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Weight Management (1718081)

Please state the name of your clinical commissioning group:

Calderdale CCG

Who is the designated policy lead for weight management/obesity-related intervention provision in your CCG? Please provide their name and email address.

Programme Manager, Service Improvement CCGFeedback@calderdaleccg.nhs.uk

 

PREVALENCE

1. Please state the number of patients requiring weight management intervention(s) in the past years 2014, 2015 and 2016 by tier 1, 2, 3 or 4.

NHS Calderdale CCG only has commissioning responsibility for Tiers 3 and 4.  Calderdale Metropolitan Borough Council is responsible for the commissioning of Tiers 1 and 2.  You may wish to direct questions relating to Tiers 1 and 2 to the Local Authority at information_management@calderdale.gov.uk.

The CCG only commenced commissioning of Tier 3 Services from April 2017.  Furthermore, responsibility for the commissioning of Tier 4 Services only transferred to the CCG in April 2017.  As such, the CCG does not hold the information for the years referenced. You may wish to direct questions regarding Tier 4 to the previous commissioner, NHS England, at england.contactus@nhs.net.

 

SERVICE PROVISION

General

2. What tier weight management intervention(s) do you commission? Please select all that apply:

  • Tier 3 – yes (from April 2017)
  • Tier 4 – yes (from April 2017)

3. Who is the commissioned organisation to deliver the intervention? Please specify and indicate which tiers each intervention covers (e.g. Tier 3, Tier 4 etc):

  •  Tier 3 – Mid Yorkshire NHS Trust
  • Tier 4 – Calderdale & Huddersfield Foundation Trust (CHFT)

4. Please state the name of the relevant organisation and intervention previously provided that has been decommissioned in the past five years.

Not applicable.  No service has been decommissioned in the past 5 years.

 

Referral route and entry criteria

5. How do patients access this intervention(s)? Please select all that apply from the list below:

  • GP/clinical referral to Tier 3 and 4

6. What is the eligibility criteria for adults? Please select all that apply from the list below:

Tier 3 eligibility criteria is:

  • BMI, including lower BMI for specific ethnic groups with type 2 diabetes;  BMI ≥ 35 with related co-morbidities (listed below) or BMI >40 without comorbidities
  • Specific co-morbidities including:
    • Diabetes type 1 & 2
    • Hypertension
    • Fatty Liver Disease
    • Established cardiovascular disease
    • Osteoarthritis
    • Dyslipidaemia
    • Sleep Apnoea
    • Depression/anxiety
  • Previous recent engagement in Tier 2 interventions

Tier 4 eligibility criteria is:

  • BMI ≥40 and other co-morbidities e.g type 2 diabetes or high blood pressure
  • The person has been receiving intensive management in a Tier 3 service but has not achieved or maintained adequate, clinically beneficial weight loss.
  • The person is generally fit for anaesthesia and surgery.
  • The person commits to the need for long-term follow-up.
  • In addition to the criteria listed above, bariatric surgery is the option of choice (instead of life style interventions or drug treatment) for adults with a BMI of ≥50 kg when other interventions have not been effective.

 

Intervention details

7. What is the title and name of the intervention(s)?

  • Tier 3 – Weight Management
  • Tier 4 – Bariatric Surgery

8. What are the aims and objectives of these intervention(s)?

The CCG has identified the following aims and objectives for Tier 3:

  • Clients are able to sustain behaviour change and improve lifestyle choices in relation to their weight
  • Quality of life for clients is improved
  • Nutritional intake/knowledge is improved
  • Amount of physical activity undertaken during an average week is increased
  • Priority groups are engaged and supported to manage weight
  • Reduced prescribing of anti-obesity drugs

The CCG does not hold any specific information described as the “aims and objectives” for Tier 4 bariatric surgery.

9. What NICE guidance is the intervention(s) based on?

  • Royal College of Surgeons – Commissioning Guide:  eight assessment and management clinics (tier 3) (March 2014)
  • The following NICE clinical guidance and quality standards describe the high-quality care that, when delivered collectively, should contribute to improving the effectiveness, safety and experience of care for people:
    • NICE Clinical Guidance 189:  obesity: identification, assessment and management of overweight and obesity in children, young people and adults (November 2014);
    • CG189 partially updates previous CG43.

10. How long does the intervention last for? Please specify in weeks, months and years:

Tier 3 weight management:

There will be an intensive phase to the intervention for a duration of approximately 12 weeks.  Clients are retained in a programme of a minimum of 24 weeks and up to 104 weeks.

Tier 4 involves a surgical procedure.  As such this question does not apply.

11. What is covered by the intervention?

Tier 3 weight management intervention covers the following:

  • Clients are able to sustain behaviour change and improve lifestyle choices in relation to their weight
  • Nutritional intake/knowledge is improved
  • Amount of physical activity undertaken during an average week is increased
  • Priority groups are engaged and supported to manage weight
  • Reduced prescribing of anti-obesity drugs

Tier 4 involves a surgical procedure.

 

Cost

12. What is the amount that has been spent on all commissioned weight management intervention by your CCG, and amount budgeted for the 2014/2015, 2015/2016 and 2016/2017 financial years?

Please see response to question 1.

13. What is this spend as a percentage of the total health programme spend for your local authority for the years 2014/2015, 2015/2016 and 2016/2017 financial years?

See response to Question 1.

14. How long is the intervention commissioned for? Please specify in months/years:

Tier 3 – commissioned for 18 months; started April 2017

Tier 4 – routinely commissioned from providers and is not a standalone contact.

15. How many individuals access or are referred to these intervention(s)?

The CCG only commenced commissioning of Tier 3 Services from April 2017.  Furthermore, responsibility for the commissioning of Tier 4 Services only transferred to the CCG in April 2017.  As such, the CCG does not hold this information at this time.  You may wish to direct questions regarding Tier 4 to the previous commissioner, NHS England, at england.contactus@nhs.net.

16. How many individuals are eligible to access the intervention(s)?

Tier 3 – we anticipate approximately 90 patients will take up this service from April 2017 to September 2018.

With regard to Tier 4, the CCG does not hold this information at this time.

17. What is the average weight loss at the end of the intervention (%)?

Tier 3 service did not commence until 1st April 2017; therefore, there is no data is available at this time.

The service specification requires a minimum of 5% weight loss at 12 weeks and a minimum of 7% weight loss at 6 months.

With regard to Tier 4, please see response to Question 15.

18. What is the average weight loss at 12 months (%)?

Please see response to Question 15.

19. How many patients as a percentage of those receiving obesity interventions have sustained weight loss beyond the 12 months following the intervention?

Please see response to Question 15.

20. As a percentage, how many people have voluntarily ceased receiving an intervention before its completion in the years 2014, 2015 and 2016.

Please see response to Question 15.

 

Exit routes

21. Are participants directed into any other intervention(s) at the end?

  • Yes:
  • Tier 2 weight management if stepping down from Tier 3; or
  • Tier 4 bariatric surgery if stepping up from Tier 3.

 

 

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