: clarifying the role of the restructured DHSC and ensuring the NHS system receives a single set of priorities communicated through agreed routes
• increased patient focus: establishing a new patient experience directorate within DHSC to improve the use of patient voice in decision-making

The work of the Transformation programme is intended to ensure that the restructured DHSC can operate effectively with reduced combined workforce, in line with the government ambition to reduce the combined headcount across both NHS England and DHSC by 50% by March 2028.

Effect on staff

NHS England functions that will become the responsibility of the Secretary of State in the restructured DHSC and new Secretary of State functions on ICBs

There may be some effects on NHS staff in ICBs and provider organisations as a result of abolishing NHS England and restructuring DHSC, such as familiarisation with new arrangements and any change in ways of working with DHSC. We assess that these higher order impacts will not differentially affect staff members with protected characteristics in ICBs and provider organisations.

The bill proposes that the Secretary of State will have legal responsibility for NHS workforce, education and training functions, continuing the exercise of functions currently done by NHS England. We expect that the way in which these functions will be carried out by the restructured DHSC will ensure continuity with current practices. For example, the restructured DHSC will continue to use the existing education quality framework and to make payments to placement providers. We expect that students wanting to train to become healthcare workers will continue to come from a diverse background reflecting the demography of the communities they want to serve.

The Secretary of State will continue to promote initiatives to widen participation in the healthcare professions, specifically the medical profession. These should encourage people from socially disadvantaged and diverse backgrounds to consider joining the profession and for the medical profession to be more representative of the community it serves. As such, there should be no differential effects on NHS staff members and students with protected characteristics.

NHS England legal transfer scheme

Any proposed transfer of NHS England employees may affect both NHS England and DHSC employees, as well as on employees of other NHS bodies or public bodies where NHS England employees may transfer. As organisation design work is progressing in preparation for the bill to progress through Parliament and to be implemented following Royal Assent, it is not possible to assess the impacts on those with protected characteristics at this stage.

The Transformation programme will formally inform and consult trade unions about the transfer, engaging on any measures relating to the transfer that affect relevant staff. Equality considerations will inform the decision-making process for the organisation design.

At this stage, we highlight areas of impact to consider:

• contractual arrangements: future arrangements for transferring NHS England employees will be consulted on, with no changes to contractual terms and conditions made without proper consultation and engagement. This may lead to differences in terms and conditions, contracts, pay structures and benefits between different members of staff in the restructured DHSC and other bodies receiving NHS England employees. This could lead to uncertainty and dissatisfaction among staff and challenges in aligning expectations among teams
• morale and wellbeing: the uncertainty coupled with organisational change may negatively affect staff morale. This could result in increased levels of stress, absenteeism, sick leave and additional pressure on existing resources for all employees
• staff turnover and capacity: some staff may choose to leave during the transition period (before and shortly after the proposed abolishing of NHS England). This could impact on skills and experience in the remaining workforce, which may then affect how the restructured DHSC and other receiver bodies exercise their new functions
• cultural integration and organisational change: the culture in the restructured DHSC will be different from both the current DHSC culture and the NHS England culture. Staff in the new organisation will need to adapt to and actively shape new culture and ways of working. Similar considerations apply to any other receiver bodies
• leadership and governance changes: a shift in leadership and governance may affect staff confidence in strategic direction and decision-making

The Transformation programme is considering these effects and will design policies and initiatives to mitigate any potential negative impacts. For example, a single joint executive team has been established between DHSC and NHS England as part of the transition to one organisation. Due regard will be given to the public sector equality duty and equality considerations when making decisions affecting the workforce, including transferring NHS England employees.

Effect on service users, patients, their carers and families

NHS England functions that will become the responsibility of the Secretary of State in the restructured DHSC

The direct effect of the primary legislation on service users, patients, their carers or families is assessed to be neutral. This is because primary legislation has been prepared in such a way as to ensure continuity of service provision and the Secretary of State is bound by the following legal duties:

• to promote a comprehensive health service
• to take account of reducing health inequalities in the exercise of their functions
• to have regard to the public sector equality duty

The change of legal responsibility for functions from NHS England to the Secretary of State, where all else remains constant, is not expected to have any differential impacts on groups of people with protected characteristics or characteristics linked to health inequalities.

The Secretary of State’s power to make arrangements for any of the Secretary of State health functions to be delegated to (or exercised jointly with) another relevant body, such as an ICB, is enabling future decisions but does not have direct impacts at this primary legislation stage. It will be important for the Secretary of State to consider equalities impacts when preparing to enter into any delegation agreements under this power. Any public body to whom the health function will be delegated will need to comply with the public sector equality duty in the exercise of the health function (see, for example, Commissioning integration: delegation of specialised services to ICBs 2025 to 2026).

In the longer term, if the aims of the policy are realised, service users, patients, their carers and families should experience positive effects as ICBs and providers deliver the neighbourhood health service:

• bringing care closer to communities
• building patient-centred teams
• improving access to general practice so hospitals can focus on specialist care

Primary legislation will enable the government to build a restructured DHSC that better supports local transformation by removing barriers and competing demands. However, these longer-term effects are dependent on wider NHS system reform and on the decisions made by ICBs and providers. They are a desired outcome of primary legislation but not a direct effect. See more information about the equality impacts of wider NHS system reform, which is supported by the bill, in the ‘Addressing the impact on the 3 equality aims’ section of the 10 Year Health Plan equality impact assessment.

