Helping to understand health and social care devolution in Greater Manchester

A map of Manchester City Centre.

By Dr Anna Coleman, Research Fellow

I have recently become part of a research team from across the University of Manchester and beyond, jointly funded by The Health Foundation and NIHR CLAHRC Greater Manchester, to assess and understand health and social care devolution in the Greater Manchester area. The purpose of our research is to support the sharing of ‘devolution learning’ locally, regionally and nationally, with the aim of supporting the local process of devolution as it occurs in ‘real time’ and taking the experiences from Manchester to share with national policymakers and others hoping to implement devolved health and social care in the future.

In February 2015, Greater Manchester (GM) secured a ground-breaking deal with the Treasury to take control of the £6 billion currently spent on health and social care for the 2.8 million population of GM. The health and social care devolution agreement via a Memorandum of Understanding (MOU), commonly described as ‘Devo Manc’, sets out plans for devolving control over health and social care decision-making to a newly established ‘Greater Manchester Strategic Health and Social Care Partnership Board’ and a ‘Joint Commissioning Board’. The latter brings together all the local authorities and clinical commissioning groups (CCGs) of GM. Signatories of the MOU are the Greater Manchester Combined Authority (all the local authorities responsible for social care), CCGs (who plan and purchase health services), NHS England (overseeing CCGs) and providers of acute, community and mental health services in the health/care economy of GM. This is further explained in the Greater Manchester health and social care devolution briefing pack and a previous Manchester Policy blog. I have also been part of a team tasked with contributing to the creation of a series of animations explaining devolution by cities@manchester.

The rationale behind the changes is that those working locally will know and better understand the needs of their local population. It is built on a strong and successful history of joint working across GM where, for example, the Association of Greater Manchester Authorities (AGMA) has overseen the extension to GM public transport, ‘Healthier Together’ brought together NHS partners to make decisions about the rationalisation of GM hospital provision, and there is already an established GM public health network.

This is one of the biggest experiments in recent years involving health budgets and it fits nicely with the development of new ways of working locally set out in the Five Year Forward View (2014). However, the proposals bring both opportunities and challenges and it must be remembered that ‘Devo Manc’ takes place in a context of austerity, unprecedented cuts in local authority budgets and a predicted almost £2 billion GM NHS deficit within the next five years if things don’t change. Opportunities include greater local decision-making and collaboration, integration of services and pooling of budgets, while challenges include complicated new organisational structures, potential loss of identity and autonomy of individual organisations and squeezed budgets, particularly in local authorities.

At the end of September 2015 it was announced that a committee to include representation from 37 local organisations, plus NHS England, will be formed to work on the devolution plans. Representatives will include council leaders, CCGs, NHS providers as well as NHS England. Additionally it is proposed that the Care Quality Commission, emergency services and Public Health England will be present but not be able to vote, although details are still to be finalised. The committee will oversee the GM-wide decision making on issues such as new specialist hospital provision and seven-day GP access. There still remains much uncertainty about how GM devolution will operate and, over the next few months to April 2016, purpose, function and form will be developed through a relatively rapid process of consultation and negotiation. Health and social care devolution is a complex undertaking, given the existing embedded organisational arrangements for commissioning and provision and the statutory roles and functions of a number of local, regional and national bodies.

Our research will take place over a two year period beginning in late autumn 2015 and will explore questions related to three areas:

1)   Mapping plans for improvements in the way services are delivered. The team aims to identify key ‘marker’ initiatives in GM looking to improve services (e.g. some of those associated with the early implementation priorities for devolution) and analyse them. We will look to understand what the initiatives entail, how they plan to meet their goals, and set out how their progress can be measured

2)   Understanding policy development and the policy process. As devolution is implemented in GM the project team will build understanding of how local leaders achieve it, and what they expect from the process

3)   Describing and analysing governance, accountability and organisational forms – understanding how they change as part of devolution, and the costs associated with making changes.

It is widely acknowledged that there is a wealth of important learning and knowledge to be gained from the ‘GM experience’, not only for national policymakers and other areas interested in pursuing similar devolution arrangements, but also for those actively involved in ‘Devo Manc’ itself. There is an opportunity for emerging learning to be fed into the process in ‘real-time’ in order to contribute to optimise further developments. This is why getting out into the field at this early stage of the process when initial decisions are being made is so exciting and important and will hopefully provide a platform for other, more focussed research by us and/or others at a later stage.

Our research team is being co-led by Professor Ruth McDonald and Professor Kieran Walshe from the Alliance Manchester Business School. I (Dr Anna Coleman) am part of the Health Policy, Politics and Organisations Group alongside Professor Kath Checkland, and other team members are drawn from the Manchester Centre for Health Economics (Professor Matt Sutton), the Personal Social Services Research Unit (Professor David Challis), the NIHR CLAHRC Greater Manchester (Katy Rothwell and Professor Ruth Boaden) and the University of Kent (Professor Julien Forder).

Read more about this project.