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Since the 19th century structures of local government in Britain have been progressively reformed to address the representative, economic, social and physical needs of urban areas. In the 1970s Metropolitan County Councils were introduced in the largest English conurbations but these were abolished in the 1980s. The 1990s and 2000s were marked by the emergence of economic development and spatial planning structures at a supra-urban regional scale. From the mid-2000s onwards, however, the city-region again rose to prominence and since 2010 new structures called Combined Authorities have emerged at the city-regional scale in a number of large conurbations. City-regions have also been linked to state initiatives designed to address regional development disparities notably the so-called Northern Powerhouse. This paper reviews the history of city and regional development in England and considers the current wave of city-regional institutions and initiatives.