Devo Manc led to significant improvements across health system

The devolution deals which granted Greater Manchester increased control over a range of public services enabled them to make significant improvements in many parts of the health system, a unique study led by University of Manchester researchers has shown.

The study, which evaluated changes in Greater Manchester from 2016 to 2020 compared to the rest of England, is published in the journal Social Science & Medicine today(25/03/24).

It 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.

It was funded by The Health Foundation and supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM).

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.

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
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."

Co-author Professor Matt Sutton from The University of Manchester and Deputy Director of the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM) said: "These improvements were achieved despite limited formal devolved authority and control over health and care resources, suggesting that other features of the health and wider devolution deals played an important role.

"However, improvements were not universal. Restricted formal powers are likely to have made it harder to fully reprioritise resources."

Co-author Dr Yiu-Shing Lau from The University of Manchester said: "Unlike what we have seen in other devolved places, enhancements were observed in Greater Manchester even with limited health and social care powers, and without the ability to significantly raise revenue through taxes.

"The success of future devolution initiatives to improve population health might depend less on the devolution of formal powers, and more on alignment and collaboration between health and other public services within the region."

Adam Briggs, Senior Policy Fellow at the Health Foundation, said: "The past decade was incredibly challenging for health and social care services across England, so it is very positive that this research finds that life expectancy in Greater Manchester has been heading in the right direction. But devolution is complex and, as the researchers point out, it’s hard to know what aspects of the approach taken in Greater Manchester have helped - untangling causation from correlation is very difficult.

"Ultimately, much of what makes us healthy sits outside of health care 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."

Chair of NHS Greater Manchester Integrated Care Board, Sir Richard Leese said: "This latest research reinforces what we know, that working together in partnership, locally has better outcomes and supports people to live healthier and happier lives.

"It’s encouraging that our approach has seen increases to healthy life expectancy and better access in some services. However, we recognise where we haven’t seen improvements or the change we hoped for, including against the national average. We’re continuing to work together as a system to improve health and care for everyone. Our commitment to partnership working will give us the best chance of success and tackling health inequalities."

Chair of Greater Manchester Integrated Care Board, City Mayor Paul Dennett said: "Devolution, in health and care and other areas, has given us the ability to unlock health benefits for our Greater Manchester communities by working together to deliver good housing, good jobs and more. The power, potential and importance of locally driven integration and collaboration is clear from this report. We must maintain this."

The paper "The Impact of Devolution on Local Health Systems: Evidence from Greater Manchester, England" is available here (link to come)