FOI 2026/1667

Questions:

I am writing on behalf of the Bolton & District Pensioners Association to request information under the Freedom of Information Act 2000 regarding NHS services in Bolton.

1. Planned Service Reductions 2026/27
   Please provide details of any planned reductions, savings targets, or service changes affecting NHS services in Bolton for the financial year 2026/27. This should include:
2. Any proposed reductions in activity, staffing, or funding in NHS hospitals or community services serving Bolton patients.
3. Any service closures, mergers, or reductions in clinical activity planned for the next financial year.
4. The value of the savings required from Bolton services as part of the wider financial plans for Greater Manchester.
5. Use of Independent Sector Providers
   Please provide information on the use of private or independent sector providers for patients from Bolton for the last three financial years (2023/24, 2024/25, and 2025/26 to date), including:
6. The names of independent providers used.
7. The clinical specialties involved (e.g. orthopaedics, gastroenterology, physiotherapy etc.).
8. The number of patients referred to each provider.
9. Are the same procedures carried out by private and independent sector providers as by the NHS, or does the NHS carry out the more complex procedures?  Please provide information about the different types of procedures which are carried out by the private and independent sector and the NHS.
10. Expenditure on Independent Sector Provision
    For the same three-year period, please provide:
11. The total annual expenditure on independent sector providers for services delivered to Bolton patients.
12. A breakdown of expenditure by provider and by clinical specialty where available.
13. Cost Comparison
    NHS officers have stated publicly that procedures undertaken in the independent sector cost the same as those provided within the NHS.
    Please provide:
14. Any cost comparison analysis undertaken by the ICB comparing procedures undertaken in NHS hospitals with those undertaken in the independent sector.
15. The average tariff or cost paid per procedure in the NHS and in the independent sector for the most common procedures outsourced from Bolton (for example orthopaedic procedures).
16. Activity Management Plans with the Independent Sector
    Please provide copies of any “Activity Management Plans” or similar agreements with independent sector providers relating to Bolton patients for 2025/26 and 2026/27.

If any part of this request exceeds the cost limit, please advise how the request may be refined.

I would prefer the information in electronic format.

Request for Clarity 30 March 2026:

I write in response to your recent Freedom of Information request, which was received by NHS Greater Manchester Friday 27 March 2026.

In order to be able to process your request and provide you with the correct information, I would be grateful if you could you provide the following clarity:

1. The language used in the FOI suggests it is aimed at secondary care e.g. references to specialities. Can we ask the requestor a clarification question to understand if they are asking about secondary care.

I am sorry we are unable to help you further at this time, and I look forward to receiving the necessary clarity to be able to action your request.

Response to Request for Clarity 1 April 2026:

Thank you for your email. I’m unsure what the term ‘Secondary Care’ means?

For clarity I am seeking the expenditure with private providers for NHS services in Bolton Hospitals and Community services. For full transparency this information is required to support our campaign to reduce the reliance on private providers who profit from NHS Contracts. We aim to provide accurate information to the public which is why this FOI request has been made.

Request for Further Clarity 7 April 2026:

I write in response to your recent Freedom of Information request, which was received by NHS Greater Manchester Friday 27 March 2026.

In order to be able to process your request and provide you with the correct information, I would be grateful if you could you provide the following clarity:

Thank you for your response to our request for clarification. Unfortunately, NHS GM requires further clarification in order to address your request as completely as possible.

NHS GM commissions a range of Community care services in respect of Bolton patients, however, not all of these are able to be delivered by NHS Trusts or other NHS bodies. For example, Hospice services are delivered by charitable hospices, rather than NHS organisations. Please can you confirm whether services which NHS GM believes are not possible or appropriate for an NHS Trust to deliver (such as Hospices) are appropriate to be removed from the consideration in response to this question?

In addition, as your clarification suggests you are interested in expenditure with “private providers”, NHS GM would be of the view that this should exclude services commissioned from the Local Authority or Voluntary sector – are you able to confirm that this interpretation is acceptable in respect of your question?

