FOI 2026/1617

Bariatric Pathway Protocol

1. Please provide the clinical protocol that allows a provider to mandate a second psychological assessment after a patient has been formally listed for Tier 4 surgery.
2. Please also provide the policy regarding ‘coerced compliance’ for patients with documented physical airway obstructions (Multinodular Goitre).

1. NHS Greater Manchester Integrated Care Board (ICB) does not hold a local protocol that mandates a second psychological assessment once a patient has been listed for Tier 4 bariatric surgery.

However, the ICB does hold and operates under the national Severe and Complex Obesity Service Specification, including:

NHS England (2016) – Appendix 7: Psychological Assessment and Support Guidance
https://www.england.nhs.uk/wp-content/uploads/2016/05/appndx-7-obesity-surgery-guid.pdf

This guidance forms the clinical basis for psychological assessment processes within Tier 4 services. While it does not use the terminology “mandate a second assessment,” it clearly establishes that:

• Psychological assessment is an integral requirement before surgery is confirmed.
• Providers have a duty to reassess patients if new concerns arise or if the initial assessment indicates additional psychological input is required.
• Providers must ensure that patients demonstrate psychological readiness, capacity, informed consent, and the ability to engage with post‑operative self‑management.

Therefore, the national service specification—held and used by the ICB—permits providers to conduct additional psychological assessments where clinically indicated, including after listing, to ensure safety and suitability for surgery.

Provider‑specific surgical pathways and operational procedures are held by the organisations delivering Tier 4 services. The requester may wish to contact:

• Manchester University NHS Foundation Trust
• Northern Care Alliance NHS Foundation Trust

These organisations may hold detailed local protocols relating to Tier 4 bariatric pathways.

2. NHS Greater Manchester ICB does not hold any policy that contains the term “coerced compliance”, nor any policy applying such a concept to patients with multilodular goitre or airway obstruction.

This terminology does not appear in:

• The national Tier 4 obesity psychological guidance, or
• ICB‑held endocrine, respiratory, or surgical pathways.

There is therefore no ICB policy permitting or endorsing coerced compliance in any pathway.

Protocols for the assessment and surgical management of multinodular goitre and airway obstruction are held at provider level. The requester may wish to contact:

• Manchester University NHS Foundation Trust (Endocrine and ENT services)
• Northern Care Alliance NHS Foundation Trust

These organisations may hold appropriate clinical guidance.