There is a wealth of important knowledge to be gained from the devolution of health and social care services across Manchester, says Dr Anna Coleman.
Whether national policymakers, other regions interested in pursuing similar devolution arrangements, or those actively involved in Devo Manc itself, there are a lot of people taking a very close interest in the great devolution experiment across Manchester. That goes for academics too, and I recently became part of a research team set up to assess and understand health and social care devolution in Greater Manchester. The purpose of our research is to support the sharing of devolution learning locally, regionally and nationally, with the aim of supporting the local process of devolution as it occurs in ‘real time’. We also want to take the experiences from Manchester to share with national policymakers and others hoping to implement devolved health and social care in the future.
So what exactly is Devo Manc? In February this year Greater Manchester secured a ground-breaking deal with the Treasury to take control of the £6bn currently spent on health and social care for its 2.8 million population. The agreement devolves control over health and social care decision-making to the newly established Greater Manchester Strategic Health and Social Care Partnership Board and a Joint Commissioning Board. The latter brings together all the local authorities and clinical commissioning groups (CCGs) of Greater Manchester. Signatories of the devolution agreement include the Greater Manchester Combined Authority (all the local authorities responsible for social care), CCGs (who plan and purchase health services), NHS England (which oversees CCGs) and providers of acute, community and mental health services in the health and care economy of Greater Manchester.
The rationale behind the changes is that those working locally will know and better understand the needs of their local population, and is built on a strong and successful history of joint working across Greater Manchester. For example: the Association of Greater Manchester Authorities (AGMA) has overseen the extension to Manchester public transport; ‘Healthier Together’ brought together NHS partners to make decisions about the rationalisation of GM hospital provision; and there is already an established Greater Manchester public health network.
Our research will explore questions related to three key areas. Firstly, we will be mapping plans for improvements in the way services are delivered. The team aims to identify key ‘marker’ initiatives in Greater Manchester looking to improve services (e.g. some of those associated with the early implementation priorities for devolution) and analyse them. We will look to understand what the initiatives entail, how they plan to meet their goals, and set out how their progress can be measured. Secondly, we want to understand policy development and the policy process. As devolution is implemented in Manchester the project team will build understanding of how local leaders achieve it, and what they expect from the process. Finally, we will be describing and analysing governance, accountability and organisational forms, and understanding how they change as part of devolution, and the costs associated with making changes.
The proposals bring opportunities and challenges in equal measure. Perhaps the biggest challenge is that Devo Manc takes place in the context of austerity and unprecedented cuts in local authority budgets and a predicted almost £2bn Greater Manchester NHS deficit within the next five years. As well as squeezed budgets, challenges also include complicated new organisational structures, and the potential loss of identity and autonomy of individual organisations. However opportunities include greater local decision-making and collaboration, the integration of services, and the pooling of budgets.
The fact that this is very much an experiment was further confirmed in September when it was announced that a committee was being formed to oversee decision-making on issues such as new specialist hospital provision and seven-day GP access. Representatives from local authorities, CCGs and NHS providers as well as NHS England will be on the committee while it is proposed that the Care Quality Commission, the emergency services and Public Health England will also be present but not able to vote.
This shows that there remains much uncertainty about how Devo Manc will operate on the ground, and over the next few months there will be further consultation and negotiation. Health and social care devolution is a complex undertaking, given the existing embedded organisational arrangements for commissioning and provision, and because of the statutory roles and functions of a number of local, regional and national bodies.
As such, there is an opportunity for emerging learning to be fed into the process in ‘real-time’ in order to contribute to these developments. This is why getting out into the field at this early stage of the process when initial decisions are being made is so exciting and important and will hopefully provide a platform for other, more focussed research by us and/or others at a later stage.