New Secretary of State functions: ICBs

The Secretary of State’s powers to direct ICBs to exercise the Secretary of State’s health functions or to direct ICBs about how they exercise any of their functions are enabling future decisions but do not have direct impacts at this primary legislation stage. However, it will be important for the Secretary of State to carry out an appropriate equalities assessment when preparing to issue a direction to ICBs under these powers. For example, where the Secretary of State may want to direct ICBs in the exercise of their commissioning functions by setting national standards for specialised services, it will be important for the Secretary of State to identify, assess and address the differential needs of all people when developing these standards, including people with protected characteristics.

Once the Secretary of State issues a direction for ICBs to take on a new function or to exercise a function in a particular way, ICBs will need to comply with the public sector equality duty in the exercise of the relevant health function (see, for example, NHS public health functions agreement 2025 to 2026).

NHS England legal transfer scheme

The proposed power in the bill to make a legal transfer scheme to move NHS England employees to the restructured DHSC, another NHS body, such as ICBs, or another public body is not expected to have direct effects on service users, patients, or their carers and families. This is because the proposed power to transfer employees will help ensure continuity and retention of expertise of the workforce carrying out these functions.

It is worth noting that the ambition to reduce the combined workforce of the restructured DHSC by 50% (compared with the workforce in NHS England and DHSC as 2 separate organisations as of March 2025) and the organisational re-design as part of transformation introduce some risks to the ability of the restructured DHSC to carry out all new functions without short-term disruption. These risks include a failure to ensure appropriate alignment of ministerial decision-making and operational matters and loss of institutional knowledge. Given these risks, primary legislation may lead to unintended consequences for service users, patients, or their carers and families in the form of some disruption to service provision.

It will be important to ensure that the risks are well managed through the early organisational design work and the close monitoring of its implementation, given the importance of nationally commissioned services to people with protected characteristics and other groups, such as children, older people, disabled people and families of armed forces personnel.

Engagement and involvement

NHS England policy, operational and legal officials have been involved extensively in the review and analysis of legislation underpinning NHS England functions and decisions on the development of the bill.

Wider engagement and involvement on the bill are summarised in the overarching equality impact assessment document.

The Transformation programme is working and will continue to work closely with staff and their representatives to ensure inclusive engagement throughout the programme. This includes engagement and future consultation with trade unions to address workforce considerations. It also includes ongoing dialogue with staff networks to reflect diverse perspectives and engagement with other relevant bodies to support transparency and equality in decision-making.

The programme also collects and analyses staff feedback from different settings, including briefings open to all staff and anonymised online forms, and will be running short surveys to gather consistent information about how colleagues are experiencing the programme. It has also brought colleagues from both organisations together to consider specific aspects of work deliberatively - for example, through an informal involvement network, focus groups and informal reference panels.

Summary of NHS England staff characteristics

This equality impact assessment focuses on the introduction of an enabling power for the Secretary of State to transfer the property, rights and liabilities of NHS England to the Secretary of State or to another NHS or public body. It is a first step in considering equality impacts associated with NHS England staff transfer. A more detailed evidence assessment, including any evidence on how organisational transfer may affect different groups of people with protected characteristics, will be required to inform transformation policies to support staff through the transfer. Such future assessment should consider equality impacts on NHS England staff and on staff in the receiving organisations, such as DHSC, ICBs or other public bodies, as appropriate.

We gathered data on NHS England staff by protected characteristic as of November 2025 to broadly understand which staff groups will be affected and where Transformation programme decisions would need to consider different groups of people. As voluntary redundancies are in progress across NHS England, this data will not accurately represent the group of staff who transfer to DHSC or other bodies receiving NHS England employees following the progress of the bill through Parliament. The data covers NHS England’s direct employees, external secondees and contractor non-payees. The data is intended to provide an indication of staff groups at this stage.

Disability

Of all NHS England staff as of November 2025, 12% indicated that they had a disability. Three-quarters indicated no disability and 13% did not provide information on their disability status.

Sex

Of all NHS England staff as of November 2025, nearly two-thirds were female (63%) and just over a third were male (37%).

Sexual orientation

Of all NHS England staff as of November 2025, 5% indicated they were lesbian, gay or bisexual. Over three-quarters indicated they were heterosexual (78%) and 18% either did not indicate a sexual orientation or indicated ‘other’.

Race

Of all NHS England staff as of November 2025, about a quarter were from Black and minority ethnic groups (23%). Two-thirds were White (58%) and 9% did not provide information on their ethnicity.

Age

Of all NHS England staff as of November 2025, 6% of staff were aged under 31 and 8% of staff were over 61. Most staff were aged 31 to 60 (82%). Age was unknown for a small proportion of staff (4%).

Gender reassignment

There is no data for NHS England staff against this protected characteristic.

Religion or belief

Of all NHS England staff as of November 2025, 37% indicated they were of Christian faith, 20% indicated ‘no religion’ and 19% indicated other religion, such as Islam (6%) and Hinduism (4%). Nearly one-quarter did not provide information on their religion or belief (24%).

Pregnancy and maternity

There is no data for NHS England staff against this protected characteristic.

