MPs Criticise Plan to Replace Council Nominees on NHS Boards

Plans within the Health Bill to remove local authority representation from London’s NHS Integrated Care Boards (ICBs) have drawn sharp criticism from London MPs. The proposed legislation would replace members nominated by local councils with individuals put forward by the Mayor of London, a move MPs argue undermines democratic accountability and the crucial integration of health and social care services.

Concerns Over Democratic Representation

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Integrated Care Boards are responsible for managing NHS budgets, planning services, and commissioning care across their areas. Currently, London’s five ICBs include at least one member jointly nominated by the local authorities within their remit. The Health Bill seeks to change this, mandating a nominee from the Greater London Authority instead. MPs on the House of Commons health and social care committee have urged ministers to reconsider, highlighting that, unlike other mayoral authorities, the Greater London Authority does not directly oversee health or social care services.

Labour MP Ben Coleman, representing Chelsea and Fulham, told the Local Democracy Reporting Service that a uniform approach to ICB composition is inappropriate for London. "We need proper, democratic representation. We have that at the moment with the local authority model," Coleman stated. He emphasised the vital role councils play in providing social care, which is essential for preventing hospital admissions and facilitating timely discharges. "The integration between health and social care is vital. We need local authorities on the board," he added, questioning the logic of removing them when the Mayor of London holds no direct responsibility for these areas.

Danny Beales, another Labour MP on the committee, described the proposed changes as "a step backwards" that "waters down" collaboration. He argued that removing local authorities from decision-making tables is short-sighted, particularly in the context of shifting towards preventative healthcare. Beales suggested that while such measures might suit areas with integrated mayoral health models, like Greater Manchester, they are ill-suited to London's distinct structure.

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Potential for Flexibility

Despite the strong opposition, there are indications that the government may be open to flexibility regarding the application of these reforms in London. Former health secretary James Murray acknowledged the capital's unique position, differentiating it from other mayoral combined authorities. He assured the committee that specific guidance would be issued for different regions, including London, to address these complexities. "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," Murray said.

A spokesperson for the Mayor of London, Sadiq Khan, stated that the proposed changes offer an opportunity for city-wide leadership to reduce health inequalities. The spokesperson also affirmed the critical role of local councils, saying, "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."