Local and regional government

The assessments of the policy area on this page were based on a snapshot of progress on 20 July 2026 and do not reflect more recent announcements.

Lead departments 

• Ministry of Housing, Communities and Local Government 
• Cabinet Office  

Why it matters to health  

Local and regional government holds key powers that shape health, including on housing, employment and skills support, transport and planning. Local authorities also have responsibility for public health, which includes addressing the causes of ill health, commissioning some health services (such as for sexual health, substance misuse and children’s public health) and responding to public health emergencies.  

English devolution, local government reorganisation and the government’s focus on local growth create opportunities to strengthen the building blocks of health and reduce inequalities. However, these benefits are not automatic, and success depends on adequate funding, clear responsibilities, local capacity and relationships and effective accountability mechanisms that embed health in decision making. The evidence on the health impacts of devolution remains mixed, and some issues still require strong national action, particularly where consistent regulation, redistribution or population-wide measures are needed.  

Labour’s commitments 

Labour’s 2024 manifesto pledged ‘landmark’ devolution legislation, including integrated settlements, greater mayoral powers, and a wider transfer of power from Westminster to support its missions and spread economic growth more evenly across England. It also promised that a Labour government would work in partnership with local government, recognising the severe financial challenges facing councils and pledging to introduce multi-year settlements to give more stability.  

Status of this policy area 

Cuts to local government funding after 2010 had a substantial impact on councils’ capacity to support health. They affected both wider services that can support a preventative approach to health, as well as public health, which saw its budget cut by more than a quarter in the decade before Labour came to power. There has been cross-party support for further English devolution, and significant action was taken under the coalition and Conservative governments. However, progress has been incremental and uneven.  

• Local outcomes and accountability: The 2026 Local Outcomes Framework embeds the government’s ambition to improve health and reduce inequalities and recognises public health as a core local government responsibility.  
• Funding: Multi-year settlements have improved certainty for councils, but funding remains below 2016/17 levels in real terms. This means that councils still face substantial pressures that affect their ability to support health.  
• Public health: Although public health funding has increased from its low point in 2023/24, it remains more than a quarter lower in real terms than a decade ago.  
• Devolution: The English Devolution and Community Empowerment Act 2026 introduced a health inequalities duty for strategic authorities and expanded their powers over planning, transport, housing, skills and employment. Meanwhile the Devolution Priority Programme is accelerating rollout to new areas.  
• Integrated settlements: Integrated settlements give strategic authorities greater flexibility over local spending. Further fiscal devolution is under consideration.  
• Growth and prevention: Strategic authorities are developing local growth plans and piloting place-based prevention approaches. 
• Governance: The NHS and mayoral leadership are becoming more closely aligned, including through joint health leadership roles in Greater Manchester and South Yorkshire.