Marriage and civil partnership

Of all NHS England staff as of November 2025, 54% indicated they were married, 26% indicated they were single and 5% indicated they were divorced. About 1 in 10 did not provide information on their marital status (12%) and 2% indicated another status.

Analysis of equality impacts on service users, patients, their carers and families

The overall analysis of impacts of primary legislation contained in the bill is that it will not have direct equality impacts (see the section ‘Effect on service users, patients, their carers and families’ of this document). However, there are risks of indirect equality impacts because of potential short-term disruption described in the sub-section ‘NHS England legal transfer scheme’ in the section ‘Effect on service users, patients, their carers and families’. The disruption is associated with how primary legislation will be implemented - namely, due to organisational re-design and combined staff headcount reduction. This analysis, therefore, provides examples of where particular consideration of equality could be helpful as the restructured DHSC begins to exercise new Secretary of State functions. The intention is to demonstrate what consideration may be needed in preparation for and during the transition from 2 central organisations to one smaller, restructured DHSC.

Disability

In the 2023 to 2024 financial year, 16.8 million people in the UK had a disability (approximately 25% of the population), according to the UK disability statistics (see section ‘5. Disability’ in Family Resources Survey: financial year 2023 to 2024). These statistics show that around 45% of adults over State Pension age, 24% of working-age adults and 12% of children were disabled.

Secretary of State’s new commissioning functions and duty to support integration across public functions in respect of adult social care

According to UK disability statistics (see link above), people of State Pension age most frequently reported mobility impairment at 69%, followed by stamina, breathing or fatigue impairments (45%). The most common impairment types among working-age adults were mental health (48%) and mobility impairments (42%).

The UK Disability Survey research report, June 2021 found that 46% of respondents were unable to access or had extreme difficulty accessing medical facilities to access the healthcare services they needed.

The Darzi report (page 69) outlined particularly severe health disparities for people with a learning disability - they are twice as likely to die from preventable causes and 4 times as likely to die from treatable causes, with areas such as respiratory care and cancer care of particular concern. The report concluded that there are multiple barriers that prevent people with a learning disability from accessing the care they need.

The bill proposes a regulation-making power to place new legal responsibility on the Secretary of State to commission healthcare services for members of the armed forces and their families and for people with certain rare diseases. While armed forces personnel are generally physically and mentally fit, members of their families may suffer from physical and mental impairments. People with rare diseases may be impaired by their disease or suffer from a co-occurring impairment. It will be important for the Secretary of State to consider the prevalence of disability among these groups when exercising new commissioning functions. It will also be important to ensure that any short-term disruption in the transition to a more efficient, restructured DHSC does not differentially impact services commissioned centrally by the Secretary of State for disabled people.

Where people who are receiving services commissioned by the Secretary of State have a need for adult social care, the bill proposes to amend an existing co-operation duty in the Care Act 2014 to require the Secretary of State to co-operate with local authorities to support and facilitate the right care. The evidence of unique needs, access barriers and health disparities experienced by disabled people will need to be an important consideration to ensure integrated support in the care of these people.

Secretary of State’s new commissioning functions and duty to support integration across public functions in respect of children and young people’s education, health and care provision

The UK disability statistics (linked above) show that for disabled children, a social or behavioural impairment was most common (59%), followed by learning (32%) and mental health impairments (29%). 

The Disabled Children’s Partnership 2023 report, Failed and Forgotten, found that just 1 in 5 parents said that their disabled child has the correct level of support from health services. The report also noted that disabled children and their families rely on multiple services and 1 in 5 parents said that they were experiencing delays with more than 10 health services.

The bill proposes a regulation-making power to place new legal responsibility on the Secretary of State to commission healthcare services for members of the armed forces and their families, including children, and for people with certain rare diseases, some of whom are children. Where the children who are receiving these services have an education, health and care plan maintained by a local authority, the bill proposes to extend an existing duty in the Children and Families Act 2014 to the Secretary of State to arrange for the provision of healthcare under the plan.

It will be important for the Secretary of State to consider the prevalence of disability among children for whom the Secretary of State will be commissioning healthcare and to better address their health needs. It will also be important to ensure that any short-term disruption in the transition to a more efficient, restructured DHSC does not differentially impact services commissioned centrally by the Secretary of State for disabled children.

Sex

Men

According to UK armed forces biannual diversity statistics, men represented 88% of UK regular forces in March 2025.

According to restricted patients statistics in England and Wales, about 88% of all restricted patients were males in 2024. A restricted patient is a mentally disordered offender (MDO) subject to a restriction order, due to the risk of serious harm they pose to others, and liable to a hospital order.

In November 2025, the government published the Men’s Health Strategy for England, which highlighted the health disparities experienced by men. For example, cancer, cardiovascular disease and type 2 diabetes have a disproportionate impact on men’s health. Suicide remains one of the leading causes of death for men under 50. Men are also more likely than women to engage in unhealthy behaviours such as smoking, harmful gambling, alcohol consumption and substance misuse.

The Men’s Health Strategy noted that some services are not reaching men as effectively as they could - for example, NHS Health Checks. Men face a range of barriers that affect how they engage with, access and experience the health system, including systemic factors, such as services that are not responsive to men’s needs, and cultural factors, such as stigma.

