On May 14, 2026, the United Kingdom Parliament introduced its NHS Modernisation Bill, launching what may become one of the most significant restructurings of the National Health Service (NHS) since the 2012 Health and Social Care Act. The bill proposes abolishing NHS England as a separate administrative body, creating a national “Single Patient Record,” and strengthening Integrated Care Boards and neighbourhood-level planning structures.
Much of the debate has focused on concerns about political centralization and digital governance. But another aspect of these reforms deserves serious attention in Canada: the growing recognition that population health must be planned and coordinated closer to communities and neighbourhoods.
The language of the bill is particularly notable from a population health perspective. It repeatedly emphasizes “Neighbourhood Health Plans,” integrated local partnerships and stronger coordination between health systems, local governments, social services, housing and communities.
The underlying message is important: improving population health requires governance systems that are more locally responsive and better able to address the broader social determinants shaping health outcomes. Canadian provinces have spent decades restructuring health system governance, often promising more local decision-making but rarely achieving meaningful integration between health systems and communities.
Canada’s health governance structure remains deeply fragmented. Constitutionally, health is primarily a provincial responsibility while municipalities, despite their central role in shaping the social determinants of health, remain “creatures of the provinces” with no independent constitutional authority. Housing, transportation, recreation, food environments, social infrastructure and urban planning are largely local responsibilities, yet municipalities often lack the authority, funding and integration necessary to meaningfully shape population health outcomes. This is only compounded by the fact that provincial health systems have never sought much integration or coordination with those municipally delivered services.
Canada’s various experiments with “regionalization” of provincial health governance created structures that sat parallel to municipal governments but did little to engage with them. Both “regional health authorities” (as they were often known) and municipalities lacked the political or financial capacity to properly integrate health and social care services in any serious way. And certainly not in a manner that could tackle the determinants of health and wellbeing.
This fragmentation matters because many contemporary health challenges are increasingly shaped by social, economic and environmental conditions that extend beyond health-care services alone. Mental health crises, houselessness, addictions, chronic disease, social isolation and climate-related health risks are all profoundly influenced by neighbourhood and built environment conditions. Yet, the governments closest to these realities frequently remain disconnected from broader health system decision-making.
Our recent national study examining partnerships between municipalities and local public health systems (within regional health authorities) across Canada found that most municipal and public health officials view health equity as central to their institutional mandates. However, they identify major structural barriers limiting effective collaboration, including inadequate financial and human resources, fragmented priorities across sectors and governments and the ad hoc nature of partnerships between municipalities and public health actors.
Our findings reveal a broader governance problem in Canada: while local actors increasingly understand health inequities as interconnected community challenges, existing governance structures continue to separate health care, public health, housing, transportation and social development into disconnected policy silos.
We heard similar concerns in our recent equity-centered urban health study in Regina, involving participants from municipal and provincial governments, Indigenous and newcomer-serving organizations, youth groups, non-profits, private sector actors and individuals with lived experience. Participants consistently described healthy cities not primarily as places defined by hospitals and health-care services but as places grounded in belonging, social connection, safety, dignity, affordable housing, transportation access, culturally welcoming environments and meaningful participation in decision-making.
Importantly, participants repeatedly emphasized that marginalized communities are too often excluded from planning processes and that decisions affecting neighbourhood wellbeing are frequently made far from the communities most impacted. Participants called for more locally responsive governance, stronger neighbourhood-level engagement and integrated collaboration across sectors.
These findings align with broader international evidence.
Nordic countries consistently outperform Canada on many population health outcomes, such as life expectancy and preventable mortality. Their success is not simply the product of health-care spending. It reflects stronger welfare systems and greater integration and coordination between local governments, social services, public health and community planning. In many Nordic countries, municipalities play central roles in health promotion, elder care, housing supports and community health initiatives.
The NHS reforms move in this direction. Beyond digital modernization, the bill explicitly acknowledges that healthier populations require stronger neighbourhood systems and more integrated local planning. Canada, by contrast, often remains trapped in jurisdictional fragmentation.
The consequences of this fragmentation are increasingly visible. Indigenous communities continue to experience substantial health inequities shaped in part by fragmented and overlapping federal, provincial, municipal and Indigenous governance arrangements. At the same time, municipalities are increasingly expected to respond to homelessness, addictions, mental health crises and climate-related emergencies while lacking formal authority or meaningful integration within broader health governance systems. The irony is striking. Municipalities are increasingly expected to manage the consequences of health inequities while having limited influence over the systems and policies producing them.
Canada does not need to replicate the NHS model wholesale. But the NHS England reforms should force us to confront an increasingly urgent question: can a highly fragmented governance system effectively address 21st century population health challenges that are fundamentally local, relational and shaped by neighbourhood conditions?
While Canada’s governance fragmentation is deeply entrenched, there may nevertheless be emerging policy opportunities for provinces to better integrate health, social care and community wellbeing systems and overcome the persistent silos separating healthcare and social services. Since 2017, federal transfers to the provinces have been governed by articulating broad policy priorities that are then operationalized through bilateral agreements between Ottawa and each province. These agreements set out (in admittedly varying detail) how each province will spend its transfer dollars in furtherance of the policy priorities such as “mental health services” or “community-based care.”
Equally important, however, is the fact that in recent rounds of negotiations about transfers both the federal and provincial governments have quietly walked away from the idea that federal dollars are meant to fund only those services guaranteed under the Canada Health Act (1985) – namely “medically necessary hospital and physician services.” This provides an opening to more thoroughly integrate traditional Medicare services with health services provided, in whole or in part, by provincial governments that exist outside of the CHA basket. Linking those health services with social care services (also almost entirely within provincial jurisdiction) could, and we would argue should, be the next logical step.
NHS England’s reforms may not be perfect. But they reflect an important recognition: healthier societies are built not only through health-care systems but through stronger neighbourhood systems, integrated and relational forms of local governance and decision-making structures that move closer, not further away, from communities.
Canadian provinces’ past experiments in regional coordination and integration of services often fall short precisely because those regional authorities lacked democratic legitimacy as health service decision-makers. Flowing that coordination and integration through democratically elected municipal governments (properly resourced and with sufficient governance capacity) could be a more lasting way to break down those silos that so stubbornly persist.
