Agenda Item 12e
Report for Information
Calderdale MBC
Calderdale Health and Wellbeing Board
Date: 15/1/2015
Subject: Obesity/Weight Management Referral Pathway
1. Background and Information
Strategic Priority
Obesity is one of the agreed priorities on which the Health and Wellbeing Board
agreed in August 2014 to focus effort. Tackling obesity is a key public health priority
as highlighted within the JSNA.
An effective obesity (weight management) referral pathway will support Calderdale’s
Joint Wellbeing Strategy Priority Outcomes, in particular; Calderdale Is A Place
Where People Have Good Health – obesity is associated with a number of comorbidities (e.g. diabetes, cardiovascular disease, bone/joint problems, stroke and
cancer). Effectively addressing this issue will have a positive impact on all these
conditions. The issue indirectly supports the other 5 priorities because the bold
whole system approach critical to making a difference will impact on industry,
communities, families and society as a whole.
At present there is no clearly defined approach to preventing and managing obesity
and its associated conditions in Calderdale. This is mainly due to the most recent
reorganisation of the NHS and a lack of clarity around responsibilities in relation to
weight management service provision and associated care pathway design, resulting
in the previous referral pathway now being out of date and no longer relevant.
Current Situation
NICE (2014) states that; systems should be in place to allow people to be referred
to, or receive support from (or across) the different service tiers of an obesity
pathway, as necessary. This includes referrals to and from lifestyle weight
management programmes. All the options in the local obesity pathway should be
made clear to both professionals and the public.
The Public Health team is currently working with Calderdale M.B.C Sports Services
to secure a comprehensive and integrated approach to tackling obesity at tiers 1 and
2 in line with Cabinet resolution.
In addition, the Obesity Sub-Group has agreed that it will be the accountable body
for receiving reports from Public Health in respect of tiers 1 and 2 obesity services
(whole population prevention activity and community weight management service
respectively) for which the Council has commissioning responsibility.
Currently there is no tier 3 provision (specialist multi-disciplinary team obesity
service) to report as none is commissioned in Calderdale by the CCG. Tier 4
(specialist interventions including bariatric surgery) is currently commissioned by
NHS England though is likely to be commissioned by Clinical Commissioning Groups
in the near future, as tier 3 is currently. This is expected to be confirmed in the
coming months.
If current NHS England guidance is implemented to the letter then potentially no
Calderdale resident is eligible for bariatric surgery, due to the lack of a
commissioned Tier 3 intervention. This poses specific risks for individuals who
would benefit from surgery and/or specialist intervention and cannot access it
(postcode lottery). Additionally reputational risks and potential public criticism for
organisations involved may need to be managed. An integrated, fully funded and
commissioned obesity pathway would ensure all risks are mitigated against.
Progressing this item
The Board is requested to note this item and approve oversight through the Health
and Wellbeing Board Obesity Sub-Group.
The Health and Wellbeing Board is also requested to acknowledge the potential
gap(s) in weight management service provision and recognise this as a priority for a
system wide response. The initial priorities of which should be the development of a
tier 3 weight management service as part of an integrated weight management
pathway. Development of this is timely given the redesign of tiers 1 and 2 and will
allow smooth integration of services along the pathway.
For further information on this report, contact:
Dean Wallace
Consultant in Public Health
Telephone:
01422 266134
E-mail:
Dean.Wallace@calderdale.gov.uk
The documents used in the preparation of this report are:
1. Report of the working group into: Joined up clinical pathways for obesity
2. Commissioning guide: Weight assessment and management clinics (tier 3)
3. Managing overweight and obesity in adults – lifestyle weight management services
National Institute for Health and Clinical Excellence (NICE)
The documents are available for inspection at:
Report of the working group into: Joined up clinical pathways for obesity:
http://www.england.nhs.uk/wp-content/uploads/2014/03/owg-join-clinc-path.pdf
Commissioning guide: Weight assessment and management clinics (tier 3):
file:///C:/Users/xe24/Desktop/Commissioning%20guide%20%20weight%20assessment%20and%20management%20clinics%20published.pdf
Managing overweight and obesity in adults – lifestyle weight management services:
http://www.nice.org.uk/guidance/ph53