Certain groups of men face disproportionately more health challenges, such as men from some ethnic minority backgrounds, gay, bisexual and men who have sex with men, and men with disabilities, among others.

Women

According to UK armed forces biannual diversity statistics, women represented 12% of UK regular forces in March 2025. Women are more likely to be spouses and partners of serving personnel. An NHS England report, Healthcare for the armed forces community: a forward view (page 10), stated that:

For families of the Armed Forces community, life can have additional worries and complications, including separation from spouses, partners, families and friends; social isolation; sudden caring responsibilities; frequent and unplanned moves; and bereavement. There is a growing body of evidence suggesting partners and spouses have an increased risk of developing mental health and wellbeing difficulties, if their serving partner is suffering from post-traumatic stress disorder (PTSD) or poor mental health.

According to restricted patients statistics in England and Wales, women constituted about 14% of the conditionally discharged population and 10% of the detained population in 2024.

In 2022, the government published the Women’s Health Strategy for England, which highlighted health disparities experienced by women. For example, women spend a significantly greater proportion of their lives in ill health and disability when compared with men, and not enough focus is placed on women-specific issues like menopause. There is evidence that women feel unheard - the Women’s Health Strategy for England reported that more than 4 in 5 (84%) women responding to the survey had at times felt that their healthcare professionals were not listening to them.

Women are more likely to be unpaid carers and interact more with healthcare services than men. The Darzi report (page 70) noted:

In 2024, 4.7 million people were unpaid carers in England, 1.4 million of whom provided more than 50 hours of care each week. Nearly 60 per cent of carers are women, and the largest group are in their late 50s.

Secretary of State’s new commissioning duties

The bill proposes a regulation-making power to allow the Secretary of State to specify that the Secretary of State (rather than ICBs) will be responsible for commissioning health services for members of the armed forces and their families. As most members of the armed forces are men and most of their spouses and partners are women, it will be important for the Secretary of State to consider health inequalities that are unique to each sex to ensure effective commissioning. 

The bill also proposes to introduce a new responsibility on the Secretary of State to commission high security psychiatric services for restricted patients. As most of these patients are men, it will be particularly important to consider health inequalities unique to and more prevalent in men.

It will also be important to ensure that any short-term disruption in the transition to the restructured DHSC does not differentially impact men or women who are receiving services commissioned centrally by the Secretary of State.

Secretary of State’s new duty to promote the involvement of patients and their carers

The bill proposes to confer a duty on the Secretary of State to promote the involvement of patients, and their carers and representatives (if any), in decisions that relate to the prevention or diagnosis of illness in the patients, or their care or treatment. This is a strategic duty to enable the Secretary of State to maintain national oversight over patient involvement, to identify national patterns and enact mitigation plans. It should help ensure that patient involvement is a consistent part of national health strategy.

As women interact more with healthcare services than men, the effective exercise of this strategic duty has the potential to empower women’s involvement in healthcare decisions and to ease the burden related to previously unheard attempts to be involved in this decision-making. It will be important that appropriate resource and expertise are allocated to the exercise of this duty in the restructured DHSC and to mitigate any short-term risks to progress due to organisational transformation.

Sexual orientation

As outlined in NHS England’s patient equality programme LGBT+ health, there is strong and consistent evidence that lesbian, gay, bisexual or other (LGB+) people have worse access to healthcare, outcomes and experiences than the general population.^{[footnote 1]} Data from the GP Patient Survey in 2025 indicates that LGB+ people had higher rates of self-reported mental health conditions across all age groups, especially among younger age groups. In addition, the Office for National Statistics (ONS) report Self-harm and suicide by sexual orientation, England and Wales, states that both females and males who identified with an LGB+ orientation had a statistically significant higher risk of suicide than those who identified as ‘straight or heterosexual’.

According to Health Survey England additional analyses on health and health-related behaviours of lesbian, gay and bisexual adults, LGB adults were generally less likely to not drink alcohol and more likely to drink at levels associated with an increased or higher risk of alcohol-associated poor health outcomes. According to the ONS Drug misuse in England and Wales 2024 report, bisexual respondents report higher rates of drug use and smoking compared with heterosexual and gay or lesbian respondents.

Internal analysis of qualitative feedback collated across 6 NHS England national patient and staff surveys suggests that LGB+ respondents have a wide range of experiences. Some LGB+ individuals report positive, inclusive care, while others encounter discrimination or a lack of understanding from staff. LGB+ representation in information provision and care is often lacking, with many materials and forms assuming heterosexual identities.

Secretary of State’s new duties on patient choice and patient involvement

The bill proposes to confer a duty on the Secretary of State to enable patients to make choices about health services provided to them. The duty should ensure a consistent national and strategic approach that centres patient choice in decision-making and the delivery of functions - for example, in the operationalisation of the 10 Year Health Plan.

The bill also proposes to confer a duty to promote the involvement of patients, and their carers and representatives (if any), in decisions that relate to the prevention or diagnosis of illness in the patients, or their care or treatment. This is a strategic duty to enable the Secretary of State to maintain national oversight over patient involvement, to identify national patterns and enact mitigation plans. It should help ensure that patient involvement is a consistent part of national health strategy.

