Guidance

Supporting adult weight management services grant to local authorities for adult tier 2 behavioural weight management services

Published 5 July 2021

Applies to England

In March 2021, the government announced an additional £100 million in the financial year 2021 to 2022 to support people living with excess weight and obesity to lose weight and maintain healthier lifestyles.

The Adult Weight Management Services Grant (number 31/5440) distributes over £30 million of this new funding between all local authorities in England who accepted the grant, to support the expansion of adult tier 2 behavioural weight management services commissioned by local authorities. This is part of a place-based, whole-systems approach to tackling obesity and promoting healthier weight. Further background to the funding can be found in appendix A below.

The funding is in addition to the money that local authorities already spend on adult tier 2 behavioural weight management services from the public health grant and must be used to commission new, or expand existing, services. The funding will be allocated via a ringfenced grant under section 31 of the Local Government Act 2003.

Please see Adult weight management services grant determination 2021 to 2022 for an outline of allocations for each local authority in England.

Allocations have been weighted according to local authority population size, obesity prevalence and deprivation levels to enable the money to go to where the need is greatest. Please refer to the grant allocation letter for further information on payment of the grant to your local authority.

Grant conditions

Conditions of the grant are set out in Annex A of the grant determination.

Key conditions

Eligible expenditure

Local authorities are required to use funding to commission new, or expand existing, adult tier 2 behavioural weight management services (expansion of existing services may be achieved through the use of current or different providers – this is to be determined locally).

Data collection

Local authorities are required to supply information on current adult tier 2 behavioural weight management service provision at the end of month 1 (services funded through the public health grant) and month 12 (services funded through the public health and the section 31 grant) (see appendix B below) from the date of receiving the grant through a survey. Local authorities currently without adult tier 2 behavioural weight management services in place will be expected to complete all applicable questions in the survey.

Local authorities are required to ensure service providers submit anonymised service-user level demographic and outcome data to the Office for Health Improvement and Disparities (OHID) on a monthly basis using a standardised minimum data set (see appendix C below).

Progress reporting

Local authorities are required to share financial reports on expenditure at regular intervals throughout the year.

Table 1: Key submission dates

Deadline	Submission
25 April 2021	Deadline for returning the signed grant acceptance form
Dates to be confirmed by OHID	Submission of financial reports on expenditure to OHID at 6, 9 and 12 months
14 May 2021	Completion of a survey of service provision data at 1 month
30 April 2022	Completion of a survey of service provision data at 12 months
The end of each month in arrears for the contract period	Submission of data to OHID will be on a monthly basis in arrears for completed activity in the month and submitted by the end of the following month

Commissioning and procurement of services: dynamic purchasing system

We recognise the challenging timeframe of this 1-year programme, particularly for local authorities who currently do not have weight management services in place. To support local authorities with the procurement of adult weight management services, a dynamic purchasing system (DPS) was launched in August 2021 by PHE. From 1 October 2021 responsibility for this was transferred to OHID. The DPS has been designed to facilitate the local commissioning and procurement of services. It aims to provide a service that enables timely and effective commissioning by:

• providing a ‘repository’ of service providers who have demonstrated they can meet a set of minimum service standards which supports a local authority need when it comes to quality assurance and the commissioning process
• reducing the time it takes to engage and implement adult tier 2 behavioural weight management services in local authorities
• aiming to bring together a dynamic system that includes small and medium enterprises (SMEs), ensuring equal access to all service providers from SMEs to larger commercial enterprises
• providing a system that is in line with all relevant procurement legislation so that local areas do not need to develop their own paperwork

Local authorities can use the DPS on a voluntary basis.

Support for commissioning and delivering weight management services

A suite of existing PHE and National Institute for Health and Care Excellence (NICE) guidance is available to support the commissioning of adult tier 2 behavioural weight management services (appendix D below). In addition to this, OHID will be working with local authorities, providers, service users and academics throughout the year to identify what additional support, evidence and tools are needed to enable the scaling up of weight management services across the country, including reaching population groups with the greatest need.

OHID does not underestimate the realities and challenges faced by local authorities, providers, service users and the public, particularly in light of the pandemic. OHID is committed to working together to explore the opportunities provided through this increased investment, how this contributes to and enables future service provision and importantly how to enable services to support a broader diversity of people living with obesity.

Engagement events with local authorities and providers

PHE delivered a series of national and regional webinars and roundtables in March and April 2021 to support local authorities with implementation of the grants.

OHID is working with the Local Government Association (LGA) and Association of Directors of Public Health (ADPH) throughout the programme to support implementation at a local level and promote the exchange of knowledge and learning. Further information on what this support looks like and future events throughout 2021 to 2022 will be shared throughout the year. These may include local support with commissioning weight management services.

OHID is keen to work with local authorities, providers, the LGA and ADPH to consider further opportunities to encourage and promote sharing of local practice. This will be particularly important when it comes to targeting approaches to under-serviced communities and population groups, to help address inequalities relating to obesity.

