Manchester’s health deal: Is devolution truly beneficial for the region?
Authors: Dalingwater  Louise 
Published: December 2022

The impetus to devolve power to regional health and social care partners is part of a general process towards devolution and decentralisation in the UK. Yet, for over a century or more, centralisation of power has been a key feature of UK regional policy. In 2015, on the eve of health budget devolution to Manchester, only 25% of public expenditure was allocated to local government. The NHS also followed a tradition of central control for much of the 20th century. From 1997 and the devolution process in Scotland, Wales and Northern Ireland, it was expected that transfer of power to the regions would be high on the political agenda, but initial attempts to create directly elected mayors failed to get much support. It was not until 2010 that a consensus emerged across political parties that power should be devolved to local communities on a much grander scale, which led to the Localism Act of 2011, the creation of Local Enterprise Partnerships and 26 City Deals. In 2014, George Osborne announced a major devolution of powers and the development of a ‘Northern Powerhouse’ in an effort to boost economic growth in the North of England. NHS England’s Five Year Forward View report of 2014 underlined the need to decentralise health policy stating that “England is too diverse for a ‘one size fits all’ care model to apply everywhere” (NHS England, 2015). It is within this context that Greater Manchester was chosen to be the first region to run its own health and social care budget. This represents a significant move to improve health outcomes in the Northern region, given that the North West has comparatively poor health outcomes. Initial evaluations of the effectiveness of devolving health budgets to the regions have been rather inconclusive. Doyle and Johnston’s (2016) review of international literature found that there was little evidence to suggest that devolution improved clinical outcomes or health status. As far as England is concerned, while there is much support for the decentralising and democratising process, there is concern that it is still largely driven at national level. Nevertheless, the Health Foundation (2017) has underlined the importance of this move. While it claims this may not bring significant changes to the way in which NHS services are run, it could well have a significant impact on overall health because devolution has also transferred more powers to the region over housing, employment and transport. However, the health deal has not led to an increase in the overall budget. The concern is that while regions may have innovative ideas to improve the health of their citizens, they may not have sufficient funding to implement such changes. This article thus seeks to assess whether six years after devolution of the health budget to Greater Manchester the ambitions to improve outcomes have been achieved. It will do so through analysis of secondary data (academic research, local government literature, publicly available minutes…) and original interviews with health and social care providers and principal stakeholders.