Devolving health and social care Learning from Greater Manchester

As part of its long-term strategy for the NHS, the Department of Health and Social Care encouraged the development of local devolution deals involving the transfer of formal powers over health and social care from central government to city regions, with Greater Manchester becoming the first devolved region. In April 2016, control of the health and social care budget was transferred to a partnership team comprising local authorities, clinical commissioning groups, NHS foundation trusts and NHS England.

These research projects from the University of Manchester are gathering evidence of the effects of devolution of health and social care. The first phase of research ran from 2015 to 2019 and used data from a range of national administrative and survey datasets to analyse the effects of health care of devolution in Greater Manchester (DevoManc) on: health care utilisation and expenditure; quality and efficiency of health care services; carer and care user quality of life; and the ability of patients to self-manage their conditions.

The research provided initial evidence on the early effects of devolution, and has highlighted the process and procedures undertaken, for example, policy development; governance, accountability and organisational forms; and plans for changes in the way services are delivered.  

Further funding has now been provided by the Health Foundation to continue with the research, building on the findings from the first phase. This second phase will run from 2020 to 2022.

Devolution has the potential to affect all areas of the health care system, and so this continuing research will take a whole-system approach to evaluation, and will extend the existing research to explore and examine:

• the effects of DevoManc on social care, public health and wider public sector outcomes, and patient satisfaction with hospital, community care and social care services
• the impact of DevoManc on inequalities in outcomes by socio-economic status, both between and within geographical areas, and on the variation in outcomes between health care providers
• the longer-term effects of DevoManc, and whether these change over time
• the mechanisms through which DevoManc impacts outcomes, for example changes in workforce and capital inputs, and whether there are differences in the implementation of national interventions
• the determinants of locality-variation in the effects of devolution.

Quantitative analysis will look at a selection of outcomes from national frameworks collected before and after the introduction of DevoManc. These will cover workforce, capital, social care, patient satisfaction, and public health and wider public sector outcomes.

Qualitative research will involve the development of a Greater Manchester intervention map – a matrix which, for each locality, includes information on interventions implemented, population groups targeted, and targeted outcomes. A two-phased approach will involve documentary analysis and a survey of policy leads in each locality.

Both phases of the project have been co-designed with key Greater Manchester stakeholders, and will support their development of the devolution programme. Findings on how devolution is evolving and the barriers and approaches taken in Manchester will also be of use to national policy makers and other areas applying for and implementing devolved health and care.

Contact details

For more information on the second phase of the research, please contact Dr Alexander Turner, Presidential Fellow (Research), University of Manchester. For more information on the first phase of the research, please contact Kieran Walshe, Professor of Health Policy and Management, or Matt Sutton, Chair in Health Economics, at the University of Manchester.