HASEX: Adult Weight Management Service – proposed contract extension
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Date: 10 December 2021 |
Service Area: Public Health |
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Report Author: Ruth Everson and Katie Needham |
HASLT Lead: Louise Wallace |
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1.0 |
Executive Summary
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1.1 |
REPORT TO
Corporate Director of Health and Adult Services (HAS) in consultation with Executive Member for Adult Services and Health Integration and the Executive Member for Public Health, Prevention and Supported Housing, including Sustainability and Transformation Plans.
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1.2 |
KEY DECISION DATE
10 December 2021 (original decision date 19 November 2021 – decision deferred)
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2.0 |
Recommendations
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2.1 |
To agree an extension to the current Adult Weight Management Service for a further two years after the contract end date (30th June 2022 for 6 lots and 2nd July 2022 for Selby lot).
The Council needs to give notice of extension by 1 January 2022.
It is recommended that a separate report will be brought to HASEX in January 2022 to consider assurance options for provider service continuity, in the context of the pressures which Covid-19 has created within the health, leisure and fitness sector nationally. |
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3.0 |
Is This Paper To Be Presented To EXEC Members? (Yes/No) |
Yes |
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4.0 |
What Type Of Report Is This? |
Yes/No |
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Information Item |
No |
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Decision |
Yes
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5.0 |
Report Details
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5.1 |
BACKGROUND TO SUPPORT THE RECOMMENDATION
Obesity is a chronic condition which requires multi-level action across all sectors, and part of this action should include local authorities and clinical commissioning groups co-commissioning weight management services across the obesity pathway.
There is a well recognised tiered approach to support the prevention and management of overweight and obesity (UK Obesity Care Pathway), illustrated below:
Local authorities are responsible for commissioning of services at tier 2 and supporting interventions at the population level at tier 1.
As a local authority responsibility, North Yorkshire County Council Public Health team formally procured A North Yorkshire Adult Weight Management Service (tier 2). The Service launching in Selby in July 2017 and the remaining 6 lots (districts areas) in January 2018. The Service was established in line with NICE guidance and was modelled using the findings from a North Yorkshire pilot service that was academically evaluated by Teesside University.
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5.2 |
The contracted service incorporates a structured assessment process from referral; triaging clients to assess eligibility and readiness to change, and supporting clients to set and review weight loss plans and physical activity agreements with their weight management advisor at an initial health assessment, 12 week and 24 week assessments. Clients are supported to achieve a 5% weight loss at 12 weeks and sustain 5% weight loss at 24 weeks. The Service provides weekly weigh-ins, structured nutritional advice and a free facilitated physical activity offer. Pre-pandemic, the Service was exceeding NICE guidance estimates of client completion and weight loss achievements.
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5.3 |
Prior to Covid-19 the Service has been exceeding modelled outcomes, based on NICE guidance, with double the amount of clients achieving 5% weight loss (around 70% of programme completers) at 12 weeks than predicted. An average of 50% of clients sustain their weight loss at 24 weeks. The impact of Covid-19 has been mostly on the number of referrals that have been received into the Service and clients being in a position to complete a 12 week programme. The percentage of clients achieving and sustaining a weight loss outcome still remain above NICE guidance and local modelling.
Through the pandemic, the Adult Weight Management Service continues to evolve and respond. The Service provides the highest flexibility, in accordance to individual circumstances, needs and within national guidance and tiered restrictions. The Service offered in each locality is a hybrid of online, telephone, and some face-to-face support (dependent on current restrictions).
In additional to local recognition of the Service success, North Yorkshire has been recognised as a national Local Government Agency case study, has been recognised at national and local conferences and webinars, and has been a significant contributor to national Public Health England weight management published evaluation and research.
Since the Service launched in July 2017 (up to end of September 2021), there have been 7,143** referrals, of which 3,718 clients completed a 12 week programme, 2,473 clients lost 5% weight loss at 12 weeks and 1,427 clients who have sustained their weight loss at 24 weeks. ** referrals have been affected by the pandemic throughout 2020 and 2021
The available annual budget for the Adult Weight Management Service is £400,000, which is made up of annual up front payments and outcome payments for each provider. Since the Service was launched in July 17 to end of September 2021, we have invested £1,307,563 (averaging £373,589* per annum) in supporting residents to manage their weight through high quality, evidenced based service delivery. *outcome payments have been affected as a result of the pandemic.
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5.4 |
Since the formal procurement of the Service, there have been formal performance management and contract review procedures in place. The Commissioner and Provider(s) meet quarterly to review performance against targets and agree any service improvement actions required or issues of concern. The Commissioner, Provider(s) and Quality Assurance team meet annually review contract requirements. Any performance issues are escalated within the HAS governance structure and managed with the support of the Quality Assurance Team. We continue to closely monitor performance of all our providers throughout the contract period.
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5.5 |
The prevalence of excess weight both in children and adults is on an upward trend both nationally and locally, with some of our localities demonstrating prevalence significantly higher than the England average. Societal changes associated with the pandemic may have increased the risk of weight gain. Over the past year, we have seen changes in the patterns of food purchases and physical activity that may be associated with increased calorie intake and excess weight gain. There have also been changes in societal, economic and psychosocial factors that have been linked to excess weight gain. For instance, rates of unemployment and mental illness have increased during the pandemic.
With an invested interest in managing obesity by the current Government, and local adult weight management pathways strengthening across the system with the new GP enhanced service specification, it is recommended that the North Yorkshire Adult Weight Management Service be extended for a minimum of two years (contract end dates 30th June 2024).
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5.6 |
This Service will be reviewed during the contract extension period as part of Local Government Review process. The leisure provision and assets are significant in delivery of the Adult Weight Management Service. An extension of the Service will provide an opportunity to explore options for effective, sustainable weight management support for our residents within new governance arrangements and opportunities explored about how they might be further integrated into the future council’s leisure provision/offer.
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6.0 |
Significant Risks And Mitigation
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6.1 |
It is noted that Covid-19 has created pressures in service delivery. We are working closely with our Service providers to assess level of risk and ensure they have business continuity arrangements in place. It is therefore recommended that a separate report be brought to HASEX in January 2022 to consider assurance options for provider service continuity, in the context of the pressures which Covid-19 has created within the health, leisure and fitness sector national.
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7.0 |
LEGAL AND GOVERNANCE COMPLIANCE
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7.1 |
Contract and Procurement Services and Legal and Democratic Services have been consulted on the contract extension. The contract will be extended under Regulation 72 (1) (e) of the Public Contract Regulations 2015.
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8.0 |
RECOMMENDATION
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8.1 |
To agree an extension to the current Adult Weight Management Service for a further two years after the contract end date (30th June 2022 for 6 lots and 2nd July 2022 for Selby lot).
The Council needs to give notice of extension by 1 January 2022.
It is recommended that a separate report will be brought to HASEX in January 2022 to consider assurance options for provider service continuity, in the context of the pressures which Covid-19 has created within the health, leisure and fitness sector nationally.
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