National Obesity Audit requirements specification

This document sets out the requirements for the National Obesity Audit (NOA) and should be read alongside the National Obesity Audit Directions 2023 issued by the Secretary of State for Health and Social Care.

The purpose of the National Obesity Audit Directions 2023 is to enable NHS England to analyse and link obesity data to support the NHS Long Term Plan, which aims to provide better outcomes for the patient.

The NOA will be a patient-level data set which will cover all aspects of services that are publicly funded by the NHS and the Department of Health and Social Care (DHSC) in England. The NOA will follow the patient journey from primary to secondary care, looking at all areas of care, interventions and outcomes. This data set supports the aims of the NHS Long Term plan to deliver:

1. Better outcomes.

2. Better experience, and

3. Better use of resources by offering better value for patients, the population and the taxpayer.

For example, the data will show where patients are being placed out of area, where care packages are being changed frequently, and other evidence which may indicate poor outcomes for the patient, allowing this to be identified and addressed.

The aims of the NOA programme are to:

a. develop a robust, high quality audit designed around key quality indicators likely to best support local and national quality improvement.

b. Achieve, articulate and maintain close alignment with relevant National Institute for Health and Care Excellence (NICE) national guidelines and quality standards throughout the audit, as appropriate;

c. enable improvements through the provision of timely, high quality data that explores variation by comparing providers of healthcare, and comprises an integrated mixture of named Trust or Health Board, commissioner, Multi-Disciplinary Team (MDT), general practitioner, consultant or clinical team level and other levels of reporting;

d. engage patients, carers and families in a meaningful way, achieving a strong patient voice which informs and contributes to the design, functioning, outputs and direction of the audit;

e. consider the value and feasibility of linking data at an individual patient level to other relevant national datasets

f. ensure robust methodological and statistical input at all stages of the audit;

g. identify full range of audiences for the reports and other audit outputs, and plan and tailor them accordingly

h. provide data in a timely, accessible and meaningful manner to support quality improvements, minimising the reporting delay and providing continual access to each unit for their own data

i. utilise strong and effective project and programme management to deliver audit outputs on time and within budget

j. close engagement with the National Diabetes Audit and other national collections to seek opportunities to align scope, methodology and outputs to optimise a whole pathway analysis of diabetes care and outcomes from pregnancy and childhood through to adulthood; and

k. develop and maintain strong engagement with local clinicians, networks, commissioners, patients and their families and carers and charity and community support groups to drive improvements in services for patients

Using the National Data Guardian public benefit guidance¹ we have evaluated that this use of data is for public benefit because:

• it will advance the understanding of the population living with overweight and obesity, their needs, current service provision and outcomes. This includes better understanding of any regional variation and inequalities 
• it will make recommendations to improve the quality of care, outcomes and experience of people living with overweight and obesity, including the identification of good practice to learn from, or areas of poorer practice which need to be addressed
• it will help inform decisions on how to effectively and equitably allocate and evaluate funding according to need

The NCAPOP is commissioned by the Healthcare Quality Improvement Partnership (HQIP) on behalf of NHS England (NHSE) and comprises around 40 projects covering care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual projects, other devolved administrations and crown dependencies.

The NOA is a national clinical audit which is part of the NCAPOP. The Secretary of State for Health and Social Care will use powers under section 254 of the Health and Social Care Act 2012 and section 13ZC of the National Health Service Act 2006 to direct NHS England to analyse and link the NOA data. HQIP assists NHS England in commissioning and contract managing the audit. 

The impact of obesity on population health and the NHS is significant and increasing. Global obesity rates have tripled since 1975, and the UK rates rank among the highest in Europe. Obesity and poor diet are linked with type 2 diabetes, high blood pressure, high cholesterol and increased risk of respiratory, musculoskeletal and liver diseases amongst others. People with obesity are also at increased risk of certain cancers, including being three times more likely to develop colon cancer. Nearly two-thirds of adults in England are living with overweight or obesity. In 2018/19, 876,000 admissions to NHS hospitals recorded obesity as a primary or secondary diagnosis. A third of children leaving primary school are living with overweight or obesity. Children and young people living with obesity have a higher risk of adverse health outcomes and more likely to start adulthood living with obesity.

Adult and children’s weight management services (WMS) are currently commissioned in four tiers (as per NICE clinical guideline 189 recommendations). Tier 1 and Tier 2 services are predominantly, though not exclusively, commissioned by local authorities. Tiers 3 and 4 are predominantly commissioned by Integrated Care Boards (ICBs) (children’s tier 4 services fall under NHS Specialised Commissioning).