Intended for healthcare professionals


Health and social care devolution: the Greater Manchester experiment

BMJ 2016; 352 doi: (Published 22 March 2016) Cite this as: BMJ 2016;352:i1495
  1. Kieran Walshe, professor of health policy and management1,
  2. Anna Coleman, research fellow2,
  3. Ruth McDonald, professor of health science research and policy1,
  4. Colin Lorne, research fellow1,
  5. Luke Munford, research fellow3
  1. 1Manchester Business School, University of Manchester, Manchester M15 6PB, UK
  2. 2Centre for Primary Care, University of Manchester
  3. 3Centre for Health Economics, University of Manchester
  1. Correspondence to: K Walshe kieran.walshe{at}
  • Accepted 10 March 2016

Although we know that the aims of devolution are to improve health and reduce health inequalities, it is less clear how this will be achieved. Kieran Walshe and colleagues examine how it might work and the likely problems

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.

Devolution: the development of the idea

England is one of the most centralised European states, with public services such as healthcare, education, …

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