Like a Circle in a Spiral, Like a Wheel within a Wheel’: The Layers of Complexity and Challenge for Devolution of Health and Social Care in Greater Manchester

The inclusion of health and social care as part of Greater Manchester devolution took many by surprise. Health and social care practitioners and managers have been working together in differing ways across the conurbation for many years. The formalisation of this working in a set of new organisational structures brings both opportunities and challenges. The Health and Social Care Act 2012 created new organisations within the English National Health Service (NHS) and added greatly to the complexity of the health and care system. Since the 1990s, this system has been characterised by the split between purchasers and providers of care. The devolution proposals add an extra layer of organisational complexity and they rely heavily on collaboration and co-operation rather than competition. We explore areas of potential tension and difficulty focussing on: public participation in health and care devolution; the imperative to simultaneously compete and collaborate; and blurred lines of responsibility and accountability between new organisations.