| Reference | FOI 2025/1490 |
|---|---|
| Description | Commissioning and Delivery of Left Atrial Appendage Closure (LAAC) Services |
| Date Requested | 02/12/2025 |
| Date Replied | 18/12/2025 |
| Category | Contract Management |
Commissioning and Delivery of Left Atrial Appendage Closure (LAAC) Services
This request is submitted under the Freedom of Information Act 2000.
Please treat each numbered question as separable should any exemption or time-limit issue arise.
If full copies of policies or data cannot be released, please provide summary information or confirm where such data are held.
1. Commissioning Responsibility and Policy Alignment
a) Which organisation currently holds commissioning responsibility for LAAC (Left Atrial Appendage Closure) services in your region (e.g. regional specialised commissioning team, delegated ICBs, or NHS England national team)?
b) Does your organisation currently follow the NHS England national commissioning policy for LAAC (2018, updated 2023), or has a local policy or adaptation been developed?
– If a local policy, pathway, or protocol exists, please provide a copy or link.
c) If a local policy is under development or review, please confirm:
– Expected date of publication or implementation.
– Whether this is being coordinated with NHS England or local ICBs.
d) Has any local clarification or interpretation been issued to providers since the 2023/24 delegation of specialised services?
– For example, memoranda, board papers, or internal briefings regarding LAAC commissioning responsibilities.
– If so please provide
2. Current Service Provision and Activity Levels
a) Please list all NHS Trusts or provider sites currently authorised or contracted to deliver LAAC procedures within your region.
b) Have any provider sites been rejected to deliver LAAC, and if so why and when?
c) Please provide if any new sites are going through approval for delivering LAAC and also when they are expected to be live.
d) Has your region set any activity targets, trajectories, or expectations for LAAC growth toward the 1,000-procedure national projection referenced in the NHS England commissioning policy?
– If yes, please provide details or supporting documentation.
3. Funding and Commissioning Approach
a) Under which funding or contracting model are LAAC procedures currently commissioned (e.g. specialised contract, delegated ICB funding, block arrangement, tariff)?
b) Has your organisation made any local amendments or clarifications to the national tariff or payment mechanism for LAAC?
4. Forward Planning for 2026–27
a) Is your organisation undertaking, or planning, a review of LAAC service commissioning as part of its specialised cardiac or cardiovascular plans for 2026–27?
b) Has LAAC been referenced in any regional delivery plan, stroke prevention strategy, or specialised cardiac service plan for 2026–27?
– If so, please provide a copy or extract.
c) Who is the designated commissioning or clinical lead for LAAC or specialised cardiac services within your region? (Name and title if publicly available.)
5. Supporting Information
If available, please share any local needs assessment or modelling undertaken to estimate the potential eligible LAAC population within your region.
Further to my initial FOI submission, I realised I omitted some contextual information.
It is our understanding that NHS England has formally delegated 59 specialised services to ICBs and regions (NHS England Board Paper, 5 December 2024 – Annex A). This includes Adult Specialist Cardiac Services, specifically:
13T – Complex Interventional Cardiology, under which LAAC/LAAO sits.
NHS England’s “Cascade Delegation: Commissioning Integration” guidance confirms that ICBs now hold responsibility for:
– commissioning,
– service oversight,
– activity and planning,
– and implementation of national policies for all delegated services.
NHS England » Speaking Up Support Scheme: eligibility criteria and supporting evidence
NHS England » A bright future for Graham
Given that 13T is a mandated delegated specialised service, this information should now be held by you as the ICB or the regional commissioning hub acting on its behalf.
1a. In the North West region, Left Atrial Appendage Occlusion (LAAO) is commissioned against the National Clinical Commissioning Policy for Left Atrial Appendage Occlusion (LAAO) for patients with atrial fibrillation and relative or absolute contraindications to anticoagulation (adults) – https://www.england.nhs.uk/wp-content/uploads/2018/07/1692-left-atrial-appendage-occlusion.pdf
LAAO falls within the Specialised Cardiac Surgery service. The responsibility for commissioning this service was delegated by NHS England to Integrated Care Boards (ICBs) in the North West region on 1 April 2024. As such, commissioning responsibility for this service for the Greater Manchester population sits with Greater Manchester ICB.
NW ICBs carry out these responsibilities supported by the Regional Specialised Commissioning Team, which is currently employed by NHS England.
1b. Services are commissioned in line with the https://www.england.nhs.uk/wp-content/uploads/2018/07/1692-left-atrial-appendage-occlusion.pdf clinical commissioning policy published in 2018.
1c. There are no plans to develop a local policy for this service. It is commissioned in line with national policy.
1d. A full list of delegated services has been shared with providers. There have been no specific briefings regarding LAAO commissioning responsibilities.
2a. This service is not commissioned from any sites in the Greater Manchester Integrated Care Board System. All patients are referred to the commissioned centre for the North West Region at Liverpool Heart and Chest Hospital NHS Foundation Trust.
2b. No provider sites in the Greater Manchester Integrated Care Board System have expressed an interest in developing a local service.
2c. There are no current plans to change the current commissioning arrangements in the North West.
2d. The North West region has not set any activity targets/trajectories or expectations for LAAO growth towards the national projected figures.
3a. Activity at providers is commissioned in accordance with the NHS Standard contract, with an activity plan agreed and funded in accordance with the NHS Payment Scheme.
3b. No local changes have been made to the national tariff for this procedure.
4a. Commissioning intentions are set yearly and there have been no identified plans for LAAO agreed for the 2026-27 cycle.
4b. LAAO is not specifically referenced in any specialised commissioning regional delivery plan, stroke prevention strategy or cardiac service plan for 2026-27 for either the NW Region or the Greater Manchester system.
4c. Katherine Sheeran as Chief Commissioning Officer at Greater Manchester ICB https://gmintegratedcare.org.uk/nhs-gm/nhsgm-board/
5. There are no specific local needs assessments that have been undertaken to estimate the potential eligible population within Greater Manchester or the NW Region.