As LGB+ people are more likely to have worse experiences in healthcare than the general population, the implementation of these new duties may have a positive effect in allowing them choice in the provision of their healthcare and enabling them or their representatives to advocate for better treatment. It will be important that appropriate resource and expertise is allocated to the exercise of these duties in the restructured DHSC and to mitigate any short-term risks to progress because of organisational transformation.

Race

According to the UK armed forces biannual diversity statistics, ethnic minorities (excluding White minorities) personnel accounted for 12% of the UK regular forces in April 2025.

The Darzi report discussed widespread disparities by ethnicity (page 69). Data from the NHS Race and Health Observatory, submitted to the investigation, showed that minority ethnic groups, particularly Asian people, experienced disproportionally longer waits for elective care after the COVID-19 pandemic than those from White backgrounds.

The investigation stated that people from minority ethnic groups experienced worse outcomes in mental health, waited longer for mental health assessment and were less likely to receive a course of treatment following assessment in the NHS Talking Therapies programme. It also reported a substantial evidence base that shows that people from minority backgrounds are more likely to be sectioned under the Mental Health Act.

Secretary of State’s new commissioning duties

The bill proposes a regulation-making power to allow the Secretary of State to specify that the Secretary of State (rather than ICBs) will have the responsibility for commissioning health services for members of the armed forces and their families. It will be important to consider the differential needs of ethnic minorities among this group. It will also be important to ensure that any short-term disruption in the transition to a more efficient, restructured DHSC does not differentially impact ethnic minorities who are receiving armed forces services commissioned centrally by the Secretary of State.

Age

Children and young people

According to the Darzi report, children and young people are 24% of the population and account for 11% of NHS expenditure, and their “mental and physical health appears to have been deteriorating in recent years” (page 41). The report noted (page 19) that the rate of mental health referrals for children and young people has increased by 11.7% a year from around 40,000 a month in 2016 to almost 120,000 a month in 2024 (much more so than for adults, where the rate of increase was 3.3% a year). It also noted that paediatric services for physical health are under pressure (page 43):

As we have seen, waiting list size and duration of waits have grown more rapidly for children than for adults. And according to the Royal College of Paediatrics and Child Health, children are 13 times more likely than adults to wait over a year for access to community services.

The Darzi report (page 42) also suggested that health inequalities begin at a very young age:

children from the most deprived decile are 2.1 times as likely to be obese in Reception than children from the least deprived decile, and this extends to 2.3 times by Year 6.

Working age adults

The 2021 Census provides insights into the self-declared general health status, general health by age, sex and deprivation, England and Wales. Over 90% of respondents aged 34 and under reported being in ‘good’ or ‘very good’ health, with fewer than 2.5% reporting ‘bad’ or ‘very bad’ health. Over 80% of respondents aged 35 to 64 reported being in ‘good’ or ‘very good’ health, with about 6% reporting ‘bad’ or ‘very bad’ health.

According to UK armed forces biannual diversity statistics, the average age of UK regular forces was 31 years in April 2025.

According to restricted patients statistics, most restricted patients in England and Wales were aged 40 to 59 (48%) and 21 to 39 (34%) in 2024.

Older people

The 2021 Census insights into the self-declared general health status suggest that general health decreases with age. Among those over 65, less than 70% of respondents reported being in ‘good’ or ‘very good’ health, with 10% reporting ‘bad’ or ‘very bad’ health. Among those aged ‘90+’, 1 in 4 (25%) reported ‘bad’ or ‘very bad’ health.

Ageing is associated with the development of long-term conditions. The analysis on NHS England’s patient level data in the Darzi report (page 18) showed that:

by the time people are aged 65 to 74, a majority will have at least one long-term condition and some 40 per cent will have 2 or more. By the time people are aged 75 to 84, this rises to nearly 60 per cent having 2 or more, and by the time people are aged 85 or above, 9 out of 10 will have at least one long-term condition.

The GP Patient Survey collects patient feedback on people’s experience of their GP practice and other healthcare services. In their submission to the Darzi report (page 47), Age UK analysis of the GP Patient Survey found significant declines in the proportion of older people who feel supported to manage their long-term conditions in the community. Findings from the 2025 survey showed that older people are less likely to use online forms, where 12% of those ages 75 to 84 and 8% of those aged over 85% said they used them, compared with the national average of 24%. This indicates a potential barrier for accessing healthcare in these populations.

Analysis by Age UK, submitted to the Darzi report, found that on any given day, over 2,000 people aged over 65 are admitted to hospital in an emergency for a condition that could have been treated earlier in the community or prevented altogether (such as a fall). People aged over 80 also represent the highest proportion of all admitted A&E attendances at 25%.

Secretary of State’s new commissioning functions and duty to support integration across public functions in respect of children and young people’s education, health and care provision

The analysis in this section overlaps with the analysis on the protected characteristic of disability in children.

The bill provides for a new legal responsibility on the Secretary of State to commission healthcare services for members of the armed forces and their families, including children, and for people with certain rare diseases, some of whom are children. Where the children who are receiving these services have an education, health and care plan maintained by a local authority, the bill proposes to extend an existing duty in the Children and Families Act 2014 to the Secretary of State to arrange for the provision of healthcare under the plan.

