National Obesity Audit, April 2024 - June 2024 [Management Information]

Hospital Episode Statistics (HES)

NHS England (previously NHS Digital) has worked closely with the British Obesity and Metabolic Surgery Society (BOMSS) and policy colleagues to develop a methodology to define how the number of people receiving bariatric surgical procedures (reported separately for primary, revisions and gastric balloons (temporary procedures)), can be most accurately derived from HES data. The names of individual bariatric procedures in HES may not directly correspond with the names commonly used by the bariatric surgeons, so clinical input has been necessary to help overcome this. We have responded to advice from BOMSS to use a more limited code list to identify primary procedures. Whilst the methodology used to derive these statistics has been designed with this input, these numbers should be viewed as developmental until we further refine the methodology with users and stakeholders. Full details of the constructions used are in the metadata document with this release. 

NHS England has historically published data on admissions and number of finished consultant episodes (FCEs) for bariatric surgical procedures in the Statistics on Public Health (SoPH) publication (previously known as Statistics on Obesity, Physical Activity and Diet (SOPAD) publication), which now proposes to use the same methodology (in terms of clinical procedure codes) as this National Obesity Audit (NOA) publication following a consultation. There are some slight differences in reporting where SoPH counts the number of procedures and admissions for bariatric surgical procedures with no separate measures for revisions or gastric balloons.  

Therefore, we will consider in liaison with stakeholders and users, whether these figures continue to be published separately from SoPH or the two publications somehow align in future. You may feedback your comments on this or any aspect of this publication using our customer survey here.  

Weight Management Services (WMS) data in Community Services Data Set (CSDS)

This release examines the coverage and completeness of certain key fields needed to monitor activity, access and wait times and patient outcomes for those using WMS using data submitted to the CSDS (v1.6). It is not until completeness improves around these key fields that we will be able to publish some further meaningful analyses around these services.  For this release, we have continued to look at the completeness of information on height and weight/Body Mass Index (BMI), demographics and number of providers submitting WMS referrals for patients. We have slightly amended the height and weight/BMI methodology, looking only at height/weight/BMI where measurements have been submitted.

The following tables from CSDS v1.6 have been used for the DQ metrics:

• CYP001: Master Patient Index
• CYP102: ServiceTypeReferredTo
• CYP201: Care Contact
• CYP202: Care Activity
• CYP611: Observation

WMS referrals

For the purpose of this analysis, WMS referrals are defined as referrals submitted to CSDS within Table CYP102 with a Service or Team Type Referred To coded as 55 (Children's Weight Management Services)  or 56 (Adult's Weight Management Services). Any referrals submitted without this completed will not be captured in the analysis.

Reporting period

The analysis includes new referrals received between July 2023 - June 2024 (reported by month), and includes care contact appointments up to one month greater than the quarter end. For example, for Q1, April to June 2024, the extended period for care contact appointments is April to July 2024. This is to allow more time for referrals to have had a first care contact appointment within the reporting period. Depending on when the new referral date falls in the reporting period, some patients may still be waiting for a first care contact appointment, some will have had one care contact appointment and some multiple care contact appointments. 

BMI derivations

BMI can be captured within CSDS in a number of different ways. We have looked at where height and weight measurements have been taken simultaneously from the information submitted to CSDS in the Observation Value and UCUM unit of measurement fields in Table CYP202, where Observation Value is not null with a corresponding valid UCUM unit of measurement relating to height and weight. This information can be used to derive BMI. We have also checked for BMI measurements in the Observation Value field with a corresponding valid UCUM unit of measurement relating to BMI.  The guidance states for information to be submitted to CYP202 (as this is where clinical codes can be submitted to support any measurements recorded) but we have also checked for any Height and Weight information being submitted in Table CYP611 (which is for those for those providers that don't yet use clinical codes).

Tier 2 and Tier 3 providers

For the purpose of the analysis (in particular the filters in the dashboard), providers of WMS who have been captured in this publication have been categorised as either a Tier 2 or a Tier 3 provider (or both) based on information collected internally.  An excel file containing this information is available to download in the Resources section of the Overview Chapter.