Study on impact of devolution on health in Manchester supports collaborative working

A new academic paper has been published showing that life expectancy in Greater Manchester has risen between 2016-2019 when compared to other regions.  

The paper, entitled ‘The effect of devolution on health: a generalised synthetic control analysis of Greater Manchester, England’ was published in the Lancet Public Health. It set out to evaluate the impact of devolution on health services and wider determinants of health in Manchester.

In 2015, a plan entitled ‘Taking Charge of Health and Social Care in Greater Manchester’ was published which set out the ambition for the city-region to support people to improve health and wellbeing and lead longer, healthier, happier lives. Greater Manchester was given its share of national transformation funding (£450 million) up front by NHS England in order to drive change, including setting up integrated neighbourhood teams in ten areas of the region to join up ways of working.

The new study, undertaken by the University of Manchester, used local district-level data collected between January 2006 and December 2019 to estimate the effect of devolution on the whole population, stratifying by sex, district, income deprivation and baseline life expectancy, relative to a control group from the rest of England (excluding London).

The research shows that life expectancy in Greater Manchester rose faster than the comparable areas in this time period. Gains of 0.2 years were seen in eight out of ten local areas, higher than expected in comparison to trends seen before the devolution agreement came about. The rise was larger in areas with low income and higher for males.

Improvements are believed to be partially due to the “opportunities of wider partnerships and closer system working across the public and voluntary sector.”

The paper notes how the study’s findings have important implications for future policy designs by providing early evidence on the potential success or failure of ICS models. It adds that the Greater Manchester model has often been considered “prototype” for the ICS approach, though it acknowledges key differences such as the representation of local authorities on integrated care boards.

One key difference is the representation of local authorities on integrated care boards, with the findings of the study suggesting that Greater Manchester local authorities might have collaborated to tackle wider determinants of health. The paper says: “Similar improvements in population health might therefore not be replicated in integrated care systems without a greater regional representation of councils on integrated care boards.”

The paper also discusses how the findings have implications for population health in different settings, noting that improvements in Greater Manchester were observed despite the “soft transfer” of heath and social care powers to the region. “The success of future devolution reforms might therefore depend on other factors beyond the types and strength of powers developed to a health system,” it states, “including the extent to which health and wider public services are aligned within a region.”

Sir Richard Leese, Chair of the NHS Greater Manchester Integrated Care Board and former leader of Manchester City Council, commented: “We are delighted that our work in Greater Manchester in improving people’s health has been recognised; and that the value we place on our relationships and strong system working has been acknowledged.

“This paper recognises that success in the NHS is dependent on greater collaboration with partners such as local government, the voluntary sector and citizens.

“Our ten local areas started at different points so it is expected that progress will be made at different rates, and we are encouraged that our approach bringing together health and other public services is having a positive impact. We will continue to invest in and grow our population health approach, working with local areas to do so. The COVID-19 pandemic had a huge impact on the poorest in our society and work to turn the tide on inequalities is more important than ever.”

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