Health and social care devolution: the Greater Manchester experiment

In February 2015, the government announced plans to devolve control of health and social care spending in Greater Manchester to a new strategic partnership board, bringing together 10 local authorities, 12 clinical commissioning groups (CCGs), 15 NHS trusts and foundation trusts, and NHS England.1 The deal, which involves over £6bn (€8bn; $9bn) a year, was done at speed mainly between the Treasury, NHS England, and key local government and NHS leaders, without much public debate or consultation.2 By April new governance arrangements will be in place. Legislation has been passed that gives the government wide ranging powers to transfer health and social care responsibilities, statutory duties, and resources from existing public bodies to other public bodies or authorities.3 In December 2015, a meeting of the newly established Greater Manchester Health and Social Care Strategic Partnership Board approved a single strategic plan for health and social care4 setting out ambitious plans for reform, and a detailed agreement on new governance arrangements.5

The devolution of health and social care builds on a growing devolution movement in England in which central government is agreeing to hand over powers to local government in areas like transport, policing, housing, economic development, and skills training.6 The proposals for Manchester are the most radical and advanced manifestation of the policy to date. We examine the background, policy discourse, intended mechanisms, and implications of health and social care devolution, using the Greater Manchester experiment as our primary focus.