Devolution outside Greater Manchester

In September 2015, NHS England published Devolution Principles and Decision Criteria, a board paper that outlined criteria to consider when taking decisions on whether to proceed with individual cases for devolution. However, the King’s Fund questioned the clarity surrounding other national bodies using the same criteria. Furthermore, the King’s Fund suggested that national bodies could still seize back control if other priorities were pursued, such as reducing overspending in NHS providers.

In an interview with the Health Service Journal (HSJ) in December 2015, Simon Stevens, Chief Executive of NHS England, suggested that few areas would be given control of devolved NHS budgets outside of Greater Manchester in the next few years. He said that the few devolution deals that did include health would not result in the imminent integration of health and social care. Stevens also suggested that NHS and social care commissioning budgets could not be joined: 'until we have clarity and a viable social care funding proposition I see no way in the real world in which you could blend £100bn plus of NHS funding with, in effect, an open-ended liability for local authority financing.'

Eleven areas other than Greater Manchester had devolution deals agreed. Three subsequently collapsed, of which two were then partially revived. These included:

  • Sheffield City Region
  • West Yorkshire
  • Cornwall
  • North of Tyne (original North-East deal was rejected)
  • Tees Valley
  • West Midlands
  • Liverpool City Region
  • Cambridgeshire/Peterborough (original Norfolk/Suffolk deal was rejected, only Norfolk’s deal was concluded successfully)
  • West of England
  • Greater Lincolnshire (rejected).

The accountability for health care services remained with NHS England and CCGs, rather than being transferred to combined or local authorities.


Williams D.
Stevens casts doubt over NHS devolution outside Manchester.
Health Service Journal; 14 December 2015.

Sandford M.
Devolution to local government in England. Briefing Paper Number 07029, 15 May 2019.
House of Commons Library; 2019.

The King’s Fund.
Devolution; what it means for health and social care in England.
The King’s Fund; 2015.

NHS England.
Devolution - Proposed Principles and Decision Criteria.
NHS England; 24 September 2015.