Government Urged to Reconsider Removing Local Authorities from ICBs

Key Points

• Health and social care secretary James Murray faced questioning from the Health and Social Care Committee over Government plans to strip local authorities of their statutory right to representation on Integrated Care Boards (ICBs).
• Labour MP for Chelsea and Fulham, Ben Coleman, urged Murray to “think again” on the proposals contained within the Health Bill.
• Coleman argued the NHS “does not understand how local government in this country works” and warned the Bill risks replacing established local authority representation with “nebulous” mayoral structures that “don’t even exist in some places”.
• Coleman highlighted that the change would be particularly problematic in London, where boroughs already have no formal role in the governance of the Greater London Authority, unlike combined authorities such as Manchester.
• Murray acknowledged there is “a difference in terms of the composition of ICBs in different parts of the country” and said there would not be a single approach applied nationally.
• The Government confirmed it will publish guidance setting out how the policy will apply differently across various ICB areas.
• Murray recognised that “different places in the country have different arrangements” when it comes to local governance structures.
• The exchange took place during a live evidence session of the Health and Social Care Committee examining the Health Bill.

London (Britain Today News) July 13, 2026 — The Government has been urged to reconsider proposals within the Health Bill that would remove the statutory right for local government representation on Integrated Care Boards, after a Labour backbencher told the health and social care secretary that ministers risked getting the policy badly wrong. James Murray was pressed repeatedly during a session of the Health and Social Care Committee to explain why local authorities were being stripped of their guaranteed seat at the table, with MPs warning that the change could leave a governance vacuum in parts of the country, including London, where alternative structures such as directly elected mayors do not yet exist.

What Did Ben Coleman Say to the Health and Social Care Committee?

Ben Coleman, the Labour MP for Chelsea and Fulham, used his questioning time to deliver a pointed critique of the Health Bill’s approach to local government representation on ICBs. Coleman told the committee:

“The NHS does not understand how local government in this country works, and the Bill is a fundamental exemplar of this in that you are removing local government, which understands health and which is essential to health, and replacing it with some nebulous, not even existing strategic position – mayors, which don’t even exist in some places. You need to think again. Do you accept that you might have got it wrong and you perhaps need to think again?”

The intervention represented one of the most direct challenges Murray faced during the session, with Coleman explicitly asking the secretary of state to concede that the policy, as currently drafted, was flawed and required further reconsideration before proceeding.

Why Does the Health Bill Propose Removing Local Authorities from ICBs?

Integrated Care Boards were established under the Health and Care Act 2022 to bring together NHS organisations, local authorities and other partners to plan and deliver health and care services across defined geographical footprints in England. Since their creation, local authorities have held a statutory entitlement to representation on ICBs, reflecting the recognised link between social care, public health and wider determinants of health that sit within council remits.

The Health Bill now under scrutiny by the committee proposes to remove that guaranteed statutory right, instead envisaging a system in which strategic oversight could, in some areas, be exercised through emerging mayoral and combined authority structures rather than through individual local authorities sitting directly on ICB boards. Critics of the plan argue this shifts influence away from councils that have built up detailed knowledge of local health inequalities and service delivery, and towards regional structures that, in many parts of England, are either newly formed or do not exist at all.

How Did James Murray Respond to Calls to Reconsider the Policy?

Responding directly to Coleman’s challenge, Murray did not concede that the Government had got the policy wrong, but he did acknowledge the complexity created by varying local governance arrangements across England. Murray told the committee:

“I definitely recognise there is a difference in terms of the composition of ICBs in different parts of the country and there won’t be a single approach that applies everywhere.”

The health and social care secretary’s response stopped short of agreeing to reverse or pause the proposals, but it did signal an acceptance that a single, uniform national model may not be appropriate given the uneven distribution of devolved and mayoral structures across the country.

Why Is the Situation Different in London Compared to Manchester?

Coleman used the disparity between London and Greater Manchester to illustrate what he described as the flawed logic underpinning the Bill. He told the committee it was “very strange” that the Government was pressing ahead with removing local authorities from ICBs in London, given that, unlike combined authorities such as Manchester, London boroughs have no formal role in the governance of the Greater London Authority.

This distinction matters because combined authorities in areas such as Greater Manchester have developed integrated structures in which councils and the mayoral authority work within a formalised governance framework, giving local government a continued voice even as strategic powers sit with a mayor. In London, however, the relationship between boroughs and the Greater London Authority does not operate in the same way, meaning that removing the statutory ICB seat for boroughs could leave a genuine gap in local representation rather than simply shifting it to another accountable tier of local governance.

