The core assertion is accurate: local integrated care boards are the primary decision-makers for NHS service reconfiguration. The Secretary of State's call-in power is an exceptional intervention mechanism, not the normal decision-making route, and government guidance explicitly confirms that ICBs lead these decisions and most reconfigurations are managed locally. The Health and Care Act 2022 established integrated care boards (ICBs) as the statutory bodies responsible for arranging the provision of NHS services in England. Under this framework, ICBs are the primary local commissioning bodies that lead decisions on service reconfiguration. The government's own statutory guidance on "Reconfiguring NHS services - ministerial intervention powers" (published on GOV.UK) explicitly states: - "NHS commissioning bodies lead decisions relating to substantial changes in the reconfiguration of NHS services." - "Most reconfigurations will continue to be managed at a local level and will not require ministerial intervention. Local organisations are best placed to manage challenges related to NHS reconfiguration." - The guidance is specifically directed at "NHS commissioning bodies (integrated care boards (ICBs) and NHS England)." There is, however, an important nuance: the Secretary of State retains a call-in power (introduced by the Health and Care Act 2022, inserting Schedule 10A into the NHS Act 2006) to intervene in NHS service reconfigurations at any stage. This means that while ICBs are the default local decision-makers, the Secretary of State can in exceptional circumstances take over or override an ICB's decision on a reconfiguration. Local authorities can also escalate concerns via Health Overview and Scrutiny Committees (HOSCs), and NHS England has a role in assuring substantial service changes before public consultation. That said, the government's guidance explicitly frames the default position as local ICB decision-making, with ministerial intervention expected only "in exceptional situations where local resolution has not been reached." The existence of an exceptional override power does not materially undermine the core claim that reorganisation of services is primarily a matter for local ICBs. Sources: - Health and Care Act 2022, legislation.gov.uk — https://www.legislation.gov.uk/ukpga/2022/31/part/1/crossheading/integrated-care-boards-functions/enacted - "Reconfiguring NHS services - ministerial intervention powers," GOV.UK — https://www.gov.uk/government/publications/reconfiguring-nhs-services-ministerial-intervention-powers/reconfiguring-nhs-services-ministerial-intervention-powers - "IRP advice - Humber Acute Services (accessible version)," GOV.UK — https://www.gov.uk/government/publications/humber-acute-services-irp-advice-to-the-secretary-of-state/irp-advice-humber-acute-services-accessible-version