Devolved powers for Greater Manchester led to some health improvements, study shows

The deal that granted Greater Manchester more control over a range of public services—known as Devo Manc—has led to some improvements in health services, social determinants of health, and health outcomes, an analysis has found.1

There were improvements in life expectancy and life satisfaction and fewer alcohol related hospital admissions, but also increases in adult obesity and higher waiting times for treatment in emergency departments.

Experts say that the devolution picture is complex and it is difficult to ascertain which aspects of the approach taken in Greater Manchester have helped.

The study, funded by the Health Foundation and supported by the National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, analysed 98 measures of performance.

Between 2016 and 2020 life expectancy increased by 0.233 years, or about 12 weeks, in Greater Manchester compared with a control group. Healthy life expectancy also increased by 0.603 years. Improvements in life expectancy were larger in areas with high levels of deprivation, found the study published in Social Science & Medicine.

There were 11.1% fewer alcohol related hospital admissions and 14.4% fewer hospital admissions for violence in Greater Manchester compared with the control group. Other measures associated with social determinants of health improved, including 11.6% fewer first time offenders and 3.1% fewer half school days missed between 2016 and 2020.

Same day GP appointments increased by 1.8% and unplanned emergency department re-attendances were 27% lower, the study found. Cancer screening rates also increased towards the national average, despite limited changes in public health spending.

Measures of social care effectiveness improved, including the proportion of people still at home 91 days after discharge from hospital into rehabilitation services. Overall satisfaction with social care services also improved by 17.6% despite decreases in expenditure and staff.

The analysis found, however, that adult obesity increased by 7.6% and median wait times for emergency department treatment worsened by 12.2%. The impact on outpatient, mental health, maternity, and dental services was also mixed.

In 2016 Greater Manchester was granted partial control of its £6bn health and social care budget for the 2.8 million people in the city region.23 The Greater Manchester Health and Social Care Partnership was established to set strategy and develop a joined up approach to improving population health across health, social care, and other devolved public services, including housing. The partnership was often viewed as a prototype of integrated care systems, rolled out nationally in 2022, although there are differences in how they are organised.

Lead study author Philip Britteon from the University of Manchester said, “Our findings suggest that devolution in Greater Manchester was associated with broad improvements in health services, social determinants of health, and, subsequently, health outcomes.”

But the study authors pointed out that the improvements were achieved despite limited formal devolved authority and control over health and care resources and few opportunities to raise additional revenue.

Adam Briggs, senior policy fellow at the Health Foundation, said, “Places are complex and so is devolution. It’s hard to know what aspects of the approach taken in Greater Manchester have helped—untangling causation from correlation is difficult.

“Ultimately, much of what makes us healthy sits outside of healthcare services and is instead driven by the building blocks of good health—such as secure housing, good work, and education. As public finances get increasingly stretched, closer partnership working between the NHS, local government, and communities is needed now more than ever, whether that’s a result of devolution or any other form of local collaboration.”

Matthew Taylor, chief executive of the NHS Confederation, said that Greater Manchester’s focus on partnerships and long term thinking can offer hope to a healthcare system under huge pressure. “It is also in stark contrast to some of the current focus on short term targets and is in line with the five and 10 year strategies that many NHS leaders would like to be following.”

He added, “It is clearly not a silver bullet, with performance across some metrics deteriorating over the time period. However, there is hope that by moving investment into preventative activity, and in working together across all parts of the public, private, and voluntary sectors, there are opportunities to improve the health of our communities.”