FOI2026/1972

a) confirm the legal and contractual basis which the ICB is relying upon to implement different minimum waiting times between NHS providers and ISPs;

b) provide an evidence-based rationale as to how the implementation of different minimum waiting times between NHS providers and ISPs supports “the effective management of elective demand, delivery of system waiting time objectives, equitable access to services and the effective utilisation of commissioned capacity across Greater Manchester”;

c) confirm the specific inequity the ICB is seeking to address through these arrangements; and

d) confirm how different minimum waiting times between NHS providers and ISPs addresses the inequity perceived by the ICB.

A) The ICB does not determine commissioning and activity management arrangements solely by reference to whether services are delivered by an NHS provider or an Independent Sector Provider. The contractual basis for the minimum waiting time requirement is Service Condition 29 of the NHS Standard Contract, together with the agreed Indicative Activity Plans, Activity Planning Assumptions and Activity Management Plan process.

B) NHS Greater Manchester commissions services from a range of NHS and independent sector providers operating under different service models, contractual arrangements and patient populations.

The minimum waiting time assumption was implemented through these contractual planning and activity management arrangements and was linked to NHS GM’s objectives of equitable access, system performance, support for agreed clinical pathways and affordability. Commissioning decisions are informed by the characteristics of the services being commissioned, including pathway complexity, interdependencies with other NHS services, operational requirements and wider system considerations, rather than provider type alone.

In developing these arrangements, the ICB has regard to a range of factors including referral demand, available capacity, patient choice, system affordability, delivery of national elective recovery objectives and the need to ensure that patients are treated within clinically appropriate timescales.

The ICB recognises that NHS and independent sector providers may operate under different contractual arrangements, accountability frameworks and service models. As a result, waiting times are not necessarily directly comparable between providers. The purpose of the arrangements is to support the management of demand and capacity across the wider system rather than to establish identical waiting times across all providers.

C) Where commissioning documentation refers to equity, this is generally in the context of equitable access for patients and the equitable management of demand and capacity across the wider healthcare system, rather than achieving equal waiting times between providers.

The ICB’s commissioning approach recognises that providers may operate under different service models, contractual arrangements and patient populations. Consequently, waiting times may vary between providers and are not necessarily directly comparable.

The purpose of the arrangements is to support system-wide commissioning objectives, including the effective utilisation of available capacity, delivery of elective recovery objectives and equitable access to services for the population of Greater Manchester.

D) Please refer to a copy of the Service Condition 29 of the NHS Standard Contract provided below. As explained in the answer provided part b), the ICB recognises that NHS and independent sector providers may operate under different contractual arrangements, accountability frameworks and service models. As a result, waiting times are not necessarily directly comparable between providers. The purpose of the arrangements is to support the management of demand and capacity across the wider system rather than to establish identical waiting times across all providers.

The NHS Contract Service Conditions are available on the NHSE website – 03-full-length-service-conditions-2627.pdf

See pages 45 – 51.