North Yorkshire Council

Health and Adult Services

Executive Member Meeting

Friday 21^st July 2023

REPORT TO Corporate Director of Health and Adult Services (HAS) in consultation with the Director of Public Health and Executive Member for Health and Adult Services

North Yorkshire Weight Management Service – proposed 6-month extension

1.0 Purpose Of Report (required)

Prior to the Local Government Reorganisation, the North Yorkshire Adult Weight Management Service (AWMS) contracts were awarded in 7 lots across the county and within the former district and borough boundaries.

Due to the one council approach from April 2023, four contracts now adapt to being service level agreements in Craven, Hambleton, Harrogate and Richmondshire and contract procedure rules no longer apply. AWMS provision contracts remain for Selby, Scarborough and Ryedale, which are due to end on 30^th June 2024.

A pilot Children and Families Weight Management Service (CFWMS) commenced in April 2023 is due to run up to the same timeframe.

The aspiration for future provision is an all-age service for North Yorkshire, which continues to further evolve in line with recent literature, weight-neutral and compassionate approaches, and with better intelligence on local communities that have the greatest health needs and/or have been under-represented in weight management service provision to date.

Weight management service provision is being considered alongside the scope of the North Yorkshire Council Strategic Leisure Review (SLR). The SLR will conclude in September 2023 with a decision on future outcomes and the operating model shortly thereafter. There is an opportunity to provide an extension to the contracts in order to provide a period of time to align with decisions on the wider model.

The report is to seek approval for the current Adult Weight Management Service contracts for Ryedale, Scarborough and Selby to be extended for a further 6 months (from 1 July 2024 to 31 December 2024) and the Children and Families Weight Management [pilot] Service is further extended for the same timeframe. This brings decisions for the future of the service in line with the Strategic Leisure Review for the future of leisure and well-being services.

2.0 Background

A North Yorkshire Adult Weight Management Service (tier 2) was formally procured with the Service launching in Selby in July 2017 and the remaining 6 district area lots launching in January 2018. An overview of the providers delivering the Service in each district area is illustrated in the table below:

District	Name of service	Service provider
Craven	Healthy Lifestyles	Craven District Council – now in-house
Hambleton	Take That Step	Hambleton District Council – now in-house
Harrogate	Fit 4 Life	Harrogate Borough Council – Brimhams Active (Teckal)
Richmondshire	Choose to Lose	Richmondshire District Council – now in-house
Ryedale	NHS Weight Management Service	Humber NHS Foundation Trust
Scarborough	NHS Weight Management Service	Humber NHS Foundation Trust
Selby	Move It, Lose It	Inspiring Healthy Lifestyles

The contracted service incorporates a structured assessment process from referral:

· triaging clients to assess eligibility and readiness to change,

· initial health assessment with 12 week and 24-week assessment review stages.

· supporting clients to set and review weight loss plans

· developing physical activity agreements with their weight management advisor

Clients are supported to achieve a 5% weight loss at 12 weeks and to sustain 5% weight loss at 24 weeks. The Service provides weekly weigh-ins, structured nutritional advice and a free facilitated physical activity offer.

The new Children and Families Weight Management Service, ‘Healthy Families’, launched for receiving referrals at the beginning of April 2023. This pilot service is provided by Brimhams Active and is delivered across North Yorkshire as a remote service.

The service provides 4 -19 year olds (up to aged 25 years for SEND) and their families, free, evidence-based, remote 9-months weight management service to improve lifestyles and achieve a healthy weight for the long term. The service uses a flexible and ‘compassionate approach’ and focuses on improving healthy lifestyles (nutrition and physical activity), wellbeing and confidence, leading to a reduction or/maintenance of BMI z-score and/or improvements in diet and physical activity behaviour.

3.0 Issues

Decisions need to align with the Strategic Leisure Review – as the AWMS is predominantly delivered through the council’s leisure offer, there is a requirement to align the delivery outcomes for services going forward.

Disparity of ‘Tiered’ services – the current review of this service and also the leisure review provide opportunities to align patient and resident pathways better with wider service offers for weight management. Currently the pathways for ‘tiered’ weight management across health and leisure providers are disjointed and inequal in offer across the county. This period of review enables time to develop better understanding of practice across the county.

4.0 Performance Implications

The AWMS continues to perform exceptionally well and exceeds modelled outcomes for client weight loss at 12 weeks and sustained weight loss at 24 weeks.

For the contract year 5 period (January 2022 – December 2022) referrals into the service continue to be encouraging; a total of 2,515 received. This is back in line with referral rate of pre-pandemic period January - December 2019 (total of 2,650).

Of those referrals, 1,213 clients have completed a 12-week programme (48% of referrals, which is short of the modelled 60% of referrals completing). Pre-pandemic completion rate was at 57%; we are aware there is a covid-legacy impact on completion rates and providers are working hard on increasing adherence to reach modelled amounts.

The Service has seen weight loss outcomes (5% at 12 weeks and sustainers at 24 weeks) exceed annual targets. 784 clients have achieved a 5% weight loss (64% of completers, which is above the 30% modelled amount). 523 clients have sustained 5% weight loss at 24 weeks (66% of 5% achievers at 12 weeks, which exceeds the modelled 50%).

So, although referral uptake is lower than modelled, for those who do engage in the programme, outcomes exceed initial targets.

Service review meetings are held quarterly, with annual contract meetings also delivered with each provider.

