This article examines the relationship between central and local government - and specifically the County Boroughs - in interwar England and Wales with respect to the provision of municipal health services. It is argued that this relationship was complex, with different local authorities being compliant to a greater or lesser degree with the aspirations of the Ministry of Health. The latter, it is further suggested, started off its life as a relatively dynamic, well-run and farsighted part of central government, but for a range of reasons lost authority and influence as the interwar era progressed. This was not helped by the limited powers the Ministry held. The local authorities, meanwhile, differed widely in their aspirations for municipally-provided health care. Some were reluctant to do much, others had ambitions somewhat in advance of those of the Ministry of Health. What did unite local authorities was their collective desire to preserve the longstanding tradition of a high degree of local independence. As is also shown, specifically local factors and personnel - for example the political dynamics of the council or the standing of the Medical Officer of Health - could significantly shape a County Borough's approach to health care. The article thus contributes to the history of English and Welsh local government and, especially, to the relatively neglected period in the history of the health services which falls between the demise of the Poor Law and the coming of the National Health Service.