FOI 2025/1529

Please treat this email as a request for information under the Freedom of Information Act 2000.

I am requesting information relating specifically to the decision to pause or restrict new ADHD and autism (ASD) assessment bookings, including Right to Choose referrals, which took effect in Greater Manchester from 1 September 2025.

Please provide copies of the following, whether draft or final:

1. Any decision papers, briefing notes or records approving the pause or restriction of ADHD and/or autism assessments.
2. Any risk assessments, safety assessments or safeguarding analyses produced specifically in relation to the pause.
3. Any Equality Impact Assessment (EqIA) or equality analysis produced specifically in relation to the pause.
4. Any options appraisals or documents considering alternatives to a pause (for example capacity expansion, prioritisation, or partial restrictions), including reasons for rejecting alternatives.
5. Any documents setting out mitigation measures, monitoring arrangements, or review criteria intended to manage risk during the pause.
6. Any documents identifying clinical sign-off, senior clinical advice, or legal advice relied upon when approving the pause.

Please include documents held in draft form, working versions, or documents described as “in development”.

In accordance with section 3(2)(b) of the Freedom of Information Act 2000, this request includes any information held on behalf of the ICB by another organisation, including any Commissioning Support Unit (CSU) or external contractor.

1. Information held that falls within the scope of this question consists of internal briefing papers, draft decision documents and records created to support internal discussions and decision-making. These documents were produced for internal use only and reflect ongoing deliberation.

This information is exempt from disclosure under section 36(2)(b)(i) and (ii) of the Freedom of Information Act, as disclosure would be likely to inhibit the free and frank provision of advice and the free and frank exchange of views for the purposes of deliberation. Release would also be likely to prejudice the effective conduct of public affairs under section 36(2)(c).
Section 36(2)(b)(i)(ii) and (c) – Prejudice to the Effective Conduct of Public Affairs.

Section 36 of the Act sets out a qualified exemption from the right where in the reasonable opinion of a qualified person such disclosure would prejudice the effective conduct of public affairs.
The Minister responsible for the Freedom of Information in the Department of Health has authorised the senior person in charge of the National Health Service bodies to act as ‘Qualified Persons’ and under Section 5 of the National Health Service Act 1977 this is the Chief Executive. Under the Section 36 exemption, the ‘qualified person’ for NHS Greater Manchester (NHS GM) is Mr Colin Scales, Acting Chief Executive.

Mr Scales is of the opinion that the information should be withheld as he considers that it would, or would be likely to prejudice, the effective conduct of public affairs.
Disclosure of the minutes would, or would be likely to:

• inhibit the free and frank provision of advice, and
• inhibit the free and frank exchange of views for the purposes of deliberation.
• would otherwise prejudice, or would be likely otherwise to prejudice, the effective conduct of public affairs.

The meetings in question were held in private and form part of the ICB’s internal governance and operational decision-making processes. They involve candid discussion of financial risk, commissioning pressures, provider performance, and clinical considerations. The ability of staff to discuss these issues openly would be undermined if detailed minutes were routinely disclosed.
The decision to apply this exemption has been made with the reasonable opinion of the qualified person, as required by the Act.

Public Interest Test

Factors favouring disclosure.

Openness and transparency – It is important that NHS GM acknowledges their responsibility to be open, transparent and accountable.

Factors favouring non-disclosure.

NHS GM consider sharing the information requested would inhibit advice/views and openness between decision makers, necessary to agree appropriate service provision for the patients it serves. It is critical that NHS GM maintain the greatest possible confidence without any concern that confidential or sensitive information provided, consulted, or relied on may be compromised. Furthermore, to divert resources to manage the impact of disclosure, would cause disruption to important services that NHS GM provides, and the organisations ability to efficiently conduct public affairs.

Balancing Test.

As such, it is the decision of NHS GM that the public interest at this time lies in non-disclosure of the information for the reasons outlined above. NHS GM consider that the public interest in withholding the information outweighs the public interest in disclosure.

