The English Devolution Bill: small but important steps on public health

The government’s decision to delay the election of four new regional mayors sits uncomfortably with its stated aim to extend devolution in England. More welcome, however, is the inclusion of new public health responsibilities in the English Devolution Bill. ⁷ Ministry of Housing, Communities and Local Government, ‘English Devolution and Community Empowerment Bill’, 10 July 2025, retrieved 16 December 2025, English Devolution and Community Empowerment Bill publications - Parliamentary Bills - UK Parliament  This will mean that, when exercising their functions, strategic authorities must “have regard to the need to improve the health of… and reduce health inequalities between” people living within their regions. ⁸ Ministry of Housing, Communities and Local Government, ‘English Devolution and Community Empowerment Bill’, 10 July 2025, retrieved 13 January 2026, English Devolution and Community Empowerment Bill publications - Parliamentary Bills - UK Parliament

The health duty is welcome – but mayors have few powers to deliver on it 

The introduction of the health duty has been welcomed by many MPs, mayors and stakeholders as an important first step in enabling mayors to address health inequalities at the regional scale. However, the duty would be more meaningful if paired with clearer expectations – and supporting powers.

At report stage in the Commons, several amendments were tabled to strengthen the new duty. The government accepted one that called for mayoral strategic authorities (MSAs) to consider the environmental determinants of health – such as air quality and green space – but rejected others, including one that would require each MSA to produce a health inequalities strategy and report on progress every five years.

Resourcing will be key: the bill imposes a new legal duty on mayors to consider health, but without sufficient resource to meet it the scope for meaningful action may be constrained. As noted in our DevoLab #1 policy briefing, establishing a dedicated health policy function within MSAs will support mayors to tackle health inequalities; without such investment, there is a risk the duty becomes largely symbolic.

Mayors can use a range of devolved levers to influence health outcomes

While they do not have control over frontline health services, MSAs do also influence many of the wider determinants of health through their powers over transport, housing, skills and economic development. Strategic choices in these areas can make a difference to long-term health outcomes.

For instance, Greater Manchester has taken steps to tackle health inequalities via employment support programmes for people with health problems. Our case study on its ‘Working Well’ family of services showed the benefits of bringing various employment support programmes under one integrated model, with wraparound links to health and other key services.

On a smaller scale, the South Yorkshire ‘Beds for Babies’ programme provides beds and bedding for children aged 5 and under, ensuring all children in the region have a safe space to sleep and helping to build trust in government among hard-to-reach communities.

Alongside this, mayors are well placed to convene local authorities, the NHS, and other partners that have more direct health levers to coordinate action. Introducing a formal health duty – alongside the parallel ‘power to convene’ in the devolution bill – should further empower mayors to embed health considerations more firmly into local decision making.

London has experience in putting a health duty into practice 

London offers a useful example of how a statutory health duty can work in practice – although this is a stronger form of the duty than that now being conferred on other mayoralties. Under the Greater London Authority Act 2007, the mayor of London has a legal obligation to produce a strategy identifying major health inequalities in the capital and setting out how the GLA and boroughs should act to address them. In response, London has taken a broad strategic approach to addressing the drivers of ill health across multiple policy areas such as housing, environment, transport and community safety.

To support this, the GLA Group Public Health Unit was set up in 2022 to embed a Health in All Policies (HiAP) approach systematically. It provides specialist public health advice and works to build understanding and engagement with health inequalities across the GLA group.

The wide scope of the HiAP approach means there are many potential projects, across a wide range of policy areas, that the unit could contribute to, so prioritisation is a crucial task for decision makers. This will be a challenge for other MSAs as they gain the health duty, especially since none will have the scale of resources available to the mayor of London.

Watch DevoLab #1 on health inequalities

Collaboration between mayors and other local leaders is key to success

While mayors can provide strategic leadership, local councils remain responsible for delivering many of the services that influence health outcomes, such as social care, education, and public health programmes – so it is essential that MSAs work closely with them. There are existing examples of good practice to learn from, such as the Beds for Babies programme described above, which used existing council infrastructure and referral routes to engage families in need of support.

The role of mayors and strategic authorities in improving health outcomes is still taking shape. The real test will be whether statutory health obligations can translate to measurable health improvements across mayoral regions. The health duty could be a catalyst for change – but only if mayors make full use of their existing powers, collaborate effectively with local authorities, and other regional partners, and receive the support they need from central government to build capacity in this policy area.