• Chief officer Jon Rouse will report into new NHS regional directorate
  • One senior source says “it sort of feels like devolution’s over”
  • But devolution team says there’s been “no dilution”

The leader of Greater Manchester’s health and care devolution project will report to the regulators’ new regional director for the North West, in what some see as another dilution of the region’s relative autonomy.

Under the original “delegation arrangements” made in 2016, Jon Rouse, the chief officer of Greater Manchester Health and Social Care Partnership, reported directly into NHS England’s national chief financial officer.

But HSJ has learned that, following the integration and restructuring of NHS England and NHS Improvement, GMHSCP is now overseen by Bill McCarthy, the new joint regional director for the North West. This means the management reporting line is no longer unique, or atypical.

In February, there was also a formal intervention from the national bodies over Greater Manchester’s poor performance against the four-hour accident and emergency target, although there appears to be no direct link between this and the new line of reporting.

One senior source in the region told HSJ: “It sort of feels like devolution’s over, although nobody’s saying it. There’s a bit of scrabbling about over money… but that’s about it.”

Another senior official in the region said: “With the formal meeting about A&E back in February as well, it does feel like things have been watered down. There’s not really anything that makes GM different from anywhere else.”

GMHSCP confirmed that Mr Rouse’s line manager is now Mr McCarthy.

It added in a statement: “Nothing has changed in terms of the devolved status, accountability agreement or Jon Rouse’s delegations and role as chief officer.

“He remains accountable to the Greater Manchester Partnership Board, made up of the NHS organisations, councils and partners in GM.

“However, the recent bringing together of NHSE, NHSI and [Public Health England] responsibilities at a regional level gives the opportunity for a single reporting line. It is not a dilution of anything, but a working partnership to help sustain change and improvement through the devolved structure.”

HSJ asked the partnership team whether it requested to report to the new regional directorate, or to continue reporting into the national office, but it did not give an answer.

Kieran Walshe, professor of health policy and management at Manchester Business School, who has analysed the devolution project, said: “It does seem that the era of Greater Manchester exceptionalism is coming to an end, and that may be no bad thing.

“In the long run, it is delivering sustained improvements in health and care, not line management arrangements or column inches that matter.”

MBS is due to publish a quantitative analysis of the project later this year.

As part of the health devolution deal, Greater Manchester received a unique transformation fund worth £450m over five years. Most of the fund was allocated over the first three years – 2016-17, 2017-18, and 2018-19.