Ministers have been urged to reconsider legislation that would strip London councils of their right to sit on NHS Integrated Care Boards (ICBs) and instead hand their seats to members nominated by City Hall.
London MPs have said the Health Bill, currently making its way through the House of Commons, would be detrimental to the way healthcare is planned in the capital.
ICBs and the Proposed Changes
ICBs are statutory organisations responsible for managing the local NHS budget, planning health services, and commissioning care for local populations. There are currently five ICBs covering London, under which NHS trusts run hospitals and deliver health services.
Under reforms in the Health Bill, the requirement to have at least one member jointly nominated by the local authorities covered by the ICB will be replaced by a new demand to have someone nominated by the Mayor.
MPs on the Health and Social Care Committee have urged ministers to rethink these proposals because, unlike other mayoral authorities, the Greater London Authority does not directly oversee health or have devolved health powers. They argue it makes little sense for the GLA to take a seat from local councils.
MPs' Concerns
Labour MP Ben Coleman, who represents 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. Social care is absolutely vital if you want people to stop going into hospital, staying there and getting out quickly – councils provide that. The integration between health and social care is vital. We need local authorities on the board – but the proposal will mean only strategic mayors sit on boards. 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. Having the three places right now works, because they all understand social care. This hasn’t been fully thought through.”
Danny Beales, another Labour MP on the committee, added: “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. Local authorities will not be round the table with decision-makers – that is short-sighted. The health landscape is changing, but there must be a way around that. These measures might work in Manchester, where there is an integrated health model within the mayoral authority, but it doesn’t work everywhere in the country.” He called the move “a step backwards” that “waters down” collaboration.
Government Signals Flexibility
There are signs that the new guidance could be applied flexibly in London, though MPs want more certainty that councils will remain involved. Former Health Secretary James Murray told the committee earlier this month that he “definitely” recognises the difference between the GLA and mayoral combined authorities like Manchester. “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. We are aware of London’s unique position. We have committed to putting out further guidance about how we will approach different parts of the country. This includes London. The issue is very specific to London – we need specific guidance for specific areas.”
Two weeks earlier, former Minister of State for Care Stephen Kinnock said: “We must ensure that local authorities are front and centre of what we do.” He later 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. We are open to local choices being made which supplement the (relatively minimal) prescribed arrangements with locally agreed ones and would emphasise the importance of non-statutory partnership, collaboration and agreement in the system at least as much as the statutory requirements. It is precisely because previous arrangements have sought to answer the ‘London question’ with an over-prescriptive national framework that has inevitably suited some places more than others, that local voices and choices have been crowded out.”
At a previous committee session, Penny Dash, Chair of NHS England, told MPs that aligning ICB structures with the mayoral authority more closely across the country “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 clear stance, saying: “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. Local councils are critical partners in improving health, and we remain committed to joint leadership and partnership working to deliver a coherent city-wide approach to preventing ill health, tackling inequalities and improving outcomes for all Londoners.”
NHS England and the Department for Health and Social Care did not respond to requests for comment.
