Introduction

Public services, nationally and locally, face an unprecedented set of financial pressures, as well as challenges to quality, performance and persistently poor population health outcomes. In April 2016, Greater Manchester (GM) signed an historic devolution deal with central government. Through this deal, GM became the first, and still only, city region with health and care devolution. Decisions about how to deliver greater, faster improvements to the health and wellbeing of the residents are now made locally.

Devolution has led to the development of detailed plans focused on people and local communities; new infrastructure to build on local strengths and assets; stronger relationships across sectors and across the city-region, in turn breaking down some of the traditional silos and structural barriers that have got in the way of policymakers and financial decisions in the past. Devolution, and the way it has been implemented in GM, has provided the foundations for reforming public services. Devolution has also been accompanied by budgetary reforms. A ￡6 billion devolution deal brought together health and social care, and a ￡450 million Health and Social Care Transformation Fund was agreed to support the development of this new integrated system. The GM strategic health and social care plan sets out how these challenges will be met. A ￡30 million Transformation Fund has also been secured to support delivery of the first GM Population Health Plan, setting out how the opportunities of devolution will be used to help ensure that all residents will have the best start in life, to live well and to age well.

Good health is vital for confident, prosperous and ambitious places – these ambitions are inseparable. At the heart of devolution in GM is a long-held belief that decisions are best made locally, by local leaders (democratic and professional) who know their communities and are able to bridge the organisational, professional, and sector boundaries that can often drive public decision-making. Localism is at the very heart of the devolution journey.

In this chapter, the context for devolution in GM, and why it matters in terms of residents’ health and wellbeing, is briefly explored.