2. Risk, safety and safeguarding considerations were addressed through internal working documents developed to support operational planning and governance. These documents are internal and form part of ongoing risk management activity.
This information is exempt under section 36(2)(b)(i) and (ii) of the Act, as disclosure would be likely to inhibit the candid identification and discussion of risks and mitigations. Premature disclosure could also undermine effective risk management processes, engaging section 36(2)(c) as outlined above.
The release of this information is exempt from disclosure by virtue of section 22 of the Freedom of Information Act 2000 as it is intended for future publication.
Section 22(1) of the Freedom of Information Act 2000 states:
(a) the information is held by the public authority with a view to its publication, by the authority or any other person, at some future date (whether determined or not),
(b) the information was already held with a view to such publication at the time when the request for information was made, and
(c) it is reasonable in all the circumstances that the information should be withheld from disclosure until the date referred to in paragraph (a).
This exemption is subject to the public interest test and for the reasons outlined below, we are satisfied that the exemption applies.
Public interest test
Factors favouring disclosure.
There is an inherent public interest in ensuring that there is openness and transparency to increase confidence in procurement processes and the purchasing decisions made by NHS GM. Furthermore, disclosure of this information would also be consistent with NHS GM’s commitment to proactively publish data that is in the wider public interest.
Factors favouring non-disclosure.
However, this information is subject to is subject to review, validation and approval, prior to publication. Early release of the requested information could be misrepresentative, and it is in the public interest that this information is true and accurate.
Balancing Test.
After considering the arguments outlined above, we have decided that, on balance, the public interest is better served at this time in withholding the latest versions of our Equality Impact and Risk Assessments under section 22 of the Freedom of Information Act 2000, on the basis that it will be published in the future once finalised, as outlined above.
3. An Equality Impact Assessment (EqIA) has been produced; however, it remains in draft form and has not been finalised or approved through the relevant governance processes.

Draft documents are exempt from disclosure under section 22(1) of the Freedom of Information Act (information intended for future publication). It is intended that the final EqIA will be published or otherwise shared once it is complete. Disclosure of a draft would risk misinterpretation of provisional analysis and conclusions that may change prior to final approval.
Disclosure is also exempt under section 36(2)(b), as release of draft equality analysis would be likely to inhibit the free and frank exchange of views during the assessment, challenge and assurance process as outlined above.
The release of this information is exempt from disclosure by virtue of section 22(1) of the Freedom of Information Act 2000 as it is intended for future publication as outlined above.
4. Information held within scope consists of internal options appraisals and working documents used to explore and test potential alternatives as part of internal deliberations.

These documents are exempt under section 36(2)(b)(i) and (ii), as disclosure would be likely to inhibit the free and frank provision of advice and exchange of views. Releasing preliminary options and reasons for rejection would risk undermining future decision-making by discouraging open and candid consideration of alternative approaches.

Section 36(2)(b)(i) and (ii) – Prejudice to the Effective Conduct of Public Affairs
Section 36 of the Act sets out a qualified exemption from the right where in the reasonable opinion of a qualified person such disclosure would prejudice the effective conduct of public affairs.
The Minister responsible for the Freedom of Information in the Department of Health has authorised the senior person in charge of the National Health Service bodies to act as ‘Qualified Persons’ and under Section 5 of the National Health Service Act 1977 this is the Chief Executive. Under the Section 36 exemption, the ‘qualified person’ for NHS Greater Manchester (NHS GM) is Mr Colin Scales, Acting Chief Executive.

Mr Scales is of the opinion that the information should be withheld as he considers that it would, or would be likely to prejudice, the effective conduct of public affairs.
Disclosure of the minutes would, or would be likely to:

• inhibit the free and frank provision of advice, and
• inhibit the free and frank exchange of views for the purposes of deliberation.

The meetings in question were held in private and form part of the ICB’s internal governance and operational decision-making processes. They involve candid discussion of financial risk, commissioning pressures, provider performance, and clinical considerations. The ability of staff to discuss these issues openly would be undermined if detailed minutes were routinely disclosed.
The decision to apply this exemption has been made with the reasonable opinion of the qualified person, as required by the Act.

Public Interest Test

Factors favouring disclosure.

Openness and transparency – It is important that NHS GM acknowledges their responsibility to be open, transparent and accountable.

Factors favouring non-disclosure.

NHS GM consider sharing the information requested would inhibit advice/views and openness between decision makers, necessary to agree appropriate service provision for the patients it serves. It is critical that NHS GM maintain the greatest possible confidence without any concern that confidential or sensitive information provided, consulted, or relied on may be compromised.

Balancing Test.

While there is a public interest in understanding how decisions are reached, NHS GM considers that the public interest in protecting the integrity of internal deliberative processes outweighs the public interest in disclosure of preliminary options and reasons for rejection.

As such, it is the decision of NHS GM that the public interest at this time lies in non-disclosure of the information for the reasons outlined above. NHS GM consider that the public interest in withholding the information outweighs the public interest in disclosure.

5. Mitigation measures, monitoring arrangements and review criteria are documented within internal operational and governance materials. This information is exempt under section 36(2)(b) and 36(2)(c), as disclosure would be likely to inhibit open discussion about risk controls and could prejudice the effective management and review of services as outlined above.

The information forms part of ongoing operational oversight and internal assurance arrangements. Disclosure could undermine the effectiveness of these arrangements by discouraging candid reporting and discussion.

