Commissioning Weight Management Services Professor Jonathan Valabhji National Clinical Director for Obesity and Diabetes Berkshire Public Health Weight Management Services Conference 4 th December 2014

Implementation of the Health and Social Care Act 1 st April 2013 Over-arching Principles Localism Clinical leadership Generic approach – away from disease specificity Public Health moved from health to local authorities Parity of esteem More proactive than reactive NHS

Commissioning Roles CCGs (n = 211) Directly commission roles for (£65 billion) secondary care (including non-elective services) community care NHS England Direct commissioning roles for: Primary Care (£12 billion) Specialist Services (£13 billion) Justice Services Armed forces health Local Authorities – Public Health England Direct commissioning roles Physical activity, nutrition, obesity

Achieving Integrated Care ProviderCommissioner Primary CareNHS England Community CareCCGs Secondary CareCCGs Tertiary CareNHS England Social CareLocal Authorities

Achieving Integrated Care Sample Diabetes Service Specification For CCGs to use if they so choose Published 29 th July t/content/view/134433/network

Commissioning Obesity Services

Tier 1Prevention strategies + health promotion (Primary responsibility = local authorities / PHE) Tier 2Interventions for weight management eg. commercial programs, exercise on referral, dietetic services, community pharmacy, community care, GP (Primary responsibility = local authorities / PHE) Tier 3Multidisciplinary team (MDT) – clinician led (Primary responsibility = ? local authorities / PHE ? CCGs) Tier 4Specialised complex obesity services (including bariatric surgery) (Primary responsibility = NHS England) Structure of Delivery of Obesity Services

Joined Up Clinical Pathways for Obesity Association of Directors of Public Health Association of Directors of Adult Social Services Clinical Commissioning Groups (CCGs) - nominations via the Commissioning Assembly Department of Health (DH) Local Authority (LAs) - Consultants in Public Health / Commissioners /Health Improvement Specialists NHS England National Institute for Health and Care Excellence (NICE) Patient User Representatives Public Health England (PHE) Royal College of Physicians National Obesity Forum Structure of Delivery of Obesity Services

Tier 1Prevention strategies + health promotion (Primary responsibility = local authorities / PHE) Tier 2Interventions for weight management eg. commercial programs, exercise on referral, dietetic services, community pharmacy, community care, GP (Primary responsibility = local authorities / PHE) Tier 3Multidisciplinary team (MDT) – clinician led (Primary responsibility = CCGs) Tier 4Specialised complex obesity services (including bariatric surgery) (Primary responsibility = NHS England, currently, later to transfer to CCGs) Structure of Delivery of Obesity Services

New NHS England Leadership 1 st April 2014 Infrastructure Reviews NHS England Direct commissioning roles Primary Care Specialist Commissioning Relative roles of: Strategic Clinical Networks Clinical Senates Academic Health Science Networks

Five Year Forward View – October 2014 Prevention – “National diabetes prevention programme” Integrated care Employer responsibility for employee health

NICE Guidance

Morbid Obesity Surgery Services In October 2014 the Prescribed Specialised Services Advisory Group recommended to Ministers that the commissioning responsibility for renal dialysis services and morbid obesity surgery services should transfer to Clinical Commissioning Groups.

Morbid Obesity Surgery Services services-from-nhs-england-to-ccgs

Morbid Obesity Surgery Services services-from-nhs-england-to-ccgs Support for CCGs and monitoring Ministers have requested guarantees from NHS England for national commissioning guidance – CCGs would be mandated to have regard to national commissioning guidelines Enhanced role of the Clinical Reference Group (NHS England would continue to commission morbid obesity services for children)

Consultation Questions Are the proposals NHS England has made for producing commissioning guidance to support Clinical Commissioning Groups in taking on the commissioning responsibility for morbid obesity surgery services appropriate? Is there any additional support that CCGs might need from NHS England to enable them to take on this new role and ensure morbid obesity surgery services are commissioned and delivered to a high standard? How long might this support be needed for? What ongoing monitoring arrangements should be put in place and who should be responsible for ensuring that the transfer is effective and is working well? Subject to the safeguards and support described in this document, do you think it is feasible to transfer commissioning responsibility for morbid obesity surgery services to Clinical Commissioning Groups from 1 April 2015?