I recently contributed a short article to The Conversation on some of the implications of Wes Streeting’s resignation for the NHS. Due to space constraints, this focused on England, but some of the concerns indicated also apply beyond England. The underlying research for the article examines the ministerial duty to promote “a comprehensive health service” also across Northern Ireland, Scotland, and Wales.
The original peer-reviewed, accepted, version of the research is available here, and has recently been updated in a final version to reflect the May 2026 elections in Wales and Scotland, as well as the launch of the Health Bill which abolishes NHS England. This research forms a chapter in the Research Handbook on Medical Jurisprudence, edited by Professor Edward Dove, with publication by Edward Elgar anticipated 2026/2027.
The chapter compares and contrasts the “politicization” approach of consistently imposing a duty to “promote a comprehensive health service” on ministers (Scotland and Wales), and the government department (Northern Ireland), with the “depoliticization” approach in England as seen with NHS England being established to reduce ministerial oversight in 2013.
What are the main differences?
In Scotland, the duty to promote a comprehensive and integrated health service for the people of Scotland is owed, following the May 2026 elections, by the Cabinet Secretary for Health and Social Care, supported by a Minister for Community Care, and a Minister for Mental Wellbeing, Public Health, Sport, Alcohol & Drugs. The supporting ministers’ focus (and number of supporting ministers) can change with each government.
In Wales, the duty to promote a comprehensive health service to for the people of Wales is owed, following the May 2026 elections, by the Minister for Health and Care, supported by a Deputy Minister for Public and Preventative Health, and a Deputy Minister for Social Care, Mental Health and Women’s Health. The focus of the ministerial titles has also changed since the previous government.
In Northern Ireland, the duty is owed to the people of Northern Ireland by the Department of Health (as distinct from the Minister of Health), and is to “promote… an integrated system of health care… and social care”.
The Secretary of State for Health and Social Care is an office in the UK government, but their duty is owed to “the people of England”. Despite the title, there is no specific duty regarding social care, only the NHS. The new Health Bill, as it stands currently, represents a missed opportunity to correct this.
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