As part of the Campaign for Social Science’s series on devolution, we jointly hosted (with the Health Foundation) a webinar on 23 September 2026 exploring the devolution of healthcare policy within England. With sweeping changes taking place to the English devolution map, we asked four experts from different regions at different points in their devolution journey to reflect on how health outcomes are being shaped through regional and local policy.
The session was chaired by Katherine Merrifield of the Health Foundation and featured presentations from Dr Phil Britteon, Professor Sheena Asthana FAcSS, Professor Sanjiv Ahluwalia and Sue Jarvis FAcSS on their research.
Phil is a Research Fellow at the University of Manchester, and focused on his evaluations of devolution in Greater Manchester, covering the period from the first devolution deal in 2014 to the start of the COVID-19 pandemic. His research tells a broadly positive story – with life expectancy rising more in Greater Manchester than in comparable areas, and the largest gains in the most deprived boroughs. Healthy life expectancy and wellbeing also improved. Alongside this, overall spending on health and care in Greater Manchester increased slightly after devolution, with most of the growth in acute and social care services. Notably, however, there was little sign of the shift in spending towards preventative services like the region’s health and care strategy had envisaged, reflective of the limits of what was devolved. Phil summarised the key lessons as being that improvements were achieved without devolved control over NHS budgets, pointing to the importance of collaboration – but noting that Greater Manchester’s collaboration was built on decades of joint working, which is not easily replicated elsewhere. The data also indicate that shifting the dial on wider issues – preventative care or social determinants of health – is a much more complex problem without simple levers which can be pulled.
We then heard from Sheena, who is Director of the Centre for Health Technology and Co-Director of the Centre for Coastal Communities at the University of Plymouth. She brought a very welcome perspective on coastal communities, which are rarely at the heart of debates around devolution and which face different challenges from city regions. She began by questioning whether meaningful health care devolution is happening outside of large cities, and the reasons which might lie behind this. She highlighted that some of these are social or demographic factors – older populations, often with complex, long-term health and social care needs – which give rise to significant financial constraints for the public bodies in those areas. Sheena pointed to data which indicate that this has a significant impact on the ability of those coastal areas to tackle neighbourhood health issues and wider social determinants. As she pointed out, it should not be a surprise, therefore, that coastal areas have higher standardised mortality rates, higher rates of long-term illness, severe health inequalities and lower life expectancy. To close, Sheena argued that there is a risk of devolution increasing rather than resolving the disparity between healthcare spending and resources in different parts of England.
Sanjiv is the Head of the School of Medicine at Anglia Ruskin University. He emphasised the importance of understanding that change takes time and we are still at the start of the healthcare devolution journey in England. But, as Sanjiv pointed out, one thing we can divine from the devolution journeys in London and Manchester to date is that although new structures and governance matter, we must not undervalue the importance of co-creating policy changes with communities – particularly those which are hardest to reach – in order to drive improvement. Likewise, Sanjiv emphasised the need to bring the health and care workforce onside with changes, as well as citizens, if any improvements are to be sustained.
Finally, we heard from Sue, who is Co-Director of the Heseltine Institute for Public Policy, Practice & Place at the University of Liverpool. She cited the fact that many non-health devolved powers (skills, housing, transport, economic development) are important levers for improving health outcomes. She also pointed to the extensive work being done by the University of Liverpool with the city region and mayor to help improve population health. One initiative has sought to address health-related economic inactivity by identifying the challenges faced by unemployed residents with a health condition who are seeking employment, as well as the challenges faced by employed residents with a health condition who want to remain in employment. Another is strengthening evidence-informed decision-making by helping Liverpool City Council to make better use of research, data, and community insight to tackle health inequalities. Finally, Sue discussed the OECD’s Health in All Policies approach (supported by the Health Foundation), which recognises that health is shaped by decisions across the wider economy, and helps localities to identify and prioritise cross-sector action. In the Liverpool City Region, this has led to a much more joined-up set of interventions which see health as being inextricably linked to other policy programmes.
Our four panellists approached the topic from different perspectives, but there were three interesting areas of consensus. Firstly, there was agreement that although there are specific policy levers which can be pulled on health by regional policymakers, the biggest impact of devolution could potentially be on wider social determinants, many of which are also closely linked to devolved policies. Many of the initiatives cited in the presentations were ones which sought to improve health outcomes by improving housing, access to employment, access to services through better transport and so on. The second area was acknowledgement by our panel that devolution needs to lead to better co-creation of health solutions with communities on the ground so that these reflect local circumstances – just transferring powers to a regional mayor or combined authority does not by itself make that engagement happen. And finally, there was also a sense of realism from our panel that none of these changes should be seen as ‘quick wins’. Devolution of health to the national governments of Scotland, Wales and Northern Ireland has been in place for 27 years, to Manchester for less than two decades, and to some regions for a matter of just a few years. It needs to be seen as a long-term project to understand how powers can and should be used effectively, and for local leaders to be held accountable.