Entrepreneurship and the development of Small and Medium-Sized Enterprises (SMEs) are key drivers of economic growth and job creation. The OECD review series on Boosting Local Entrepreneurship and Enterprise Creation, of which this study is a part, examines the capacity of local economies to support successful new enterprise creation and the growth of small enterprises and make recommendations on how this capacity can be enhanced through local policies. The reviews entail an assessment of entrepreneurship and SME performance at the local level, the local framework conditions affecting this performance and the policies in place to back entrepreneurship and SME development. The reviews involve a comprehensive examination of conditions and policies including the key domains of skills, financing, business support infrastructure and innovation. In the case of Lombardy, the economically most powerful region of Italy, the review includes a specific assessment of local entrepreneurship policies against the framework of the European Union’s Small Business Act (SBA). The SBA prioritises the role of business-friendly regulations for the creation of new start-ups and the development of existing small enterprises. SMEs and their clusters constitute the backbone of Lombardy economical structure. In such a context and given the impact of the persisting current financial and economic downturn, supporting the development of innovative SME and their networks is a priority for addressing the recovery challenge.