FOI2026/1720

I am writing to request information under the Freedom of Information Act 2000 from NHS Greater Manchester ICB, preferably in electronic / digital form.

This request concerns commissioned and non-contracted activity (i.e. right to choose) for neurodevelopmental services. Please provide separate information, where held, for each of the following service lines (or, if not available separately, as a combined response clearly identifying what is included within the data):

• Adult autism assessments.
• CYP autism assessments.
• Adult ADHD assessments.
• CYP ADHD assessments.
• Adult ADHD medication (splitting titration and ongoing medication pathways if commissioned separately);

• CYP ADHD medication (splitting titration and ongoing medication pathways if commissioned separately);

Please provide the following recorded information held by the ICB at aggregate contract or service level only:

1. For financial years 2023/24, 2024/25 and 2025/26, for commissioned and non-contracted activity (i.e., RTC) for each service line:
   a. the planned spend and the actual spend;
   b. the actual activity volume and the actual unit cost; and
   c. the contracting model or structure used, for example block contract, activity-based contract, framework, spot purchase, Right to Choose, Any Qualified Provider, or equivalent.
2. For financial year 2026/27, for both commissioned and non-contracted activity (i.e., RTC):
   a. the planned spend;
   b. where held, the associated planned activity volume and unit cost; and
   c. the contracting model or structure planned, for example block contract, activity-based contract, framework, spot purchase, Right to Choose, Any Qualified Provider, or equivalent.

Given the April 2026 restructuring of some ICBs, please explicitly indicate which area the data provided relates to and please provide data for all areas managed by your ICB (both in 2026/27 and in previous years).

Please provide information at aggregate contract or service level only. I am not requesting patient or provider-level data. If information is held only in part, under different service labels, or using different activity or cost measures, please provide the closest equivalent information held.

1a.

Commissioned activity

Non-Commissioned Activity

* This figure is derived from invoices received to date and is likely to underrepresent

the full annual expenditure due to delays in invoice submission and processing.

1b. Activity costs for contracted services are shown below. For Optimise, the contract was delivered as a block contract prior to 25/26, so no activity levels are shown

Dr Leach ADHD Service:

2023/24 Unit Prices:

2024/25 Unit Prices:

2025/26 Unit Prices:

Axia (Autism only):

For non-commissioned activity delivered via the Right to Choose (RTC) pathway, providers operate under a range of pricing structures, including episode-based tariffs, bundled assessment and treatment pricing, and, in some cases, itemised billing approaches. This variation in pricing models means that costs are not consistently structured or reported across providers.

In addition, invoice data do not consistently provide sufficient granularity to separate expenditure into discrete elements of care (for example, assessment, follow-up, or titration), limiting the ability to attribute costs to specific activity types on a like-for-like basis across the cohort of providers.

1c. For commissioned services, block contracts were utilised. For right to choose providers, all activity was delivered under non-contractual activity

2a. Planned spend and actual spend

For commissioned activity, providers are currently operating under implied 2025/26 contract arrangements pending the issuance of formal 2026/27 contracts. As such, there is no separately defined or formally agreed planned spend available at service line level. Current activity is therefore continuing at the 2025/26 prices referenced in response to Question 1 until the 2026/27 contracts have been formally issued, at which point services will transition to the NHS England 2026/27 tariff guidance for ADHD and autism services (NHS England 2026/27 Payment Guidance for ADHD and Autism Services).

For non-commissioned activity delivered via the Right to Choose (RTC) pathway, planned and actual spend is not held in a standardised or consistently reportable format. RTC activity is delivered by a range of independent providers operating under differing pricing models, and detailed provider-level financial information is considered commercially sensitive. Disclosure of this information could reasonably be expected to prejudice the commercial interests of both providers and the commissioning organisation, particularly given variability in pricing structures and the competitive nature of the market. Actual expenditure is recorded through invoice payments; however, this is not routinely disclosable at provider or service line level due to the commercial sensitivity of the underlying arrangements.

2b. Actual activity volume and actual unit cost

For commissioned activity, services are in transition towards NHS England national tariff-based arrangements for relevant activity-based services. At present, activity is monitored through routine contract management processes; however, due to the ongoing transition and the fact that contracts are not yet fully aligned to the national tariff structure, expenditure and activity reporting is not consistently mapped to individual costed units of activity across all services. As a result, unit cost analysis is not currently undertaken in a consistent or comparable format during this transitional period. Activity data may be available at aggregate service or contract level depending on reporting arrangements but is not routinely structured at a granular costed activity level.

For non-commissioned activity delivered via the Right to Choose (RTC) pathway, activity volumes are recorded where submitted by providers, but these are not consistently standardised across all providers due to variation in reporting and invoicing practices. Providers operate under differing pricing structures, including episode-based and bundled tariffs, and invoice data does not consistently provide sufficient granularity to link expenditure to discrete components of activity. As a result, a consistent or comparable unit cost cannot be derived across providers or service lines.

2c. Contracting model or structure planned

The planned contracting model for commissioned activity is an activity-based contract operating within an agreed financial envelope. Right to Choose (RTC) activity is also commissioned on an activity-based basis. Providers are currently operating under implied 2025/26 contractual arrangements pending the issuance of formal 2026/27 contracts.