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 and Cornwall are leading the way in health and social care devolution.

Greater Manchester (‘Devo Manc’)

First announced in November 2014 on the basis of a mayor being elected (expected in May 2017), Greater Manchester has been 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 controls long-term health and social care spending, ready for full devolution of a 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 will involve a single council, Clinical Commissioning Group, Health and Wellbeing Board, acute trust, mental health trust, community provider and GP federation.

The Government has also agreed to work with partners in Cornwall to transform health and social care services. Local partners and NHS England are developing a business plan to move progressively towards the integration of health and social care.

Other areas

The Chancellor used his budget speech in July 2015 to announce that the government was working towards devolution deals with the Sheffield and Liverpool City Regions, Leeds, West Yorkshire and partner authorities. In launching the Spending Review 2015, the Chancellor invited regions wanting to agree a deal in return for a mayor (which has proved to be a sticking point for some areas) to submit ‘formal, fiscally neutral proposals’ to the Treasury by 4th September 2015. Once the deadline had passed, the Prime Minister announced that 38 submissions had been received for a range of devolved powers. Around half are thought to have requested some form of devolution over health and social care. These proposals are being reviewed.

Further resources

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