FOI2026/1876

Has NHS Greater Manchester ICB implemented, proposed, discussed or considered any pause, restriction, cap or suspension relating to ADHD Right to Choose referrals since 1 January 2024?

If yes, please provide:

The date on which the decision was made.

The date the change took effect.

The rationale for the decision.

The legal basis relied upon for the decision.

Please provide copies of all board papers, committee papers, briefing notes, decision logs, risk assessments, business cases and other documents relating to any pause, restriction or change in funding arrangements for ADHD Right to Choose referrals.

Please identify the individual, committee, board or executive group responsible for authorising any pause, restriction or limitation on ADHD Right to Choose referrals.

Please provide copies of the reports, data analyses, demand modelling, activity forecasts and financial modelling used to support that decision.

Please provide copies of any advice, guidance, instruction or correspondence received from:

NHS England;

The Department of Health and Social Care; or Any legal advisers

regarding the legality of restricting, pausing or otherwise limiting funding for ADHD Right to Choose referrals.

Please provide copies of any correspondence between NHS Greater Manchester ICB and NHS England concerning the compatibility of any ADHD Right to Choose restriction, pause or funding limitation with:

The NHS Constitution;

Patient rights under the NHS Right to Choose framework; and The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012.

Please confirm whether the ICB sought or obtained legal advice regarding:

Its obligations to fund ADHD assessments and treatment under the Right to Choose framework; The lawfulness of restricting access to selected providers; and The lawfulness of pausing or refusing funding for ADHD Right to Choose referrals.

If so, please provide the date such advice was obtained, the source of the advice and a summary of the conclusions where disclosure is permitted under FOIA.

Please state whether the ICB considers ADHD Right to Choose referrals to be:

A legal patient entitlement under current NHS regulations; or A discretionary service that may be restricted on financial grounds.

Please provide any policy documents, legal advice summaries or guidance relied upon in reaching that position.

Please provide the total spend on ADHD Right to Choose referrals for:

2023/24

2024/25

2025/26

2026/27 (to date)

Please provide the number of ADHD Right to Choose referrals received, approved and funded for the same periods.

Please provide the budget allocated for ADHD Right to Choose assessments and treatment for:

2024/25

2025/26

2026/27

Please provide the actual expenditure and committed expenditure against those budgets as at:

30 April 2026

31 May 2026

30 June 2026

For each date, please separately identify:

Budget allocated.

Actual expenditure incurred.

Expenditure committed but not yet invoiced.

Forecast year-end expenditure.

Remaining available budget.

If ADHD Right to Choose referrals were paused, restricted or capped during the 2026/27 financial year, please state:

The date the decision was taken.

The date the restriction came into effect.

The reason for the restriction.

Whether the allocated budget had been fully spent.

Whether the allocated budget had been fully committed.

The value of any forecast overspend.

The evidence used to justify the restriction.

NHS financial budgets for 2026/27 commenced on 1 April 2026. If ADHD Right to Choose referrals were paused or restricted during May 2026, please provide:

The amount of the 2026/27 ADHD Right to Choose budget that had been spent by the date of the pause.

The amount that had been contractually committed by the date of the pause.

The percentage of the annual budget represented by those amounts.

Any reports, forecasts or risk assessments indicating that the budget would be exceeded.

Any alternative reasons relied upon in making the decision.

Please provide details of any overspend, underspend or budget recovery plans relating to ADHD Right to Choose services during 2025/26 and explain whether these influenced decisions taken during 2026/27.

Please confirm whether any part of the 2026/27 ADHD Right to Choose budget had been pre-committed before 1 April 2026 to meet costs arising from referrals made in previous financial years. If so, please provide the value of those commitments.

Please explain how NHS Greater Manchester ICB determined that it was necessary to pause or restrict ADHD Right to Choose referrals during May 2026, approximately one month after the commencement of the 2026/27 financial year, and provide all documents, reports, financial forecasts and correspondence relied upon in reaching that decision.

