Weight Management Services, Quarter 1 to Quarter 4 2022/23 – National Obesity Audit [Management Information]

Hospital Episode Statistics (HES)

NHS England (previously NHS Digital) has worked closely with the British Obesity and Metabolic Surgery Society (BOMSS) and policy colleagues to develop a methodology to define how the number of people receiving bariatric surgical procedures (reported separately for primary, revisions and gastric balloons (temporary procedures), can be most accurately derived from HES data. The names of individual bariatric procedures in HES may not directly correspond with the names commonly used by the bariatric surgeons, so clinical input has been necessary to help overcome this. We have responded to advice from BOMSS to use a more limited code list to identify primary procedures. Whilst the methodology used to derive these statistics has been designed with this input, these numbers should be viewed as developmental until we further refine the methodology with users and stakeholders. Full details of the methodology used are in the metadata document with this release. 

NHS England  (previously NHS Digital) has historically published data on admissions and number of finished consultant episodes (FCEs) for bariatric surgical procedures in the National Statistics on Obesity, Physical Activity and Diet (SOPAD) publication, which uses a different methodology, as explained in the Technical notes. SOPAD counts the number of procedures and admissions for bariatric surgery , groups reporting on primary and revision procedures, excludes gastric balloon procedures and uses a wider range of different procedure codes. Therefore, the SOPAD figures are higher than the counts of people provided in this release. SOPAD has recently been through a consultation Statistics on Obesity, Physical Activity and Diet which didn’t include a revised methodology for these estimates. Therefore, as this dashboard and statistics develop, we will consider in liaison with stakeholders and users, whether they continue to be published separately from SOPAD or realign back into SOPAD, a National Statistic, as part of the combined compendia publication. In the meantime, there is a need to consider the confusion that may be caused by having two sets of statistics based upon differing methodologies. You may feedback your comments on this using our customer survey here.  

This is the fourth release of data to form part of NOA which includes updates to the quarterly time series for patients who had a primary bariatric surgical procedure in Q3 and Q4 in 2022/23. 

Weight Management Services data in Community Services dataset (CSDS)

This release examines the coverage and completeness of certain key fields needed to monitor activity, access and wait times and patient outcomes for those using Weight Management Services using data submitted to the Community Services Dataset (v1.6). It is not until completeness improves around these key fields that we will be able to publish some further meaningful analyses around these services.  For this initial release, we have looked to gather completeness of information on height and weight/BMI, demographics and number of providers submitting team type referrals for WMS patients. The following tables from CSDS v1.6 have been used:

• CYP001: Master Patient Index
• CYP102: ServiceTypeReferredTo
• CYP201: Care Contact
• CYP202: Care Activity
• CYP611: Observation

WMS referrals

For the purpose of this analysis, WMS referrals are defined as referrals submitted to CSDS within Table CYP102 with a Service or Team Type Referred To coded as 55 (Children's Weight Management Services)  or 56 (Adult's Weight Management Services). Any referrals submitted without this completed will not be captured in the analysis.

Reporting period

The analysis includes new referrals received between January 2023 - March 2023 (reported by month), and includes care contact appointments for the extended period January - April 2023. This is to allow more time for referrals to have had a first care contact appointment within the reporting period. Depending on when the new referral date falls in the reporting period, some patients may still be waiting for a first care contact appointment, some will have had one care contact appointment and some multiple care contact appointments. 

BMI derivations

BMI can be captured within CSDS in a number of different ways. We have looked at where height and weight measurements have been taken simultaneously and the information submitted to CSDS in the Observation Value and UCUM unit of measurement fields in Table CYP202 . This information can be used to derive BMI. We have also checked for actual BMI entries using any clinical coding in the Coded Procedure,  Coded Finding and Coded Observation fields in Table CYP202.  The guidance states for information to be submitted to CYP202 but we have also checked for any Height and Weight information being submitted in Table CYP611.

Tier 2 and Tier 3 providers

For the purpose of the analysis (in particular the filters in the dashboard), providers of WMS who have been captured in this publication have been categorised as either a Tier 2 or a Tier 3 provider (or both) based on information collected internally as follows:

Tier 2 Providers

North Lincolnshire Council

Medway Council

Public Health Derbyshire County Council

Weight Watchers (UK) Ltd

Morelife

DDM Health Ltd

Livewell Dorset

Turning Point

City Health Care Partnership Cic

HCRG Care Ltd

South Warwickshire University NHS Foundation Trust 

Watford FCS Community Sports and Education Trust

Miles Bramwell Executive Services T/A Slimming World

Tier 3 Providers 

North East London NHS Foundation Trust

Mid Cheshire Hospitals NHS Foundation Trust

The Rotherham NHS Foundation Trust

Healthy Minds

Homerton Healthcare NHS Foundation Trust

Midlands Partnership NHS Foundation Trust

Barnet, Enfield and Haringey Mental Health NHS Trust

Leicestershire Partnership NHS Trust

Gloucestershire Hospitals NHS Foundation Trust

North Bristol NHS Trust

Mersey Care NHS Foundation Trust

South West Yorkshire Partnership NHS Foundation Trust

Blackpool Teaching Hospitals NHS Foundation Trust

Leeds Community Healthcare NHS Trust

Derbyshire Community Health Services NHS Foundation Trust

Central London Community Healthcare NHS Trust

Both a Tier 2 and a Tier 3 Provider

Everyone Health