Regional assemblage and the spatial reorganisation of health and care: the case of devolution in Greater Manchester, England

Abstract

In this paper, we examine how space is integral to the practices and politics of restructuring health and care systems and services and specifically how ideas of assemblage can help understand the remaking of a region. We illustrate our arguments by focusing on health and social care devolution in Greater Manchester, England. Emphasising the open‐ended political construction of the region, we consider the work of assembling different actors, organisations, policies and resources into a new territorial formation that provisionally holds together without becoming a fixed totality. We highlight how the governing of health and care is shaped through the interplay of local, regional and national actors and organisations coexisting, jostling and forging uneasy alliances. Our goal is to show that national agendas continued to be firmly embedded within the regional project, not least the politics of austerity. Yet through keeping the region together as if it was an integrated whole and by drawing upon new global policy networks, regional actors strategically reworked national agendas in attempts to leverage and compete for new resources and powers. We set out a research agenda that foregrounds how the political reorganisation of health and care is negotiated and contested across multiple spatial dimensions simultaneously.

Deprivation and primary care funding in Greater Manchester after devolution: a cross-sectional analysis

“…Nevertheless, some success has been had by the new organisational structure at championing regional priorities within central government, with Greater Manchester successfully competing to gain access to limited national capital for several tailored health programmes. 32 However, as this study demonstrates, the ability of devolution to address the issues (the inequalities), on which it was promoted, remains to be questioned. Further translational investigation is clearly indicated to assess how Greater Manchester may tackle deprivation and health inequities, within its limited remit, and to investigate alternative financing structures.…”

“…18,19,29 Previous work has discussed the uncertainties of the devolution experiment, the effects of austerity on its motivations, and the complexities in the de-scaling of national organisational concentration to their current local assemblage in Greater Manchester. 12,32 However, no previous work has looked at primary care funding or quality in the context of the devolution. Although average payments per weighted patient are not necessarily representative of the amounts directly available for patient care, they nonetheless offer a helpful indicator of the funding available to practices.…”

“…Thus, claims about DevoManc producing much needed improvements in health inequities, particularly in light of the central government-led austerity firmly embedded in the devolution process, should be treated with caution. 32 By 2020, Greater Manchester is predicted to have a shortfall in funding of several billion pounds a year that, even with integration and improved efficiency of services, 34 will likely curtail capacity for local responsiveness.…”

Editorial: the importance of sociological approaches to the study of service change in health care

“…The English case (Lorne et al . ) takes a macro‐/meso‐level approach to large‐scale service change in Greater Manchester. Stewart () explores meso‐level service change across three hospitals in Scotland, and Wright () explores service change at the micro‐level though a study of a newly integrated sexual and reproductive healthcare facility – once more in Scotland.…”

Guest editors’ introduction: the power of now. Reimagining the future of local government through studies of ‘actually existing’ practice

“…At first glance, any questioning of this mature and dynamic field of political studies may seem misguided, particularly given the range of important work being published. This includes investigations into the local as a space for progressive politics and the new municipalism (see, for example, Penny 2017; Russell 2019; Thompson 2020), studies of the local governance of austerity (see Bello et al 2018;Davies et al 2020;Fuller and West 2017;Gray and Barford 2018;Hastings et al 2015;Lowndes and McCaughie 2013), of devolution and the hybridisation of local political landscapes (see Berry and Giovannini 2018;Lowndes and Gardner 2016;Lorne et al 2019), as well as critical explorations of community empowerment and new spaces of democracy within local civil societies (see Richardson, Durose, and Dean 2019;Willett and Cruxon 2019;Wills 2016Wills , 2020. Such dialogues have further 'softened' the disciplinary boundaries of local government studies, attracting contributions from disciplines such as critical theory, political geography, and urban studies.…”