It will be important for the Secretary of State to consider the growing trend of poor mental health in children and how it relates to the needs of children for whom the Secretary of State will be commissioning healthcare. It will also be important to ensure that any short-term disruption in the transition to the restructured DHSC does not differentially impact services commissioned centrally by the Secretary of State for children and young people.

Secretary of State’s new commissioning functions and duty to support integration across public functions in respect of adult social care

The analysis in this section overlaps with the analysis on the protected characteristic of disability in adults.

The bill proposes a regulation-making power to allow the Secretary of State to specify that the Secretary of State (rather than ICBs) will have the legal responsibility for commissioning healthcare services for people with certain rare diseases. Some of the people for whom the Secretary of State will be commissioning specialised services will be older people, likely with multiple needs. It will be important for the Secretary of State to consider the complex needs of older people when exercising new commissioning functions, including barriers to access and interaction with health services. It will also be important to ensure that any short-term disruption in the transition to the restructured DHSC does not differentially impact services commissioned for older people by the Secretary of State.

Where people who are receiving services commissioned by the Secretary of State have a need for adult social care, the bill proposes to amend an existing co-operation duty in the Care Act 2014 to require the Secretary of State to co-operate with local authorities to support and facilitate the right care. Older people are more likely to be in receipt of both health and adult social care services. The evidence of unique needs and access barriers experienced by older people will need to be an important consideration to ensure integrated support in the care of these people.

Gender reassignment

According to NHS England’s patient equality programme, LGBT+ health, there is strong and consistent evidence that transgender people have worse access to healthcare, outcomes and experiences than the general population. Data from the 2021 Census insights into the self-declared general health status indicates that all gender minority groups, such as transgender and non-binary people, experienced higher rates of self-reported bad or very bad health than respondents whose gender corresponds to the sex registered at birth (cisgender).

According to the Active Lives Survey 2025, physical activity levels are generally lower among transgender respondents than cisgender respondents, with the gap widening with age. Transgender respondents were also more likely to report being regular smokers compared with cisgender respondents in the 2025 GP Patient Survey.

Transgender respondents were less likely to report having a good overall experience of their GP, pharmacy services or dental services than cisgender respondents in the 2025 GP Patient Survey. Findings from the Women’s Health Strategy call for evidence 2022 also indicated that transgender respondents were more likely to have experienced an instance where they were not listened to by a healthcare professional compared with cisgender respondents.

Internal analysis of qualitative feedback collated across 6 NHS England national patient and staff surveys suggests that transgender respondents have a wide range of experiences. While some transgender individuals report positive, inclusive care, others encounter discrimination, misgendering, or a lack of understanding from staff. Transgender representation in information provision and care is often lacking, with many materials and forms assuming heterosexual and cisgender identities.

The independent review into gender identity services for children and young people identified long waiting lists to access clinical services relating to gender identity as a significant concern and showed that there has been an increase in children and young people presenting with issues around gender identity alongside mental health difficulties. This population has higher rates of depression, anxiety and eating disorders than the general population, which suggests children and young people are seeking and accessing care across a broader range of NHS services.

Secretary of State’s new duties on patient choice and patient involvement

The analysis in this section overlaps with the analysis on the protected characteristic of sexual orientation.

The bill proposes to confer a duty on the Secretary of State to enable patients to make choices about health services provided to them. The duty should ensure a consistent national and strategic approach that centres patient choice in decision-making and the implementation of functions - for example, in the operationalisation of the 10 Year Health Plan.

The bill also proposes to confer a duty to promote the involvement of patients, and their carers and representatives (if any), in decisions that relate to the prevention or diagnosis of illness in the patients, or their care or treatment. This is a strategic duty to enable the Secretary of State to maintain national oversight over patient involvement, to identify national patterns and enact mitigation plans. It should help ensure that patient involvement is a consistent part of national health strategy.

As transgender people are more likely to have worse experiences in healthcare than the general population, the implementation of these new duties may have a positive effect in allowing them choice in the provision of their healthcare and enabling them or their representatives to advocate for better treatment. It will be important to ensure that, as appropriate in exercising these duties, this group is not disadvantaged and any short-term risks to progress because of organisational transformation are mitigated.

Religion or belief

There was limited evidence on health disparities for people with this protected characteristic.

The ONS report Religion and health in England and Wales: February 2020 identified that religious groups that have an older age profile have a higher percentage of people who report poor health compared with religious groups with a younger age profile. In England and Wales in 2016 to 2018, it found that a lower percentage of those with no religion (64%) were estimated to be satisfied with their overall health compared with those from Christian (68%), Hindu (72%) or Jewish (77%) religious groups. People in the ‘any other religion’ group were also found to be more likely to have long-standing physical or mental impairments, illness or disability (53%) than those in the Christian (36%), Muslim (35%), Hindu (27%) or Sikh (22%) religious groups.

Any health disparities related to religion or belief are also influenced by age and race and are covered in the analysis in those sections.

Pregnancy and maternity

The Darzi report (page 38) described “huge inequalities that exist in maternity care”, citing as an example that Black women are almost 3 times as likely as White women to die in childbirth. The investigation also noted that complexity of healthcare for pregnant women is increasing as the age that women become pregnant increases and more expectant mothers have health conditions such as obesity or diabetes. It concluded that “too many women, babies and families are being let down”.

