The impact of devolution in Greater Manchester on the local health system
What were we trying to do?
We set out to evaluate whether the devolution of health and wider public service powers to Greater Manchester had a measurable impact on population health and the local health system.
Why was this important?
Greater Manchester was the first region in England to receive devolved control over its health and care budget in 2016.
This shift aimed to improve health outcomes through more locally coordinated decision-making and service delivery. But until recently, there was limited evidence on whether these changes made a difference to people’s health or healthcare services.
How did we do it?
We analysed the impact of devolution using advanced policy evaluation methods, comparing trends in Greater Manchester with similar areas elsewhere in England.
In two major studies, we looked first at changes in life expectancy, then assessed 99 measures across the whole health system – including services, outcomes, and wider social determinants of health.
We worked closely with partners in the Greater Manchester Integrated Care System (GM ICS) to shape and interpret the research.
Findings
Impact on population health
Devolution in Greater Manchester was linked to a modest but meaningful increase in life expectancy, especially in areas with the greatest deprivation and poorest baseline health.
This improvement stood out at a time when many other parts of England saw life expectancy stall or decline, which suggests that the changes introduced in Greater Manchester helped protect local health outcomes during a challenging period nationally.
Impact on whole health system.
Our more detailed follow-up study looked at nearly 100 measures across the whole health system. It found improvements in areas such as:
- primary care access
- public health
- hospital performance
- wider social factors like employment and early years development.
However, the impact of devolution was not seen across all areas. Some parts of the system showed little or no improvement, including:
- outpatient care
- maternity
- dental services
- mental health support.
Rates of adult obesity increased in Greater Manchester in line with national trends.
Interpretation of findings
The varying results reflect the limitations of the health and social care devolution deal itself. Although Greater Manchester gained greater responsibility for planning and partnership working, it did not receive full control over NHS budgets or statutory powers. As a result, local leaders could influence but not directly manage all aspects of service delivery.
It is therefore likely that the observed improvements were due to other factors. Possible mechanisms include:
- local collaboration across health, care, and wider public services
- the use of flexible transformation funding to support locally agreed priorities
- the wider devolution of other public services.
These appear to have enabled progress despite limited formal powers over NHS budgets and service delivery.
Resources
- Publications
- Britteon P, Fatimah A, Gillibrand S, Lau Y-S, Anselmi L, Wilson P, Sutton M, Turner AJ. (2024) The impact of devolution on local health systems: Evidence from Greater Manchester, England. Social Science and Medicine
- Britteon P, Fatimah A, Lau Y-S, Anselmi L, Turner AJ, Gillibrand S, Wilson P, Checkland K, Sutton M. (2022) The effect of devolution on health: a generalised synthetic control analysis of Greater Manchester, England. The Lancet Public Health
- Blogs
Who did we work with?
This work was led by the Health Organisation, Policy and Economics (HOPE) group at The University of Manchester.
We collaborated closely with NHS Greater Manchester Integrated Care and the Greater Manchester Combined Authority throughout.
Funding information
This research was funded by The Health Foundation.
More information
Senior Programme Lead
Mike Spence
Michael.spence@manchester.ac.uk