London MPs have warned that proposed NHS reforms would strip local councils of their seats on Integrated Care Boards (ICBs) and hand them to nominees from City Hall, potentially undermining healthcare planning in the capital. The Health Bill, currently before the House of Commons, would replace the requirement for at least one member jointly nominated by local authorities with a mayoral nominee, sparking concerns about the loss of democratic representation.
ICBs and the proposed changes
Integrated Care Boards are statutory bodies responsible for managing local NHS budgets, planning health services, and commissioning care. London currently has five ICBs, each overseeing NHS trusts that run hospitals and deliver services. Under the Health Bill, the requirement for local authority representation would be replaced by a nominee from the Mayor of London, Sadiq Khan.
Labour MP Ben Coleman, representing Chelsea and Fulham, told the Local Democracy Reporting Service: "Not all parts of the country are the same - a one-size-fits-all approach won't work when it comes to ICBs. We need proper, democratic representation. We have that at the moment with the local authority model." He added that social care integration is vital, and councils provide that expertise.
Criticism from MPs
Danny Beales, another Labour MP on the Health and Social Care Committee, called the removal of local authorities "short-sighted" and "a step backwards." He said: "The Health Bill is a key opportunity for the Government to enable the ambitions of the NHS 10-year plan, a shift to preventative healthcare. But this is a space where the Bill falls short in delivering that - the removal of local authorities on ICBs is the reverse of it." Beales noted that while the model might work in Manchester, which has an integrated health model within the mayoral authority, it does not suit London's unique structure.
MPs emphasized that the Greater London Authority does not directly oversee health or social care, unlike policing or transport. Coleman stated: "The Mayor of London isn't responsible for health or social care - this isn't policing or transport. It makes no sense to get rid of all the local authority places in the London ICBs."
Government signals flexibility
Former Health Secretary James Murray told the committee earlier this month that he "definitely" recognizes the difference between the GLA and Mayoral Combined Authorities. He said: "In terms of the composition of ICBs in different parts of the country, there won't be a single approach that applies everywhere. There's a requirement to have a mayoral representative but there is flexibility about what individual ICBs can do." Murray committed to issuing further guidance for London.
Ex-Minister of State for Care, Stephen Kinnock, wrote to committee chair Layla Moran: "It is precisely because of these differences (which are often sources of local strength) that we have sought to be less prescriptive about governance arrangements than was the case under the previous government." He emphasized openness to local choices supplementing minimal statutory requirements.
NHS England's stance
Penny Dash, Chair of NHS England, told MPs that aligning ICB structures with mayoral authorities "is not my decision to make for London." She added: "We were also very clear that people would make the decisions locally on what is the right structure."
Mayor's office response
A spokesperson for the Mayor of London did not take a stance on whether Khan should gain additional powers, stating: "The scale, diversity and complexity of London's health and care system requires all partners to work together to drive forward improvements. The proposed changes to ICBs are still being developed, but offer a real chance to provide city-wide leadership and build on the work of the Mayor and partners to reduce health inequalities." The spokesperson affirmed commitment to joint leadership with local councils.
NHS England and the Department for Health and Social Care did not respond to requests for comment.