The Darzi report (page 19) also found that referrals for perinatal mental health services for mothers have risen “by 23 per cent a year since 2016, rising from around 1,400 a month in 2016 to more than 7,600 a month in 2024”. There has been a significant expansion in access to these services, with the aim to continue it further.

The National Audit Office (NAO) Costs of clinical negligence 2025 report stated that the government’s liability for clinical negligence claims was £60 billion. In 2024 to 2025, damages for very-high-value claims accounted for 68% of total costs, but these claims represent only 2% of claims by volume. The highest value claims were typically those associated with brain injuries suffered in maternity care. Maternity-related cases for obstetrics claims involving brain damage had an average compensation of £11.2 million.

Secretary of State’s new duties on monitoring and improving the safety of healthcare services

These proposed duties will allow the Secretary of State to continue the work currently undertaken by NHS England, specifically by allowing the restructured DHSC to continue collecting and analysing information about patient safety across the health system. Evidence on maternity care highlights the need for continuous effort to improve the safety of these services. It will be important to ensure that, as appropriate in the exercise of these duties, this group is not disadvantaged and any short-term risks to progress because of organisational transformation are mitigated.

Secretary of State’s new duties on patient choice and patient involvement

The analysis in this section overlaps with the analysis on the protected characteristic of sex for women.

The bill proposes to confer a duty on the Secretary of State to enable patients to make choices about health services provided to them. The duty should ensure a consistent national and strategic approach that centres patient choice in decision-making and the implementation of functions - for example, in the operationalisation of the 10 Year Health Plan.

The bill also proposes to confer a duty to promote the involvement of patients in decisions that relate to the prevention or diagnosis of illness in the patients, or their care or treatment. This is a strategic duty to enable the Secretary of State to maintain national oversight over patient involvement, to identify national patterns and enact mitigation plans. It should help ensure that patient involvement is a consistent part of national health strategy.

As pregnant women and new mothers experience health inequalities and issues with the safety of services, the implementation of these duties may have a positive effect in allowing them more choice in the provision of their healthcare and enabling them to advocate for better treatment. It will be important that appropriate resource and expertise is allocated to the exercise of these duties in the restructured DHSC and to mitigate any short-term risks to progress because of organisational transformation.

Marriage and civil partnership

We did not find any evidence that there will be any disproportionate impact on people with this protected characteristic.

Other identified groups

These are not covered by the Equality Act 2010.

Socioeconomic background and geography are routinely included in considerations on health and social care policy. This is due to health inequalities, which are differences in health outcomes that are unfair and avoidable and which are rooted in socioeconomic background and geography.

Poor mental health is considered to be closely linked to health inequalities and is therefore also routinely included in considerations of health and care policy.

Socioeconomic background and geography

Evidence shows that those living in the most deprived areas of England face the worst healthcare inequalities in relation to healthcare access, experience and outcomes (see NHS England information on deprivation).

The 2021 Census insights into the self-declared general health status in England can be split by index of multiple deprivation (IMD) decile. The data shows that individuals living in lower deprivation deciles have poorer health. The most deprived (decile 1) had the highest rates of ‘bad’ and ‘very bad’ health at 11% and the least deprived (decile 10) had the lowest levels of ‘bad’ or ‘very bad’ health at 3%. In the 2025 GP Patient Survey, when asked how they would describe their experience at their GP practice, individuals living in the most deprived areas had the highest proportion of poor responses at 13%. The least deprived areas had the lowest proportion of responses at 10%.

The bill proposes to confer a duty on the Secretary of State to enable patients to make choices about health services provided to them. The duty should ensure a consistent national and strategic approach that centres patient choice in decision-making and the delivery of functions - for example, in the operationalisation of the 10 Year Health Plan. It may have a positive impact on people living in deprived areas as they will have choice in terms of where they seek their healthcare.

Mental health

People living with serious mental illnesses have significantly lower life expectancy than the rest of the population, typically dying 15 to 20 years earlier.^{[footnote 2]} The Darzi report (page 47) concluded that while there have been positive developments with more mental health patients receiving physical health checks, this is still below the ambitions set by NHS England, and that there is significant scope for improvement in the quality, safety and consistency of care for people with serious mental illnesses.

The bill proposes to place the legal responsibility for commissioning high security psychiatric services on the Secretary of State and it is expected that the needs of this group will continue to be addressed in the exercise of this function. It will also be important to ensure that any short-term disruption in the transition to a more efficient, restructured DHSC does not differentially impact the commissioning of high security psychiatric services for mentally ill people.

Mental health is closely linked to the protected characteristics of age, disability, sexual orientation and gender reassignment. This is summarised below, and the analysis of impacts is covered under the relevant headings for protected characteristics earlier in this document.

There has been a recent increase in mental health conditions reported among children and working-age adults. According to the House of Commons research briefing, UK disability statistics: prevalence and life experiences, people with long-term health conditions and disabilities have an increased risk of experiencing a mental health problem. Based on the GP Patient Survey 2025, across all age groups, people in England who identify as lesbian, gay, bisexual, transgender or other (LGBT+) have higher rates of self-reported long-term mental health conditions compared with heterosexual and cisgender people.

Summary of equalities analysis

Our overall assessment of the primary legislation proposals is that they do not carry any direct equality impacts with respect to any of the 3 equality aims. However, there may be indirect equality impacts if the implementation of primary legislation leads to short-term disruption to how the Secretary of State exercises their new functions in the restructured DHSC.

