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Study shows positive impact of devolution on health and care services

Devolution deals which granted Greater Manchester increased control over a range of public services enabled them to make significant improvements in many parts of the health system.

Devolution deals which granted Greater Manchester increased control over a range of public services enabled them to make significant improvements in many parts of the health system, according to results of a new study.

The study, published in Social Science & Medicine, found the devolution was associated with improved population health, driven by improvements in health services and wider social determinants of health.

The changes occurred despite limited devolved powers over health service resources suggesting that other mechanisms played an important role, including the allocation of transformation funding and the alignment of decision-making across health, social care, and wider public services in the region.

Funded by The Health Foundation and supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM), the study evaluated changes between 2016 and 2020 compared to the rest of England.

It found that there were 11.1% fewer alcohol related hospital admissions, 11.6% fewer first-time offenders, 14.4% fewer hospital admissions for violence, and 3.1% fewer half school days missed from 2016 to 2020.

Same day GP appointments increased by 1.8% and unplanned A&E re-attendances were 2.7% lower, in line with increases in the GP and hospital workforce. Cancer screening rates also improved. Adult social care effectiveness and overall satisfaction also improved by 17.6%, despite decreases in expenditure and staff.

However, adult obesity increased by 7.6% and median wait times for A&E treatment worsened by 12.2%. There were also mixed impacts of devolution on outpatient, mental health, maternity, and dental services.

Lead author Dr Philip Britteon from The University of Manchester said: “This study provides new evidence on the impact of devolution on health and care services, focusing on a large set of performance measures. Our findings suggest that devolution in Greater Manchester was associated with broad improvements in health services, social determinants of health, and subsequently, health outcomes.”

Devolution is complex so hard to know what aspects have helped

The researchers argue that the positive changes are likely to have been a result of different aspects of the Greater Manchester devolution deals. These include the transfer of control over transformation funding for improving services to the Greater Manchester Health and Social Care Partnership, the development of collaborative relationships between the NHS agencies and local governments represented on the Greater Manchester Health and Social Care Partnership Board, or the impact of wider devolved public services.

The negative changes on other indicators, they add, are likely to be a result of difficulties local decision-makers had in re-prioritising how they used their resources given their limited powers to raise additional revenue through taxation or other means.

Adam Briggs, Senior Policy Fellow at the Health Foundation, however said that devolution is complex and, as the researchers point out, it’s hard to know what aspects of the approach taken in Greater Manchester have helped – untangling causation from correlation is very difficult.

He added: “The past decade was incredibly challenging for health and social care services across England, so it is very positive that this research finds that life expectancy in Greater Manchester has been heading in the right direction.

“Ultimately, much of what makes us healthy sits outside of health care services and is instead driven by the building blocks of good health – such as secure housing, good work and education. As public finances get increasingly stretched, closer partnership working between the NHS, local government and communities is needed now more than ever, whether that’s a result of devolution or any other form of local collaboration.”

Health leaders say study provides encouragement

The NHS Confederation said that Greater Manchester’s focus on partnerships, integration and joined up long term thinking will offer encouragement to health leaders that a new way of whole system, whole public sector thinking can offer hope to a healthcare system under huge pressure. It is also in stark contrast to some of the current focus on short term targets and is in line with the five- and 10-year strategies that many NHS leaders would like to be following.

Chief executive Matthew Taylor said: “Our members will welcome the study’s findings that there was a drop in alcohol related hospital admissions, first time offenders, hospital admissions for violence and half school days missed. The increase in same-day GP appointments, drop in unplanned A&E attendances and improvement in cancer screening rates is all very promising.

“It is clearly not a silver bullet, with performance across some metrics deteriorating over the time period. However, there is hope in this study that by moving investment into preventative activity, and in working together across all parts of the public, private and voluntary sectors, there are opportunities to improve the health of our communities.”

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