Health and social care devolution: what can we learn from Greater Manchester?
A blog by Kieran Walshe, Professor of Health Policy and Management at the University of Manchester, and a CLAHRC Greater Manchester academic lead
It is now almost a year since the formal devolution of the £6 billion budget for health and social care commissioning to the Greater Manchester Health and Social Care Partnership (GMHSCP) – a coalition of 37 NHS organisations and local authorities – in April 2016. So what has happened?
Our research team, supported by the Health Foundation and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) for Greater Manchester, has been following the progress of health and social care devolution since October 2015, when the new devolved arrangements were still being planned. We’ve been given access to meetings and documents and been able to interview key individuals. A briefing on our findings so far has just been published.
From the outset, expectations of devolution have been high. GMHSCP set out an ambitious vision in its strategic plan, meaningfully titled Taking Charge. First, it articulated a new way of making decisions and governing the health and social care system. Second, it outlined four ‘transformation themes’:
- population wellbeing and health promotion
- improved community based care and support
- standardising acute and specialist care
- reorganising clinical support and back office services.
It is the first point which marks out Greater Manchester as different. The transformation themes reflect the NHS England Five Year Forward View and in effect, the Greater Manchester Sustainability and Transformation Plan (STP) have much in common with the other 43 STPs in England. (GMHSCP might suggest though that they are being more ambitious about the scale and pace of change than other STPs.)
But much effort has gone into the new arrangements for making decisions. Without any new statutory powers or bodies, GMHSCP has secured agreement from all 37 organisations to create a new Strategic Partnership Board – in what we’ve described as a ‘managed consensus’. It has made it harder for any organisation to defect from a jointly reached decision, and although the new arrangements look complex, they provide a way of building important networks and relationships. Nothing has yet been done to change organisational structures or accountabilities, though it is notable that shared leadership arrangements among clinical commissioning groups (CCG), and across CCGs and local authorities are evolving. The level of collaboration, and particularly of local government engagement, does seem to put Greater Manchester ahead of other STP areas.
Arguably, these new arrangements have yet to be really tested: in dealing with issues on which there are strongly held and divergent views; where there are acute political and geographic sensitivities; or where changes pose threats to organisational or professional interests. This cannot be far off though with the creation of new ‘Local Care Organisations’ in the ten localities of Greater Manchester moving forward, and changes to acute and specialist care for the Salford, Pennine, Central Manchester and South Manchester NHS trusts taking shape.
All this is happening in the most challenging financial context in the recent history of the NHS and local government. Whether that makes it more possible to pursue change – because the status quo is not an option – or means that leaders are consumed with dealing with crises and can’t make time or space for strategic change, remains to be seen.
The real test of health and social care devolution is whether it makes a positive contribution to services provided, and to health outcomes for the local population. The GMHSCP has set out a series of quantitative targets, including outcome measures linked to its ‘Start Well, Live Well, Age Well’ philosophy. Over the next few years, we will be tracking those measures and comparing Greater Manchester to other areas of England to see if devolution has really made a difference that matters.
This blog is also published on the Health Foundation website.