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Feature NHS

The big devolution deal—or no deal?

BMJ 2018; 360 doi: (Published 19 March 2018) Cite this as: BMJ 2018;360:k1217
  1. Richard Vize, freelance journalist
  1. London, UK
  1. richard.vize{at}

Two years on, is Greater Manchester’s gamble on taking control of its £6bn health and social care budget paying off, asks Richard Vize

Two years after Greater Manchester got control of its £6bn (€7bn; $8bn) health and social care budget, the bold experiment in devolving power over health services is starting to make a difference to people’s lives. But its long term success is far from assured.

The five year devolution deal with the government and NHS England for the area’s 2.8 million inhabitants began in April 2016 and has been followed by a similar agreement in Surrey Heartlands (box).

Much of the early work of the Greater Manchester Health and Social Care Partnership— the body that oversees the devolution project—has been hidden from public view. Groundwork includes an immense effort to bind the 37 NHS organisations and local authorities together, and beginning the long journey to shift the staff and leadership culture so that people begin to think of themselves as working for a patient driven system rather than just their own organisation.

The big goals are to make the Greater Manchester health and social care system financially sustainable by 2021 and to improve health indicators such as large numbers of low birthweight babies and high cancer mortality under the age of 75.

Professor Kieran Walshe at the University of Manchester, who is leading research into the development and effect of the devolution programme, says the past two years have seen a big effort to build “a lot of institutional architecture—the provider board, the strategic partnership board, a whole host of groups [covering priorities such as] pathology, pharmacy, and acute service reconfiguration. They have been an important investment in getting lots of people from different organisations around the table and engaged in trying to work collectively.

“That is a …

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