What Role Do Combined Authorities and Mayors Currently Play in ICB Governance?

Under the existing framework, ICBs are expected to work closely with local authorities, combined authorities and, where they exist, mayoral bodies, in planning health and care services. In areas with well-established combined authorities, mayors and their offices already play a significant strategic role in areas such as transport, housing and economic development, and in some cases health-related functions have started to be devolved or aligned with these structures.

However, Coleman’s evidence to the committee underlined that this model of mayoral and combined authority involvement is far from universal. Large parts of England, including London in the specific context he raised, do not have the same integrated relationship between councils and a mayoral tier, meaning the Health Bill’s reliance on such structures to fill the gap left by removing statutory local authority representation may not translate consistently nationwide.

Will the Government Publish Guidance on Regional Differences?

Murray confirmed to the committee that the Government intends to publish guidance addressing how the policy will be applied differently depending on local circumstances. He said the guidance would set out how the approach would work in different ICB areas, and reiterated his recognition that

“different places in the country have different arrangements”.

This commitment to guidance suggests ministers are attempting to build flexibility into the implementation of the policy, rather than mandating an identical model for every ICB area regardless of whether a functioning mayoral or combined authority structure is in place locally. Whether this guidance will be sufficient to reassure MPs such as Coleman, and the local authorities that stand to lose their guaranteed seat, remains to be seen.

What Are Integrated Care Boards and Why Do They Matter?

Integrated Care Boards are statutory NHS organisations responsible for planning and funding most NHS services within a defined area, working alongside Integrated Care Partnerships that bring together a broader range of health, social care and other partners. They were designed to break down historic silos between hospitals, primary care, community services, mental health provision and social care, on the basis that better coordination between these services and local authorities improves outcomes and reduces pressure on acute settings.

Local authority involvement on ICBs has been viewed as central to this model because councils hold statutory responsibility for adult social care, public health, housing and a range of other services that directly affect population health. Removing the guaranteed right to representation therefore raises questions, as posed by Coleman, about whether the reformed system will retain the depth of local knowledge and accountability that council representatives currently bring to ICB decision-making.

How Have Local Authorities Historically Been Involved in NHS Governance?

Local authorities have played a formal role in NHS governance structures for well over a decade, dating back to arrangements introduced under the Health and Social Care Act 2012, which established health and wellbeing boards bringing together councillors, NHS commissioners and public health officials. That tradition of embedded local government involvement was carried through into the design of ICBs when they replaced clinical commissioning groups in 2022.

Coleman’s evidence to the committee drew on this history, arguing that local government’s long-standing and detailed understanding of health inequalities, social care pressures and community needs is not easily replicated by strategic bodies operating at a larger geographic scale, particularly in areas where such bodies are still in their infancy or do not exist.
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What Has Been the Reaction from Local Government Representatives?

While the committee session captured on record featured Coleman’s own direct challenge to Murray, his intervention reflects concerns that have been raised more broadly by figures within local government about the practical implications of losing statutory ICB representation. The central worry articulated by Coleman was that the Bill would replace a concrete, understood form of local accountability with what he termed a “nebulous” alternative, given that mayoral and combined authority structures are not yet established in every part of England.

Coleman’s questioning placed particular emphasis on the risk that ministers may not have fully grasped how local government operates in practice, telling the committee bluntly that

“the NHS does not understand how local government in this country works”.

This framing positioned the exchange not simply as a technical dispute over ICB board composition, but as a wider concern about the extent to which health policymaking engages meaningfully with local government expertise.

What Happens Next with the Health Bill?

The Health Bill remains under scrutiny, with the Health and Social Care Committee continuing to examine its provisions, including the proposals affecting local authority representation on ICBs. Murray’s acknowledgement that a single national approach will not apply everywhere, together with the Government’s commitment to publish area-specific guidance, indicates ministers are seeking to manage concerns about inconsistency rather than reversing the underlying policy direction at this stage.

For MPs such as Coleman, and for local authorities watching the passage of the Bill closely, the key question will be whether the forthcoming guidance goes far enough to address the gap identified in areas like London, where the alternative structures the Bill appears to lean on for strategic oversight simply do not exist in the same form as they do in areas such as Greater Manchester. Until that guidance is published and its detail examined, uncertainty is likely to persist over how local voices will be represented within ICBs once the statutory right to a seat is removed.