Devolution is the transfer of certain powers and responsibilities from national government to local government in a particular region and has emerged as one of this Government’s flagship policies.

Devolving health care was not core to the original devolution agenda, which was focussed on driving local economic growth; however, the inclusion of health and social care in the Greater Manchester ‘Devo Manc’ agreement has paved the way for this.

Where is it happening?

Greater Manchester (‘Devo Manc’)

First announced in November 2014 on the basis of a “Metro Mayor” being elected, Greater Manchester was offered the broadest devolution deal to date, including powers over transport, planning and housing as well as uniting 38 different organisations as part of health and social care devolution plans. The Greater Manchester footprint covers 2.8 million residents in a monocentric city region with a compact geography, and with a number of economic and clinical interdependencies and flows.

Greater Manchester now has full devolution of the health and care budget (of around £6 billion in 2016/17).


With much of the devolution rhetoric centred on cities and the ‘northern powerhouse’, Cornwall was the first rural county to reach an agreement in July 2015. It includes responsibilities for apprenticeships, European Union structural funds, business support services, franchising of bus services, and a ‘One Public Estate’ initiative. Cornwall is the largest rural unitary authority in the country and has a considerably smaller population than Greater Manchester, at just under 550,000, greatly dispersed across the length and breadth of the region. Boundaries are coterminous, so devolution involves a single council, Clinical Commissioning Group, Health and Wellbeing Board, acute trust, mental health trust, community provider and GP federation.

Other areas

The Government has agreed devolution deals in several areas, including Sheffield, Liverpool City Region, West Yorkshire and the West Midlands, but these have not involved devolution of health powers. In December 2015, five health devolution pilots were announced in London, alongside a health devolution agreement.

Further resources

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