The devolution of power in Manchester has led to improvements in health services and patient outcomes, according to new research.
A series of devolution deals between the Government and Greater Manchester combined authority were made from 2014 onwards, transferring powers to the local authority. This included control of the region’s £6bn health and social care budget in 2015.
The research, published in the journal Social Science & Medicine, evaluated changes in Greater Manchester from 2016 to 2020, compared to the rest of England.
It found that same-day GP appointments increased by 1.8% while unplanned A&E re-attendances were 2.7% lower over the period. Researchers said this was in line with increases in both GP and hospital workforce.
Despite decreases in staff and expenditure, adult social care effectiveness and satisfaction was also up by 17.6%.
Life expectancy and healthy life expectancy ‘increased more in GM than in the estimated synthetic control group following devolution,’ the paper said.
‘These increases were driven by improvements in public health, primary care, hospital, and adult social care services as well as factors associated with social determinants of health, including a reduction in alcohol-related admissions. In contrast, the impact on outpatient, mental health, maternity, and dental services was mixed.’
The researchers said the positive changes were likely due to several aspects of the devolution deals, including the handover of control of transformation funding for improving services to the Greater Manchester Health and Social Care Partnership.
They also suggested the development of collaborative relationships between NHS agencies and local governments represented on the Greater Manchester Health and Social Care Partnership Board had played a role.
However, the research, which was funded by The Health Foundation and supported by the National Institute for Health and Care Research, also found that adult obesity went up by 7.6% during the period and median wait times in A&E increased by 12.2%.
It suggested these negative changes might have been a result of difficulties in re-prioritising how they used their resources due to limited powers to raise additional revenue.
The researchers said the findings had ‘important implications’ for the design of future policy, and particularly the organisation of ICSs.
They claimed that ICSs could have a greater impact than the Manchester partnership because they are a legal entity who can receive funds and hold contracts.
However, it noted that there were differences between the two, such as in the lack of representation of local authorities on ICBs, which may mean that improvements in population health ‘may not be replicated in ICSs without a significant regional contribution from local government’.
They also recognised that wider public services have not been devolved to the same extent as Manchester in other regions of England and will not have the same history of collaboration across health, social care and other public services, which also could limit the impact of ICSs.
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.’
NHS Greater Manchester ICB chair 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.’
However, Adam Briggs, senior policy fellow at the Health Foundation, added that it was hard to know what particular aspects of devolution had contributed to the improvements.
He 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.’
A version of this article was first published by Pulse’s sister title Healthcare Leader
