FOI 2025/1496

This is a request under the FOI act. Please provide me with the following information in relation to the ICB’s assertive outreach audit, which was completed last year following instructions from NHS England for ICBs to review policies regarding the care of people with severe mental illness who requirement treatment, but where engagement is a challenge.

1. Please share the findings of the audit/review into your ‘assertive outreach’ provision and the following action plans.
2. Please also share a summary, including how many patients require the services of assertive outreach.
3. How much will it cost to implement a full assertive outreach service?

1. Greater Manchester Integrated Care Board (NHS GM) completed a comprehensive system-wide review of Assertive Outreach (AO) provision in 2024, in response to national guidance. The updated report on the AO plan is attached below:

**A PDF document was sent to the requester with this response.  If you require a copy of the full response, together with the attachments, please contact NHS GM’s FOI team – nhsgm.foi@nhs.net **

The review found significant variation across localities in AO provision, including gaps in commissioned models, referral routes, workforce configuration, and policy alignment. Key themes included the need for:

• A clear, GM-wide service model
• Clarity on workforce and caseload definitions
• Cultural and policy shifts (e.g. reducing blanket DNA discharges)
• Stronger interface between AO and Community Mental Health Teams (CMHTs)
• Improved engagement with individuals at high risk of disengagement or crisis

The action plan outlines immediate and long-term steps for addressing these challenges.

2. Using the regional estimation model provided by NHS England (which applied a 10–15% multiplier to the SMI cohort known to secondary care), GM ICB submitted an indicative AO cohort estimate of 2,800 to 4,200 individuals across the system.

However, the review concluded that this estimate was not based on validated local data and should not be used for planning purposes. A full gap analysis is now underway with providers to determine:

• Actual cohort size by locality
• Current case numbers managed via AO pathways
• Overlap with forensic, CRHTT, and CMHT caseloads

3. The indicative investment required to deliver a consistent, sustainable, and evidence-based AO model across all 10 GM localities is estimated at £8 million to £11 million annually.

This figure reflects:

• Staffing levels in line with AO fidelity (e.g. 8–10 FTE per 100 patients)
• Multidisciplinary teams with medical, psychological, and social care input
• Caseload sizes of 10–12 patients per practitioner
• Full coverage of GM’s estimated AO cohort

This estimate is subject to change pending the outcomes of the system-wide gap analysis and any decisions around integration with wider community mental health transformation.