Equality aim 1: giving due regard to eliminating discrimination, harassment and victimisation and other conduct prohibited by the act

The bill proposes to confer on the Secretary of State 2 strategic duties related to patient choice and patient involvement. The aim is to continue national work to improve the healthcare experience and outcomes of service users and patients, as well as the involvement of carers and representatives in decision-making. The bill also proposes to allow the Secretary of State to continue national work on improving the safety of services by collecting and analysing information about patient safety across the health system.

There is evidence that the following groups are particularly likely to have negative healthcare experiences:

• women more generally and pregnant women, particularly regarding the safety of maternity services (protected characteristics of sex and pregnancy and maternity)
• LGBT+ people (protected characteristics of sexual orientation and gender reassignment)

To the extent that there is any short-term disruption to the provision of health services during the organisational transformation, this is likely to disproportionately impact people who share these protected characteristics and other people who have greater need for health services, such as older people and those with long-term conditions. The Transformation programme will consider this risk and take steps to ensure any such impacts are minimised.

Equality aim 2: giving due regard to the advancement of equality of opportunity

The bill proposes a regulation-making power to allow the Secretary of State to specify some direct commissioning functions that will be the responsibility of the Secretary of State (rather than ICBs). These are expected to cover services for members of the armed forces and their families and some specialised services for rare diseases.

The bill also proposes to confer on the Secretary of State the legal responsibility for commissioning high security psychiatric services. In addition, with respect to the Secretary of State commissioned services, the bill proposes to confer duties for the Secretary of State to support and facilitate integration across public functions - for example, in respect of children and young people’s education, health and care provision, and adult social care.

With regards to advancing equality of opportunity in terms of access to and quality of the Secretary of State’s commissioned services, there is evidence that the following groups are particularly likely to face challenges:

• disabled adults and children
• men more generally and ethnic minority men (protected characteristics of sex and race)
• older people (protected characteristic of age)

To the extent that there is any short-term disruption to the provision of health services during the organisational transformation, this is likely to disproportionately impact people who share these protected characteristics and other people who have greater need for health services, such as older people and those with long-term conditions. The Transformation programme will consider this risk and take steps to ensure any such impacts are minimised.

Equality aim 3: fostering good relations

The good relations duty recognises the importance of taking steps when developing and implementing policies that reduce the potential for community conflict. It will be most relevant to the transfer of some NHS England staff into the restructured DHSC (see sub-section ‘NHS England legal transfer scheme’ in the section ‘Effect on staff’ of this document). As the transfer and staff support policies are developed, it will be important to be sensitive to the views and opinions expressed on behalf of different staff groups to ensure that all voices are heard and the needs of different protected characteristic groups are properly considered.

Addressing risks of equality impacts in the transition to a restructured DHSC

NHS England and DHSC are mitigating risks to service provision during the transfer of NHS England functions into DHSC through existing, business-as-usual governance and risk-management processes. Responsibility sits with the relevant director generals and executives who manage risks through their established functional registers.

DHSC and NHS England continue to work collaboratively, with aligned governance practices and consistent risk-management activity. Each organisation maintains its own group-level risk register, reviewed regularly and escalated to the relevant organisational governance forums where appropriate.

Both the DHSC departmental risk register and the NHS England strategic and operational risk registers are being refreshed and will be brought to relevant organisational governance forums to ensure senior oversight of any risks associated with the transfer, including any potential impacts on service delivery.

Monitoring and evaluation

Impacts on staff in preparation for and after staff transfer

DHSC and NHS England work with staff to monitor wellbeing and the impact of the proposed transformation. Regular all-staff calls, led by the DHSC Permanent Secretary and the NHS England Chief Executive, provide updates on the Transformation programme and give staff the opportunity to raise questions and concerns directly. Alongside these calls, both organisations track feedback from engagement sessions to identify emerging issues and ensure appropriate support is in place in preparation for the transfer of some staff from NHS England to DHSC.

DHSC policy is to ensure there are quality 2-way conversations between individuals and their line managers, which happen at least monthly and cover employee wellbeing, performance and personal development. These conversations should ensure that for those NHS England staff who transfer to DHSC, any impacts on individuals with protected characteristics are identified and that individuals are directed to timely and relevant support.

DHSC also takes part in the annual Civil Service People Survey, which collects information on staff wellbeing and engagement, and can be used to understand any differential experiences for staff groups with protected characteristics. The People Survey offers a way to monitor and evaluate the effects of staff transfer, alongside other efforts. 

Impacts on service users, patients, their carers and families

The overarching equality impact assessment document for the bill provides detail of the developing monitoring and evaluation framework. The primary success indicator that DHSC must monitor is the extent to which the bill successfully meets its aim of enabling the department and the wider health system to operate more efficiently and effectively.

1. Note that we refer to LGB+ people in this section, as this grouping aligns more closely with the protected characteristic of sexual orientation. Evidence on transgender individuals is covered under the protected characteristic of gender reassignment. ↩

2. Chesney E and others. Risks of all-cause and suicide mortality in mental disorders: a meta-review Psychiatry World 2014: volume 13(2), pages 153 to 160. ↩