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PhD Study: Mapping the flow of funding for the Greater Manchester health and care system

What did we do?

We described the flow of funding for Greater Manchester health and care system: with a particular focus on understanding how funds enter the system and how these funds are subsequently spent.

We did this by quantifying the funding allocated by the central government to the ten local authorities and ten Clinical Commissioning Groups (CCGs) in Greater Manchester (which since the 1st July 2022 have been subsumed into Greater Manchester Integrated Care Partnership), and the funds raised by local authorities through local taxes and looking at how the money is then spent by the local authorities and CCGs on different health care, social care, and public health services and providers.



Why was it important?
For several years there has been movement towards systems of integrated health and social care, and local health systems, with this culminating into the creation on Integrated Care Systems from the 1st of July 2022.


Integrated Care Systems are partnerships of local/regional organisations that come together to plan and deliver joined up health and care services, and to improve the lives of people who live and work in their area. As a starting point for considering how GM may take advantage of these changes, particularly how resources allocated to Greater Machester as an Integreated Care System may be redistributed within the region, it was useful to consider the volume of funding available and how it flowed through the health and care system.

As far as we are aware there is no mapping of the flow of funding for the whole health and care system for any area in England. Data on health and care funding for CCGs and Local Authorities are publicly available, but information on how these resources are spent is not currently available in an organised format, hindering comparisons and analysis. 



How did we do it?

  • We analysed how financial flows changed in GM during the four years post-devolution (2016/17 to 2019/20), and whether spending was aligned with local ambitions to move towards prevention of ill-health and integration of health and social care.
  • We adaptated the System of Health Accounts (SHA) framework to map the flow of public health and care funding within local systems, with an application for Greater Manchester.
  • We quantified the income and expenditure for all of GM together, and compared the 10 localities and changes over time.
  • We drew conclusions on the potential for pooling resources across localities and across functions and feasibility of options for allocations across different levels of commissioning and service provision.  



We found that:

  • Mapping financial flows at a local level is a useful exercise to examine whether spending is aligned with system goals and highlight areas for further investigation.
  • Greater Manchester decreased spending on public health by 15%, and increased spending on general practice by 0.1% in real terms.
  • The share of total Greater Manchester expenditure paid to NHS Trusts for general and acute services increased from 70.3% to 71.6%, while that for community services decreased from 11.7% to 10.3%.
  • The results suggest that Greater Manchester may have experienced challenges in redirecting resources towards their goals.



Who did we work work with:


Downloadable resources:



More information:


Senior Programme Lead


Mike Spence


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