NHS Governance by Local Authorities

The Health Bill 2026 proposes changes to the membership of ICB Boards.

The bill proposes the following significant changes:

Mayors of strategic authorities (or a deputy nominated by them) will have the right to be nominated as Integrated Care Board members as part of this bill.

The requirement for local authorities and provider organisations (including primary care providers) to be nominated as members will be removed.

The aim is to enable greater strategic alignment across the health, wellbeing and economic priorities of local areas. Facilitating more integrated working between mayors and ICBs may also support local people to benefit from healthier lives, greater independence, and more opportunities for economic participation. For example, strategic authorities will have a strategic responsibility to deliver local energy and environmental plans, so integration between these and health strategies would be beneficial to allow each to support the other.

Ensuring these organisations sit on ICBs helps enable this type of integrated working. Membership changes also help to reduce the administrative burden on ICBs in managing potential conflicts of interests with provider members in taking commissioning decisions.

The Manchester Example

Combined Authorities are being created in many areas of England (See more on this Link) including Surrey.  This brings a higher level of local engagement from the leaders in of the Combined Authority.  The area where this has happened to the greatest extent is Manchester, where the Mayor of Greater Manchester holds some of the strongest health‑related powers of any English metro mayor, due to the region’s unique devolution agreements. The powers were created in two phases:

1/ Health & Social Care Devolution Deal 2016

The Original 2015 Health & Social Care Devolution Dea, in force since 2016, under which The Mayor does not run the NHS, but has strategic influence over a £6 billion health and social care system and chairs the political leadership of the devolved partnership.

Key powers and responsibilities

• Strategic oversight of the devolved £6 billion health & social care budget
  Greater Manchester’s councils and NHS bodies jointly control this budget under the 2015 devolution deal. The Mayor chairs the Greater Manchester Combined Authority (GMCA), which is one of the partners in the system.
• Influence over integrated care and prevention strategy
  The deal created the Greater Manchester Health and Social Care Partnership, enabling the Mayor and local leaders to shape long‑term priorities such as prevention, mental health, and community‑based care.
• Ability to align health with other mayoral powers
  The Mayor can integrate health priorities with:
  • transport (e.g., active travel, clean air)
  • housing and homelessness
  • skills and employment
  • policing and fire services

These are areas where the Mayor has direct powers, and which strongly affect population health.

Political leadership and accountability,  The Mayor provides a single, visible point of accountability for the region’s health strategy, even though operational control remains with NHS organisations and councils.

2/ 2026 Health Devolution Trial

This extends mayoral influence by the the Mayor being placed at the heart of local NHS leadership through a new governance model.

NHS England will appoint a new ICB Chair who also serves as the Mayor’s Health Commissioner
This person reports jointly to NHS England and the Mayor.

(How this works vs. the Health Bill 2026 above is not defined)
This effectively gives the Mayor a deputy mayor for health embedded inside the NHS governance structure

Greater mayoral influence over NHS priorities

The Mayor will have a direct role in:

• shaping prevention strategy
• tackling health inequalities
• improving coordination between NHS, councils, and community services
• ensuring services reflect local needs rather than Whitehall priorities
   

Part of the national 10‑Year Health Plan and devolution bill
This trial is intended to test whether devolved leadership improves outcomes and reduces the “postcode lottery”.

What the Mayor does not have

The Mayor still has limits on their powers:

• No direct operational control of hospitals or GP practices
• Cannot hire or fire NHS staff
• Cannot set NHS pay or national service standards
• Cannot unilaterally change social care charging rules
  These remain national responsibilities.

Why Greater Manchester is unique

Greater Manchester is the only English region with:

• a fully devolved health & social care partnership (since 2016)
• a mayoral‑linked ICB chair (from 2026)

This, arguably, makes the Mayor of Greater Manchester the most influential local health leader in England, even though formal powers remain shared.