Section 36(2)(b)(i) and (ii) – Prejudice to the Effective Conduct of Public Affairs
Section 36 of the Act sets out a qualified exemption from the right where in the reasonable opinion of a qualified person such disclosure would prejudice the effective conduct of public affairs.
The Minister responsible for the Freedom of Information in the Department of Health has authorised the senior person in charge of the National Health Service bodies to act as ‘Qualified Persons’ and under Section 5 of the National Health Service Act 1977 this is the Chief Executive. Under the Section 36 exemption, the ‘qualified person’ for NHS Greater Manchester (NHS GM) is Mr Colin Scales, Acting Chief Executive.

Mr Scales is of the opinion that the information should be withheld as he considers that it would, or would be likely to prejudice, the effective conduct of public affairs.
Disclosure of the minutes would, or would be likely to:

• inhibit the free and frank provision of advice, and
• inhibit the free and frank exchange of views for the purposes of deliberation.

The meetings in question were held in private and form part of the ICB’s internal governance and operational decision-making processes. They involve candid discussion of financial risk, commissioning pressures, provider performance, and clinical considerations. The ability of staff to discuss these issues openly would be undermined if detailed minutes were routinely disclosed.
The decision to apply this exemption has been made with the reasonable opinion of the qualified person, as required by the Act.

Public Interest Test

Factors favouring disclosure.

Openness and transparency – It is important that NHS GM acknowledges their responsibility to be open, transparent and accountable.

Factors favouring non-disclosure.

NHS GM consider sharing the information requested would inhibit advice/views and openness between decision makers, necessary to agree appropriate service provision for the patients it serves. It is critical that NHS GM maintain the greatest possible confidence without any concern that confidential or sensitive information provided, consulted, or relied on may be compromised.

Balancing Test.

NHS GM recognises the public interest in assurance that risks are being managed. However, this must be balanced against the public interest in maintaining effective internal governance and service management.

As such, it is the decision of NHS GM that the public interest at this time lies in non-disclosure of the information for the reasons outlined above.

6. Clinical and senior advice was provided through internal channels and recorded within internal documents. Where information includes legal advice, it is subject to legal professional privilege.

Legal advice is exempt from disclosure under section 42(1) of the Freedom of Information Act. Other internal clinical or senior advice is exempt under section 36(2)(b), as disclosure would be likely to inhibit the free and frank provision of advice. There is a strong and well-established public interest in maintaining the confidentiality of legal advice.

Section 42(1) – Legal professional privilege states that, Information in respect of which a claim to legal professional privilege or, in Scotland, to confidentiality of communications could be maintained in legal proceedings is exempt information
Section 36 of the Act sets out a qualified exemption from the right where in the reasonable opinion of a qualified person such disclosure would prejudice the effective conduct of public affairs.
The Minister responsible for the Freedom of Information in the Department of Health has authorised the senior person in charge of the National Health Service bodies to act as ‘Qualified Persons’ and under Section 5 of the National Health Service Act 1977 this is the Chief Executive. Under the Section 36 exemption, the ‘qualified person’ for NHS Greater Manchester (NHS GM) is Mr Colin Scales, Acting Chief Executive.

Mr Scales is of the opinion that the information should be withheld as he considers that it would, or would be likely to prejudice, the effective conduct of public affairs.
Disclosure of the minutes would, or would be likely to:

• inhibit the free and frank provision of advice, and
• inhibit the free and frank exchange of views for the purposes of deliberation.

The meetings in question were held in private and form part of the ICB’s internal governance and operational decision-making processes. They involve candid discussion of financial risk, commissioning pressures, provider performance, and clinical considerations. The ability of staff to discuss these issues openly would be undermined if detailed minutes were routinely disclosed.
The decision to apply this exemption has been made with the reasonable opinion of the qualified person, as required by the Act.

Public Interest Test

Factors favouring disclosure.

Openness and transparency – It is important that NHS GM acknowledges their responsibility to be open, transparent and accountable.

Factors favouring non-disclosure.

NHS GM consider sharing the information requested would inhibit advice/views and openness between decision makers, necessary to agree appropriate service provision for the patients it serves. It is critical that NHS GM maintain the greatest possible confidence without any concern that confidential or sensitive information provided, consulted, or relied on may be compromised. Furthermore, to divert resources to manage the impact of disclosure, would cause disruption to important services that NHS GM provides, and the organisations ability to efficiently conduct public affairs.

Balancing Test.
As such, it is the decision of NHS GM that the public interest at this time lies in non-disclosure of the information for the reasons outlined above. While transparency is important, NHS GM considers that the public interest in protecting legal privilege and ensuring that clinical and professional advice can be provided candidly outweighs the public interest in disclosure.