I am sorry we are unable to help you further at this time, and I look forward to receiving the necessary clarity to be able to action your request.

Response to request for Further Clarity 15 April 2026:

We do not believe there are many services which the NHS would be unable to deliver, however, in order to make progress we would agree to the exclusion of ONLY local authority and hospice provision.

In the meantime, please can you provide me with a link as to any information which is publicly available regarding contracts awarded to ‘for profit’ organisations.

In the context of this response, it is necessary to consider how services are commissioned in respect of local services. The former NHS Bolton CCG commissioned health services specifically for the registered population of Bolton. However, from 1 July 2022, these services were transferred to NHS Greater Manchester Integrated Care Board (NHS GM) as part of NHS reorganisation.

NHS GM became the responsible commissioner for the registered population of Greater Manchester. As a result of this, a range of services were now commissioned for the GM patients as a whole, rather than specifically for Bolton patients. Previously, all 10 CCGs of Greater Manchester commissioned services from the Royal Bolton Hospital NHS Foundation Trust, and Bolton CCG was able to specify which of these services were in respect of Bolton patients. As a combined organisation, NHS commissions many services on behalf of all GM patients, rather than in respect of a specific locality. For example, the services procured from Bolton Hospital are in respect of all patients in GM, not just Bolton residents. Therefore, for many services, it is not possible to identify services commissioned for Bolton patients.

A minority of services in 2025/26 were commissioned by the Bolton locality specifically for Bolton patients.

1. At the point of replying, there are no planned reductions to services commissioned by NHS GM in respect of the Bolton locality. For service changes in respect of those delivered by Bolton NHS Foundation Trust, you are requested to contact the trust directly via Freedom of information – Bolton NHS Foundation Trust

2a. & 2b. Please refer to the table below and the attached link Publication scheme | Greater Manchester Integrated Care Partnership

2c.

Please note – NHS Greater Manchester (NHS GM) does hold the information requested however, due to the low numbers involved (where patient data is 5 or less <5) we consider this to be exempt under section 40(2) of the Freedom of Information Act 2000 as the disclosure of this information may lead to the identification of individuals. This exemption is not subject to the public interest test.

2d. Top 25 recorded Procedures for IS and NHS

3. Owing to the volume of information requested, and the consequent time required to complete the response to this FOI, it is not possible to provide information within the cost limit defined by Section 12 of the Freedom of Information Act.

The Freedom of Information Act allows Public Authorities to decline to answer FOI requests when we estimate it would cost us more than £450 (equivalent to 18 hours, calculated at £25 per hour) to identify, locate, extract, and then provide the information that has been asked for. It is estimated that to provide the full information requested would take approximately 22 hours in total (based on the amount of time taken to provide the information the data in respect of 2025/26) which would exceed the appropriate limit prescribed in the act.

Therefore, to comply with your request as best as possible, we have provided information for the 2025/26 financial year. Information is not held in a way which enable the specific speciality to be identified.

In the table below, expenditure with a particular provider which totalled less than £5k in 2025/26 has been excluded, to reduce the risk identification of an individual patient (please refer to exemption 40(2), above. The value of items excluded from disclosure on this basis totals £17,431.

Please note, the table below specifically only considers providers commissioned in respect of Bolton patients only, because, as explained above, it is not possible to separately identify the cost of Bolton patients within GM wide contracts.

4. Where NHS GM commissions services, this may be done on the basis of a tariff

for each unit of activity performed. Such tariffs can either be nationally defined, or locally specified, depending on the service. No distinction is made within the tariff as to whether the organisation charging it is an NHS body, or an Independent Sector body. Therefore, the price charged to NHS GM for a specified service under an activity-based contract is consistent irrespective of the provider type.

NHS GM does not hold data in terms of the cost to the individual providers, only the cost that NHS GM is charged by those providers.

National tariffs are available at NHS England » National Tariff.

5. 5. NHS Greater Manchester can confirm that no Activity Management Plans have been issued in 2025/26 or 2026/27