The pilot CFWMS began receiving referrals at the beginning of April 2023. Already the Service is supporting over 30 families with multiple beneficiaries in each family. Performance reporting is beginning in June 2023 but early verbal reports indicate very strong adherence to weekly service sessions.

Monthly service review meetings take place and will continue to be delivered throughout the contract.

5.0 Policy Implications

None to note

6.0 Options considered

Alternative options

Option 1 - Decision not to extend AWMS contract

Without the proposed extension and maintaining the current approach to the Adult Weight Management Service, we would need to commence new procurement practices from June 2023 at a time when we are not clear what the future service requirements are.

There needs to be a period long enough for contract value to be worth delivery, which impacts longer term potential planning arrangements. To note – new leisure operating model should begin to take phased effect from 2027.

Option 2 – Do nothing.

The current contracts would expire leaving no service provision in the areas of Selby, Scarborough and Ryedale. Services would continue to be provided in the Craven, Hambleton, Harrogate and Richmondshire areas creating an inequal access to services across the county. This would affect some of our more deprived communities.

Option 3 - Decision not to extend Children and Families pilot Service

The pilot service programme would run to 30 June 2024. The pilot Service will be evaluated but it is potentially too early prior to finalised review of the Adult Weight Management Service. A robust evaluation of the Children and Families pilot Service is required if we are to reshape the Adult Weight Management Service into all age.

7.0 Financial Implications

The extension of the AWMS contract would be at no extra cost to the budget; the annual budget allocation is accounted for within the Public Health grant. The AWMS contract extensions can be funded from the current core allocated budget as planned. The providers are extremely well established in delivering the service and have continued to implement service improvement and development to increase effectiveness of the service to our local residents. As a result, weight loss outcomes exceed NICE guidance modelling, meaning a greater percentage of referrals into the service are achieving weight loss and sustained weight loss outcomes. This is a highly effective service for the value of the contract that is currently in place. There are no savings assigned to this service. Recent uplifts have been agreed for NHS Humber at 2.81% of contract value (Ryedale lot and Scarborough lot).

The impact of the extension financially would be in relation to the requirement for additional Public Health reserve funding for the CFWMS pilot project extension.

8.0 Legal Implications

Procurement and Legal colleagues have confirmed that we are able to further extend the AWMS contracts for the 3 areas as this remains within financial thresholds under current contract procedure rules. Any further extensions would not be permissible due to contract expiry and contract value thresholds being reached. A Gateway 4 has been completed and is with procurement and legal colleagues ready to go to Procurement Management Board.

9.0 Consultation undertaken and responses

No formal consultations planned related to the contract decision.

10.0 Impact on other services/organisations

The AWMS and CFWMS are currently delivered through a mix of in-house and contracted providers. All contracts/agreements except Ryedale and Scarborough are delivered through the council’s leisure services. Ryedale and Scarborough are delivered through the NHS.

Extending the funding provides some stability to these services/organisations whilst a review of service delivery and the SLR are underway. It reduces need for procurement activity for a potential shorter period and enables services/organisations to contribute fully with the SLR and AWMS reviews.

11.0 Risk Management Implications

None to note.

12.0 Human Resources Implications

None to note.

13.0 Equalities Implications

Public Health have drawn up an ‘addressing inequalities’ action plan to support service improvement in relation to access for targeted community groups. Public Health are working with providers to implement actions within the plan.

In addition to this, community engagement is targeting key population groups where there are known health inequalities. Some groups targeted for engagement are also known to be under-represented in the current service. These include men, rural communities, minority communities (ethnic minorities and military), learning difficulties and neurodiversity, physical disabilities and long-term conditions, serious mental illness, pregnant women, teens, & low-income families. A mix of focus groups and surveys are being delivered throughout June and July 2023.

14.0 Environmental impact

None to note.

15.0 Community safety implications

None to note.

16.0 Conclusion and reason for recommendation/s

See recommendation below. Nothing further to add.

14.0 Recommendation/s

Adult Weight Management Service

To extend the contract for:

· 6 months from 1 July 2024 – 31 December 2024 (2 Lots – Scarborough & Ryedale)

· 6 months from 3 July 2024 to 2 January 2025 (Selby)

To ensure aligning of weight management transformation and Strategic Leisure Review planning, it is proposed that the current Adult Weight Management Service contract is extended for a further 6 months (timeframes noted above). The AWMS contract extensions can be funded from the current core allocated budget as planned.

In addition to the alignment of strategic leisure review timeframes, the extended 6 month period will allow more time for analysis of engagement insight and framing of a new service model.

AWMS provision contracts would only need to be extended for Selby, Scarborough and Ryedale. All other areas became ‘in-house’ from April 2023 and will be delivered under current allocated funding arrangements.

The original contracts, taken as individual lots, fell below the threshold (under the Light Touch Regime). The Harrogate lot was the only one that was above threshold. However, taken as a whole the contract values certainly exceed the threshold. Therefore, it is prudent to consider that these contracts fall within the scope of the Public Contracts Regulations 2015 (“PCR 2015”).

Children and Families Weight Management Service pilot

Extend the Children and Families Weight Management Service pilot for 6 months from 1 July 2024 – 31 December 2024. Fund the extension of the pilot through additional Public Health reserve funding.

Report authors and presenters:

Ruth Everson

Public Health Manager

Angela Crossland

Head of Healthier Lives, Communities and Economies