The impact of devolution on local health systems

Evidence from Greater Manchester, England

Bibliographic Data

ID4596716
AuthorsPhilip Britteon (0000-0002-7766-0336, University of Manchester, corresponding author), Alfariany Fatimah (0000-0001-7164-5170, University of Manchester), Stephanie Gillibrand (0000-0003-1007-8824, University of Manchester), Yiu-Shing Lau (0000-0002-3915-4168, University of Manchester), Laura Anselmi (0000-0002-2499-7656, University of Manchester), Paul Wilson (0000-0002-2657-5780, University of Manchester), Madeline Sutton (0000-0002-6635-2127, University of Manchester), A Turner (0000-0003-4139-941X, University of Manchester), Alex J Turner
Year2024
Volume348
Pages116801
Publication date2024-05-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueSocial Science & Medicine (JOURNAL)
Journal identifiersISSN: 0277-9536 • E-ISSN: 1873-5347
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2024.116801
PMID38564957
OpenAlexW4393165893
LanguageEN
Citations received4
References cited31

Devolution and decentralisation policies involving health and other government sectors have been promoted with a view to improve efficiency and equity in local service provision. Evaluations of these reforms have focused on specific health or care measures, but little is known about their full impact on local health systems. We evaluated the impact of devolution in Greater Manchester (England) on multiple outcomes using a whole system approach. We estimated the impact of devolution until February 2020 on 98 measures of health system performance, using the generalised synthetic control method and adjusting for multiple hypothesis testing. We selected measures from existing monitoring frameworks to populate the WHO Health System Performance Assessment framework. The included measures captured information on health system functions, intermediatory objectives, final goals, and social determinants of health. We identified which indicators were targeted in response to devolution from an analysis of 170 health policy intervention documents. Life expectancy (0.233 years, S.E. 0.012) and healthy life expectancy (0.603 years, S.E. 0.391) increased more in GM than in the estimated synthetic control group following devolution. These increases were driven by improvements in public health, primary care, hospital, and adult social care services as well as factors associated with social determinants of health, including a reduction in alcohol-related admissions (-110.1 admission per 100,000, S.E. 9.07). In contrast, the impact on outpatient, mental health, maternity, and dental services was mixed. Devolution was associated with improved population health, driven by improvements in health services and wider social determinants of health. These changes occurred despite limited devolved powers over health service resources suggesting that other mechanisms played an important role, including the allocation of sustainability and transformation funding and the alignment of decision-making across health, social care, and wider public services in the region

Decentralization · Devolution (biology · Economic growth · Economics · Environmental health · Health care · Health promotion · Health services research · Life expectancy · Political science · Population · Population health · Public economics · Public health · Social determinants of health · Global Health Care Issues · Health disparities and outcomes · Healthcare Policy and Management · Medicine · Nursing · Health Policy