Marginalising prevention during Health Devolution in Greater Manchester? A qualitative study of the perceptions and experiences of public health professionals

BACKGROUND: There are increasing moves across the globe towards devolution of various state services, including health. However, Greater Manchester (GM) is the only region in England with fully devolved health powers. A key feature of the policies supporting devolution in GM was a proposed uplift in focus and funding for prevention of ill-health. This was deemed important for supporting people's health and wellbeing, and economic stability. This study explores the experiences of people working in public health during devolution in GM, and seeks to understand the constraints and opportunities of this novel approach. METHODS: Forty two semi-structured interviews were conducted with people in public health roles in GM, examining how relational processes contributed to how prevention was perceived and enacted. RESULTS: Prevention work was considered less of a priority than treatment-centred activities in GM, both in terms of planning and practice. Some plans for increased prevention were neglected, and lacking direction, which tended to lead to stagnation of genuinely innovative prevention-based plans. CONCLUSIONS: Continued marginalization of prevention could be explained through processes such as lifestyle drift and the enduring prestige attached to treatment work. Despite the intentions behind the policies, there were instances where devolution seemed to exacerbate these tendencies.