FOI 2025/1415

Manchester City Council’s internal review (October 2025) confirmed that Learning Disability (LD) nurses who conduct BBAT or equivalent behavioural assessments for adult CHC patients are employed by Manchester University NHS Foundation Trust and commissioned by NHS Greater Manchester ICB.

Please therefore treat the following request as directed to your organisation as the relevant data holder under the Freedom of Information Act 2000.

Please provide the information in electronic format. If any part of this request engages an exemption, please cite the exact statutory exemption relied upon and provide the reasoning under section 17 of the Act.

If any part of the information is not held by your organisation, please confirm this formally and identify, under section 16 (duty to advise and assist), which body holds it or whether a transfer can be made.

I am writing under the Freedom of Information Act 2000 to request information regarding BBAT (Brief Behavioural Assessment Tool) or equivalent behavioural/sensory assessments conducted by LD nurses for adult patients receiving NHS Continuing Healthcare (CHC).

Please provide the following information, ideally covering the most recent 12 months and any previous periods for which records are available:

1. Assessment Responsibility and Qualifications
a. Confirm that these assessments are conducted by LD nurses.
b. Provide information on the qualifications, training, and prior experience of staff conducting these assessments with complex adult CHC patients.

2. Handling of Non-Applicable Questions
a. How are questions in the assessment that do not apply to the patient handled?
b. Are carers or professionals instructed to pick arbitrary answers, skip questions, or use alternative methods?
c. Please provide guidance documents or protocols used in these cases.

3. Use of Carer Input
a. Are carer-based questionnaires or input used to inform assessments?
b. Who completes them (family, paid carers, LD nurses, etc.), and how is this information incorporated into CHC eligibility or care planning?

4. Volume of Assessments
a. How many adult CHC patients have received a BBAT or equivalent assessment in the past 12 months?
b. Specifically, for the 100 adult CHC patients currently under care, how many have had such an assessment?

5. Outcomes / Effectiveness
a. Provide information on assessment outcomes or evidence of how they informed care planning or CHC decisions.
b. Confirm whether there is a formal appeal or dispute process if the findings or recommendations of a BBAT assessment are contested.

6. Historical Data
a. Provide information on any previous BBAT or equivalent assessments conducted by LD nurses, including approximate numbers, timeframes, and lead professionals.

7. Commissioning and Communication
a. Who requests or commissions BBAT or equivalent assessments for adult CHC patients?
b. If commissioned externally, provide organisation/professional details and any service agreements.
c. How are assessment results communicated to CHC patients, particularly those who lack capacity?
d. How are family members, deputies, or carers involved in understanding and acting on assessment outcomes?
e. Provide any policies or guidance documents used for communicating assessment findings.

8. Consent, Capacity, and Best Interests
Provide the procedure followed before commencing a BBAT or equivalent assessment for adult CHC patients in the following situations:
1. Patients with capacity but no advocate, including how consent is obtained, documented, and communicated.

2. Patients who lack capacity and have no advocate, including how best interest’s decisions are made, who is involved, and how outcomes are documented and communicated.

Include any policies, guidance documents, or protocols used in these situations.
Please provide the information in electronic format. If any part of this request is unclear, please contact me for clarification.

NHS Greater Manchester does not hold the information requested. As stated above, the BBAT or equivalent behavioural assessments for adult CHC patients are conducted by Learning Disability (LD) nurses employed by Manchester University NHS Foundation Trust. NHS GM is not the data holder for this information; therefore, it will be necessary for you to direct your request to the Trust for the information you seek. To assist you please find below a link to the Trust’s website and information about how to make a Freedom of Information request.

https://mft.nhs.uk/freedom-of-information/