The impact of devolution on local health systems: Evidence from Greater Manchester, England (May 2024)

Summary

Devolution and decentralisation policies involving health and other government sectors have been promoted with a view to improve efficiency and equity in local service provision. Evaluations of these reforms have focused on specific health or care measures, but little is known about their full impact on local health systems. This study evaluated the impact of devolution in Greater Manchester (England) on multiple outcomes using a whole system approach.

Content

The study evaluated changes in Greater Manchester from 2016 to 2020 compared to the rest of England and builds on previous evidence by investigating how changes in the health system may have led to increases in life expectancy in Greater Manchester over this period, analysing 98 measures of performance.

According to the study, there were 11.1% fewer alcohol related hospital admissions, 11.6% fewer first time offenders, 14.4% fewer hospital admissions for violence, and 3.1% fewer half school days missed from 2016 to 2020.

Same day GP appointments increased by 1.8% and unplanned A&E re-attendances were 2.7% lower, in line with increases in the GP and hospital workforce. Cancer screening rates also improved.

Adult social care effectiveness and overall satisfaction also improved by 17.6%, despite decreases in expenditure and staff.

However, adult obesity increased by 7.6% and median wait times for A&E treatment worsened by 12.2%. There were also mixed impacts of devolution on outpatient, mental health, maternity, and dental services.

The positive changes, argue the researchers, are likely to have been a result of different aspects of the Greater Manchester devolution deals.

These include the transfer of control over transformation funding for improving services to the Greater Manchester Health and Social Care Partnership, the development of collaborative relationships between the NHS agencies and local governments represented on the Greater Manchester Health and Social Care Partnership Board, or the impact of wider devolved public services.

The negative changes on other indicators, they add, are likely to be a result of difficulties local decision-makers had in re-prioritising how they used their resources given their limited powers to raise additional revenue through taxation or other means.

Lead author Dr Philip Britteon from The University of Manchester said: “This study provides new evidence on the impact of devolution on health and care services , focusing on a large set of performance measures.

“Our findings suggest that devolution in Greater Manchester was associated with broad improvements in health services, social determinants of health, and subsequently, health outcomes.”