Decentralisation reforms in France have helped to reshape relations between the State and cities. While many researchers maintain that cities have capitalised on this new climate to assert their power, others offer a more nuanced view of these changes, highlighting that the ability of cities to establish themselves as a relevant and autonomous level of political regulation has yet to be affirmed. The aim of this article is to contribute to this debate by offering an analysis of local health-care governance, the foundations of which have been called into question in France by the adoption of a series of reforms. The provisions of these reforms, which have been driven by the ministries of Health, Urban Affairs and Decentralisation, and Civil Service have changed the institutional, partnership and financial framework, and, in doing so, have raised many questions. Although this uncertain climate is by no means new, it invites us to put into perspective the ability of cities to deploy their own strategies in an area of the public sector that has traditionally been marked by the pervasive influence of the State. For several years, the policies implemented by the city of Bordeaux in France have demonstrated a certain voluntarism and therefore offer fertile ground for analysing the process of change that is underway.