FOI 2026/1719

Under the Freedom of Information Act 2000, we kindly request the following information relating to service configuration, governance and strategic priorities within your organisation.

This request relates to organisational structures and planning only and does not seek patient‑level data, commercially sensitive information, or confidential clinical detail.

Section 1: System Structure & Governance

1. Have there been any changes to your commissioning or service delivery structures in the past 24 months (including mergers, hosted services, or collaborative arrangements)?

2. Are any services related to respiratory, transplant, or rare diseases commissioned or managed collaboratively (e.g. regional networks, hosted models, or lead‑commissioner arrangements)?

3. Are there any planned organisational or governance changes affecting these service areas over the next 12–24 months?

Section 2: Roles, Committees & Decision‑Making

4. Which committees or governance groups hold responsibility for pathway design and medicines optimisation in:

1. • respiratory services
   • transplant services
   • rare disease services?

5. Are there any named clinical leads, programme leads or specialist roles associated with these service areas?

6. Have any new roles or groups been established in the past 18 months that influence pathway design or medicines decision‑making?

Section 3: Strategic Priorities & Pressures

7. Please list any published strategies, transformation programmes or priority documents currently relevant to:

• • respiratory services
  • transplant services
  • rare disease services.

8. Are any of these services currently subject to financial recovery, service sustainability review, or workforce mitigation activity?

9. Are national or regional policy initiatives currently influencing planning in these areas?

Section 4: Respiratory Services

10. Are respiratory services currently undergoing pathway review or service redesign (e.g. community respiratory, diagnostics, prevention, or virtual wards)?

11. Which respiratory disease areas are identified as priorities within current planning documents (if applicable)?

Section 5: Rare Disease & Transplant Services

12. How are rare diseases and transplant services overseen within your organisation (e.g. specialist pathways, regional networks, named leads, or national commissioning arrangements)?

Section 1: System Structure & Governance

1. Since statutory establishment in July 2022, NHS Greater Manchester Integrated Care Board (ICB) has continued to develop its role as a strategic commissioner, consistent with the draft Model ICB Blueprint and the future NHS operating model. Over the past 24 months, changes have focused on strengthening strategic commissioning, system oversight and collaborative delivery through Places and provider partnerships, rather than creating new organisational entities.

Key developments include:

• Greater delegation of delivery responsibilities to Places, provider collaboratives and clinical networks
• Increased use of system programmes and partnerships to reduce unwarranted variation and improve outcomes

There have been no service‑specific organisational mergers or structural changes directly relating to respiratory, transplant or rare disease services.

2. Yes, consistent with NHS reform.

Respiratory services are planned and improved through system‑level clinical strategies, supported by collaborative delivery across Places, providers and clinical networks.

Transplant and rare disease services are primarily commissioned through national specialised commissioning arrangements led by NHS England, with collaborative regional clinical networks supporting delivery and assurance.

The ICB’s role is focused on strategic alignment, outcomes, quality oversight and system integration, rather than direct service management.

3. There are no planned service‑specific organisational restructures affecting respiratory, transplant or rare disease services within NHS Greater Manchester ICB over the next 12­­24 months.

Ongoing operating model and governance development is expected to continue, consistent with the draft Model ICB Blueprint and Fit for the future: 10 Year Health Plan for England, including:

• Further strengthening strategic commissioning capability and system leadership
• Simplifying governance and accountability routes to reduce duplication and speed up decision‑making
• Increasing emphasis on outcomes, inequalities and value, including delivery of the 10‑year plan “three shifts” (hospital to community, analogue to digital, sickness to prevention)

Section 2: Roles, Committees & Decision‑Making

4. In line with the ICB operating model:

System‑level committees and programme groups provide strategic oversight, clinical leadership and assurance

Pathway design and medicines optimisation frameworks are agreed at system level but delivered through Places, providers and clinical networks

For transplant and rare disease services, pathway and medicines decisions are determined nationally through NHS England specialised commissioning and clinical reference groups, with the ICB providing local assurance and system integration.

Respiratory services – Clinical Reference Group (CRG) as subgroup of GMMMG would oversee asthma and COPD pathways, however these documents are limited to pharmacological interventions and predominantly focused on treatments available in primary care. NHSE is responsible commissioner for management of asthma in secondary care.

5. Dr Murugesan Raja – Clinical Lead for Respiratory
6. A new subgroup has recently been created under GMMMG to oversee ICB- commissioned high cost drugs.

Section 3: Strategic Priorities & Pressures

7. Any published documents relating to use of medicines are available on Welcome to GMMMG – GMMMG
8. NHS GM continues to manage system‑wide financial and workforce pressures through strategic commissioning and recovery planning.

Respiratory services form part of wider long‑term condition and urgent care priorities.

Transplant and rare disease services are reviewed primarily through national specialised commissioning processes.

9. Yes, including:

• Fit for the future: 10 Year Health Plan for England (including the “three shifts”: hospital to community, analogue to digital, sickness to prevention)
• NHS Long Term Plan and future NHS operating model / Model ICB Blueprint reform priorities
• National specialised commissioning policy (including clinical networks and national service specifications for transplant and rare diseases)
• System productivity, performance and financial recovery frameworks

Section 4: Respiratory Services

10. COPD treatment pathway review is being undertaken in GM by CRG and is currently open for public consultation until 7^th May: GMMMG Consultations – GMMMG
11. Priority areas typically include:

• Chronic respiratory disease
• Health inequalities and prevention
• Smoking cessation
• Earlier and more accurate diagnosis

12. Rare disease and transplant services are overseen primarily through national specialised commissioning arrangements led by NHS England.

NHS Greater Manchester’s role is to:

• Ensure effective pathway interfaces with locally commissioned services
• Provide system quality oversight and assurance
• Support population health and inequalities objectives