If ADHD Right to Choose referrals were paused or restricted during May 2026, please confirm whether this was because:

The annual budget had already been fully spent; The annual budget had already been fully committed; A budget overspend was forecast; A commissioning decision was taken to limit activity; An operational or administrative pause was implemented; or Another reason.

Please provide supporting documentation and correspondence relating to the reason identified.

What assessment was undertaken of the impact on:

Adult patients awaiting ADHD assessment; Children and young people awaiting ADHD assessment; and Patients with protected characteristics under the Equality Act 2010?

Please provide details of any Equality Impact Assessment undertaken specifically in relation to restricting, pausing or limiting ADHD Right to Choose referrals.

Please provide:

The number of patients waiting for an ADHD assessment within Greater Manchester NHS services; The average waiting time; and The longest waiting time

for each quarter from January 2024 to the date of this request.

If funding for ADHD Right to Choose referrals was restricted due to financial pressures, please provide details of any alternative ADHD assessment services, pathways or contracts that continued to receive funding during the same period.

Please provide copies of any communications sent to:

GP practices;

Primary Care Networks;

Mental Health Trusts; or

ADHD service providers

concerning any change to ADHD Right to Choose referral arrangements.

Please provide the number of complaints, concerns, appeals, legal challenges, judicial review pre-action correspondence or formal disputes received by the ICB relating to ADHD Right to Choose referrals since 1 January 2024.

Please provide details of any financial pressures, savings targets, cost improvement programmes, financial recovery plans or budget recovery plans that referenced ADHD Right to Choose services.

If compliance with this request would exceed the appropriate cost limit under Section 12 of the Freedom of Information Act 2000, please advise and assist me in narrowing the scope of the request in accordance with your duty under Section 16 of the Act.

I would prefer the information to be supplied electronically in PDF or spreadsheet format.

Having considered your request, NHS Greater Manchester ICB estimates that complying with it in its current form would exceed the appropriate cost limit set out in Section 12 of the Freedom of Information Act 2000.

Your request covers a period of more than two years and seeks a substantial volume of information, including documents, correspondence, reports, financial information, legal advice, communications and operational records held across multiple directorates and services. In order to determine what information is held, the ICB would need to conduct extensive searches across numerous teams and consult a significant number of individuals, including (but not limited to) commissioning, finance, contracting, primary care, mental health, governance, legal services, executive offices and corporate records. The time required to identify, locate and retrieve all potentially relevant information would considerably exceed the appropriate limit of 18 hours prescribed by the Freedom of Information and Data Protection (Appropriate Limit and Fees) Regulations 2004.

In accordance with our duty under Section 16 of the Freedom of Information Act, we are happy to assist you in refining your request so that it may fall within the statutory cost limit.

For example, you may wish to limit your request to one or more of the following:

• Documents relating to a specific decision or meeting concerning ADHD Right to Choose referrals (for example, Board, Executive or a named committee) within a defined time period.
• Copies of board papers, committee papers or decision records relating to any decision to pause or restrict ADHD Right to Choose referrals, rather than all supporting correspondence and documentation.
• Financial information only, such as expenditure, budgets and referral numbers for a specified financial year.
• Correspondence with NHS England only, within a defined date range.
• Information relating solely to any decision made during May 2026 regarding ADHD Right to Choose referrals.

Alternatively, if your primary interest is whether NHS Greater Manchester ICB made a decision to pause or restrict ADHD Right to Choose referrals, you may wish to submit a request limited to:

“Please confirm whether NHS Greater Manchester ICB implemented any pause, restriction or limitation on ADHD Right to Choose referrals between 1 April 2026 and 31 May 2026. If so, please provide the date of the decision, the decision-making body, and copies of any board papers, committee papers or formal decision records relating to that decision.”

A request of this nature would significantly reduce the number of areas required to be searched and is more likely to fall within the appropriate cost limit.