Beyond Manchesterism: lessons for a prevention-focused health service

Alongside the now-famous buses, health and care is the area most associated with Prime Minister Andy Burnham's previous tenure as Mayor of Greater Manchester. Over the past decade, Greater Manchester has become the country's most significant experiments in place-based public service reform, using devolved powers to reshape how health and care are planned and delivered.

As the government seeks to develop a prevention-focused Neighbourhood Health Service, it is increasingly looking to places for answers. Greater Manchester has plenty to offer, not just in how it organised itself, but how it brought together health services, local government and wider partners around a shared set of outcomes.

The original devolution settlement gave Greater Manchester greater influence over health and care than other parts of England. Over time, this enabled local leaders to move towards a model based on collaboration rather than competition, encouraging hospitals, councils, NHS organisations and other public services to work together around the needs of the population rather than the priorities of individual institutions.

This reflects what Mr Burnham has often described as a "place first" approach, bringing "everyone to face the same way and then pull in that same direction together".

A second important feature of Greater Manchester's approach has been its focus on prevention and the wider determinants of health. National policymakers have long argued that improving health outcomes requires action beyond healthcare services alone. Greater Manchester has sought to put this principle into practice by linking health more closely with employment, housing, opportunity and inequality.

Initiatives such as Live Well bring together health organisations, local government, businesses and community partners to tackle barriers to opportunity and address the wider social and economic factors that shape people's health and wellbeing.

There is some evidence that this approach has delivered benefits. Analysis by the Health Foundation identified improvements in healthy life expectancy, life satisfaction and screening coverage. At the same time, challenges remain, including continued pressure on urgent and emergency care services.

Taken together, Greater Manchester's experience suggests that sustained collaboration around place can support a different approach to improving population health. It does not remove the wider pressures facing the health system, but it does offer an example of how local partners can work differently to address them.

Given the attention Greater Manchester has received, it is tempting to see it as a model that can simply be lifted and shifted elsewhere. However, the reality is more complicated.

The city-region has benefited from more than a decade of devolved leadership, strong civic institutions and a level of local influence over health and care that has not been available in most parts of England. More recently, this has been strengthened further by the appointment of the Chair of Greater Manchester ICB also serving as the Mayor’s Health Commissioner.  

Other places start from very different positions. The factors that have supported reform in Greater Manchester have been built over many years and cannot simply be recreated elsewhere. The focus should instead be on which aspects of its approach can travel, which are most likely to be the principles - partnership, prevention and a willingness to organise services around places rather than organisations.

Examples of this broader approach are already emerging across the country.

In the Thames Freeport, partners - including ourselves here at Avencera - have been exploring how health, economic development, technology and community engagement can be brought together to address longstanding inequalities.

The Mobile Health Innovation Programme provides one example. Delivered through a partnership between public, private and community organisations, the programme brought preventative screening directly into neighbourhoods through a mobile health bus model. Over a nine-week period, 687 residents received cholesterol and blood pressure checks, with the evaluation finding that 77% of those attending would not otherwise have accessed preventative screening. Locations were selected to target communities with the greatest need, combining local insight, community engagement and technology-enabled approaches to reach people who are often underserved by traditional models of care.

The programme showed that improving prevention often requires services to reach out into communities rather than expecting communities to navigate complex systems themselves. It also demonstrated how partnerships between health services, local authorities, technology providers and community organisations can extend the reach of preventative interventions.

This reflects a broader lesson from place-based reform. While structures may differ, successful initiatives share the same golden thread - with organisations brought together around a shared understanding of local need and a collective responsibility for improving outcomes.

For decades, governments of all political persuasions have argued for a greater focus on prevention. The challenge has never been articulating that ambition, but instead creating the conditions that allow local partners to act on it.

Greater Manchester demonstrates that a more locally led and prevention-focused approach is possible, as does our work in the Thames Freeport. Examples around the country, like those highlighted by the Kings Health Fund’s recent analysis also show how other areas have already begun to embed neighbourhood health principles in different ways.  

But if the government's ambition is to create a genuinely prevention-focused Neighbourhood Health Service, it will need to do more than identify examples of good practice. It will need to create the conditions for new approaches to emerge, be tested and prove their value across different places.

That is where Avencera is focused – helping places turn the aspiration of prevention into practical delivery. By bringing together local health systems and their partners, technology providers and communities, we are testing new ways to reach underserved populations, generate evidence at pace and build models that can be adapted elsewhere in a wider movement for prevention.