Confusion about the role of regional quangos and meddling from Whitehall have held back Birmingham, a major new Government study has warned.
Civic and business leaders are uncertain how the region's system of government is supposed to work, the investigation said.
The warning was issued in a report called the State of the English Cities, launched by David Miliband, the Government Minister responsible for local government.
Ministers are preparing to publish plans for the reform of local government, which may include abolishing district councils and creating elected mayors in cities such as Birmingham.
But Conservatives said the study had exposed the failings of the Government's "top down" approach to local government.
Caroline Spelman (Con Meriden) accused Ministers of creating "too many disjointed initiatives and conflicting regional quangos".
The report was produced by Prof Michael Parkinson, from Liverpool John Moores University, who interviewed political and business leaders in 12 major cities.
In a section dealing with the West Midlands, he said the creation of bodies to allow more decisions to be taken locally had been welcomed.
These include the West Midlands Regional Assembly, Advantage West Midlands and the Government Office for the West Midlands.
However, there was uncertainty about how the quangos were supposed to work with each other and with local councils, he said.
"Many felt that the relationship between the different tiers of regional governance and the role of local government within it should be clarified," the report said.
There was concern that relationships between regional bodies and local councils "could be improved", he added.
And there was also concern that "the proliferation of detailed targets" imposed on local bodies by Whitehall was unhelpful.
The complaints were echoed in a section of the report dealing with the national picture.
Prof Parkinson warned: "Organisational arrangements have become ever more complex.
"Questions remain about the local accountability of many regional institutions."
Mr Miliband said there had been "remarkable progress" in England's cities over the past 10 to 15 years.
He said: "British cities have the best opportunity for 100 years to recreate that sense of leadership that was present in the 19th century."
He added: "But it doesn't hide the fact that, if we want to get into the European Champions League of cities, we have got further to go."