Lighten Up is a service commissioned in Birmingham to help people lose weight, and as a result enjoy an improved quality of life. The service has also reduced expenditure on long-term care due to weight related health problems. The programme includes a city-wide integrated referral and monitoring system where clients are triaged via telephone support to a commercial weight management programme. Weight management is encouraged by offering a free 12-week voucher pack and ongoing support.
The provision of the service aligns to NICE PH53 which recommends that clinical commissioning groups, health and wellbeing boards and local authorities should commission a range of lifestyle weight management programmes (Recommendation 13).
Commissioner: Mark Roscoe, Commissioning Lead-Lifestyles, Birmingham City Council, Birmingham Public Health, 10 Woodcock Street, Aston. Birmingham, West Midlands B7 4BL. Tel: 0121 303 5721 email: firstname.lastname@example.org
Aims & Objectives
Obesity costs Birmingham £2.6 billion per year including NHS costs, social care and wider economic costs. The aim of the Lighten Up service is to reduce these costs and improve the quality of life for people in Birmingham.
NICE recommends that clinical commissioning groups, health and wellbeing boards and local authorities should commission a range of lifestyle weight management programmes (Recommendation 13). Our first objective was to bring eligible patients into a support system and triage them to the most suitable of 4 weight management interventions - Slimming World, Weight Watchers, Rosemary Conley or NHS MyChoice. Following this, the service aim was to encourage patients to commence a programme most suitable to their individual needs and maximize their weight loss during a 12-week period.
On completion of the initial 12 weeks, the service continues to support the client to maintain their weight loss or to continue to lose weight, if appropriate. In line with NICE recommendation 13, the programme encourages client empowerment to increase the likelihood of sustainable weight management, as well as providing maintenance calls and support packs at 12 weeks and 12 months after the initial intervention.
Prior to the Lighten Up programme weight management was largely undertaken via general advice in general practice with little standardised support or capacity to support patients appropriately with general patient appointments. While the option of referral to commercial provision was possible, many chose to undertake weight management within the surgery with variable success.
Commercial provision married with support and administration via a standardised system enabled improved access and sustained engagement from those that required the service. A study was commissioned on the efficacy of commercial support when compared to GP clinical support for weight management. This was undertaken in co-operation with the University of Birmingham and the progenitor of the current Lighten Up service was formed to handle administration and support duties. The results were published in the British Medical Journal.
It was found that the commercial providers were more effective in producing the significant initial weight loss required for transitioning to maintenance than practice led services. Cost per patient was standardised, allowing for far easier budgeting based on demand figures, while still allowing flexibility in choice of support. The use of a dedicated admin team and call-centre format for the service eliminated practically all paperwork and administration for GP practice staff. This also gives a single point of contact for patients, and a conduit through which service users can voice concerns or find solutions to problems with their service providers.
When Lighten Up was first set up there was an initial cost incurred in setting up a dedicated database system to help with the administration and support for patients engaging in our programme. Practical barriers were encountered in taking concepts from the pilot programme and making them viable for sustained use. An example of such a concept is the issuing of a voucher or starter pack to a client. We must be able to track the use of, and if necessary reclaim unused vouchers. This required co-ordination with our providers as well as implementing an auditing system to track what resources had been issued.
Another obstacle was proper negotiation of pricing and service from the commercial weight loss providers. Reporting of patient data, including frequency and accuracy, had to be ratified and outlined in Service Level Agreements. This transferring of personal data to and from external sources also necessitated careful consideration and implementation of data security protocols. In terms of resource cost, it can be seen as similar for every patient. Most support activities and administration duties take the same resources in terms of time and manpower, and materials issued to patients have set prices. Overspend only occurs when demand for the service outstrips initial annual projections.
Results and evaluation
There are several vectors of evaluation and results gathering that are continually being pursued in Lighten Up to ensure our service is still effective. Initial trial outcomes are supported by continual analysis of weight loss data received from commercial providers, with annual reports being generated to collate average weight loss and ensure our methods are still effective.
We also undertake informal evaluation of our service impact using a data capture technique called Impact Assessment. We ask patients how we have helped them and record their comments, as well as a rating of their overall happiness. In addition to this we have more formal evaluations at the end of the 12 week support period. These are intended to ensure that the voice of service users is heard, and that any discontent with ourselves or our partners - perceived or otherwise - is dealt with properly. We have maintained consistent positive outcomes during the entire length of the Lighten Up programme's existence.
During reporting period 01/04/2012 to 31/03/2013, 68.5% of those engaging in our service achieved weight loss during their first 12 weeks, with 26.3% of those engaging with our service achieving greater than 5 per cent body mass loss. 25.6% of those responding to follow up inquiries at 3 months report sustained weight or continued weight loss, though many were unaware of their current weight or were unable to be contacted.
We also received scores averaging 8.4/10 for overall service delivery and all patients who submitted evaluations would recommend the Lighten Up service to others. We feel that these outcomes have been consistently above expectations set out by commissioners, and are also evidenced by year on year increase in demand for our service.
Key learning points
To implement a successful programme in the mould of Lighten Up, there are several key areas that must be properly addressed:
- Appropriate training and support for staff to ensure they provide effective brief intervention advice and support for patients that reflects the differing needs of a diverse population.
- Potential for offering additional vouchers packs to 'successful' service users whose BMI is still above eligibility criteria.
Consideration of early dropout rates amongst service users should be considered both in terms of supporting them to stay in groups but also for negotiation with providers around cost.
- Proper database systems and IT support must be in place to handle patient, provider and auditing data. Data volumes and reporting that are necessary to effectively deliver Lighten Up cannot be handled without this.
- Management of demand may be an issue so consideration of parameters to manage this should be considered to include deprivation data or BMI information.
- Set agreements on price, data submission, service delivery and communications protocols with service delivery partners early. Continually revise these as required to ensure service goals are being met.
- Ongoing revision and evaluation of models of good practice to ensure the service remains effective. Recent reviews of the service have resulted in the embedding of online weight management programmes specific for men and women for those patients that may not require the support of an intensive 12 week commercial sliming programme.