Appendix A: background to the funding

Tackling obesity is one of the greatest long-term health challenges this country faces. Today, around two-thirds (64%) of adults are above a healthy weight, and of these, half are living with obesity. One in 3 children leaving primary school are already living with overweight or obesity, with 1 in 5 living with obesity. Children in our most deprived communities are twice as likely to be living with obesity compared to children in the least deprived communities. This has a cost to the individual, but also an estimated cost to the wider economy of £27 billion. In the year 2014 to 2015, the NHS spent £6.1 billion on overweight and obesity-related ill health in the UK.^{[footnote 1]}

We have known for decades that living with obesity reduces life expectancy and increases the chance of serious diseases such as cardiovascular disease, type 2 diabetes, some cancers and liver disease. There is also now consistent evidence that people who are living with overweight or obesity who contract coronavirus (COVID-19) are more likely to be admitted to hospital, to an intensive care unit and sadly to die from COVID-19 compared to people of a healthy body weight status. As in many areas including health inequalities, COVID-19 has shone a light on an existing problem and bought it to the forefront so that obesity is now an immediate concern for our health and care services and for people living with excess weight.

The Prime Minister has made tackling obesity a priority, recognising that healthier populations are at decreased risk of diseases like COVID-19. Given the huge socio-economic disparity in healthy life expectancy in the UK, tackling obesity is fundamental to, and at the heart of, the government’s ‘levelling-up’ agenda.

In July 2020 the government launched Tackling obesity: Empowering adults and children to live healthier lives, which demonstrated the government’s commitment to supporting a healthier environment to help support a healthy weight and to expand weight management services so that more people get the support they need to lose weight. The current funding is part of this commitment.

Appendix B: adult tier 2 behavioural weight management services provision data

As part of the grant conditions, local authorities are required to submit information on service provision at the end of month 1 and month 12 from the date of receiving the grant (or at such intervals as may be specified by OHID) through an online survey. For local authorities who do not currently have adult tier 2 behavioural weight management services in place, there are fewer questions to complete.

The purpose of this data collection is to monitor progress in expanding weight management services and to understand how providers, services and the referral process vary across the country.

Appendix C: minimum data set

As part of the grant conditions, local authorities are required to ensure that service providers supply OHID with data on their services in the form of a minimum data set. This will be the first time that data has been collected, in such a systematic way, on local authority adult tier 2 behavioural weight management services at a national level. In this first year, we are taking a pragmatic approach to data collection and are focusing on a minimum data set of process, demographic and outcome data. In the longer term, we hope that data on local authority commissioned services will be collected, via the Community Services Data Set, to the National Obesity Audit (NOA) that is being developed by NHS England and NHS Improvement (NHSE&I). Through the collection and analysis of data on service provision and outcomes, the NOA will, at its core, be a mechanism to drive improvement in access to and outcomes from care for the benefit of those living with overweight and obesity.

For the current programme, local authorities, through their service providers, are required to submit a minimum data set of de-personalised participant-level demographic and outcomes data to OHID on a monthly basis in arrears for adult tier 2 behavioural weight management services that are commissioned with the funding from this grant. We recommend that local authorities include this as a requirement in their contract with service providers. The purpose of this data collection is to monitor progress with expanding weight management services across the country and to contribute to the understanding of what interventions are being delivered across the country and which interventions work for different population sub-groups. It will also help build the future case for additional investment for adult tier 2 behavioural weight management services.

Although not a mandatory requirement of the grant, we would also encourage local authorities and providers to share the same data for services that are commissioned through the public health grant to enable us to have a full picture of all services delivered in England.

If submitting both sets of data (that is services funded through the public health grant and services funded through the section 31 grant), providers will need, where possible, to specify the source of funding for each data set provided.

The minimum data set and the accompanying technical guidance Adult tier 2 behavioural weight management services commissioned by local authorities: guidance for submitting organisations were sent to local authorities with the grant allocation letter. An updated version of the technical guidance and reporting datasheet will be published on GOV.UK in due course.

The technical guidance includes information on:

• data items for national submission
• how to complete the minimum data set
• measures that OHID will be monitoring

It is anticipated that more data items will be collected locally to facilitate a robust process and impact evaluation of the service, which is critical for local service monitoring and development. It is important that these additional local data collections also meet national standards to ensure that weight management service data is collected consistently between services and aligns with other health and care data sets.

Separate guidance on the data required to facilitate a comprehensive local level evaluation will be provided in an updated version of the standard evaluation framework and supporting data collection tool.

Process for national submission

Local authorities, through their service providers, will be required to submit a minimum data set of de-personalised, participant-level data to OHID on a monthly basis in arrears. The data will be shared with OHID securely, stored and processed in accordance with the law.

Appendix D: guidance to support the commissioning of adult tier 2 behavioural weight management services

The following guidance can support local authorities and providers with the commissioning and delivery of adult tier 2 behavioural weight management services:

NICE (2014):

• Weight management: lifestyle services for overweight or obese adults (PH53)
• Obesity: identification, assessment and management (cg 189)

NICE (2016):

• Obesity in adults: prevention and lifestyle weight management programmes Quality standard (qs111)

PHE (2017):

• A guide to commissioning and delivering tier 2 weight management services
• Key performance indicators: tier 2 weight management services for adults
• Capturing data: a tool to collect and record adult weight management service data
• Changing behaviour: techniques for tier 2 adult weight management services
• Let’s talk about weight: a step-by-step guide to brief interventions with adults for health and care professionals

PHE (2018):

• Standard evaluation framework for weight management interventions

PHE (2021):

• Supporting weight management services during the COVID-19 pandemic

References

1. Scarborough P and others. ‘The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006–07 NHS costs’ Journal of Public Health 2011: volume 33(4), pages 527-35 (NB: The direct cost to the NHS in the financial year 2006 to 2007 of people being overweight and obese was £5.1 billion. These costs have been updated to £6.1 billion to take into account inflation.) ↩