The National Health Service has many quirks. One of them is its ability to convince every incoming government that it only requires one more reorganization to make it function. Tony Blair reorganized it. Andrew Lansley reorganized it. Theresa May reorganized it. Boris Johnson reorganized it. Now Wes Streeting is having his turn — via his replacement as health secretary, James Murray. Once again, clearer accountability and billions in savings are signposted as being just around the corner.

Now, the process has reached Parliament. The Government’s Health Bill yesterday passed Committee stage before it returns to the Commons, where Labour’s majority means it is all but certain to pass. The House of Lords may yet force concessions around the edges, but the broad direction of travel is unlikely to change.

Coverage has understandably focused on the abolition of NHS England. Buried beneath that headline, however, are a series of institutional changes that have received far less attention but deserve far greater scrutiny.

To be fair to Streeting, abolishing NHS England seems to be an obvious move. For years, ministers have hidden behind the arms-length body whenever waiting lists rose and hospitals struggled. However, abolishing NHS England does not require even half the additional reforms attached to the Bill. The Government has presented the legislation as little more than a technical transfer of functions when, in reality, it is expanding ministerial influence over the hiring and firing of NHS Trust and NHS Integrated Care Board (ICB) leaders and scrapping both Healthwatch England and the Health Services Safety Investigations Body.

It can certainly be argued that greater ministerial accountability should come with greater responsibility for senior appointments. But under the current model, and with the NHS still a national love object immune to criticism, this will likely mean micromanagement from the top stifling local autonomy, as well as making appointees hostages to political fortune.

The same applies to Healthwatch England. Since 2013, it has acted as an independent voice for patients, raising uncomfortable questions about standards of care. The Bill abolishes this, replacing it with a Patient Experience Directorate inside the NHS itself, instead placing greater responsibility on trusts and ICBs to gather and respond to patient feedback.

The proposed abolition of the Health Services Safety Investigations Body is even harder to justify. HSSIB was deliberately established as an independent, no-blame investigator, modeled on the approach long used by aviation, where investigators are separated from regulators in order to encourage candor and improve lessons from any given failures.

Nor does the Government’s financial case appear as settled as suggested. Streeting has repeatedly pointed to annual savings of about £1 billion from abolishing NHS England and reducing bureaucracy. Every past government that has embarked on a reorganization promises efficiency savings, and yet remarkably few of them have delivered on the timescale suggested.

The Bill also reflects a broader misconception about accountability. Governments continue to believe that accountability flows downwards from Whitehall through reporting structures. In reality, the strongest forms can often come from outside the system. Rather than yet another cycle of bureaucratic redesign, the Government should be asking how greater pluralism and competition could embed accountability into the NHS itself.

None of this is an argument for preserving NHS England. Its abolition may well prove one of the more sensible aspects of the Bill. However, in abolishing one quango, hoarding up powers, and refusing to expose the health service to market forces, ministers may end up ultimately weakening precisely the checks and balances that exist to hold both the NHS, and ministers themselves, to account.