NHS England » Summary of the National Obesity Audit Directions 2023 issued to NHS England by the Secretary of State for Health and Social Care in November 2023

Organisation objective

Statutory item
Governance

Executive summary

This paper is for the Board’s information only to provide an overview of the National Obesity Audit 2023 (Directions) issued to NHS England in November 2023 by the Secretary of State for Health and Social Care (SoS). These Directions have been issued under section 254 of the Health and Social Care Act 2012 (2012 Act) and section 13ZC and 272(7) and (8) of the National Health Service Act 2006 (the 2006 Act).

The purpose of these Directions (Purpose) is to establish the National Obesity Audit (NOA), which will support the implementation of the NHS Long Term Plan which aims to provide better outcomes for the patient.

Action required

The Board is asked to note the new Directions and the information provided in this Paper regarding their purpose, effect, and requirements.

Background

1. Under section 254 of the 2012 Act, the SoS may direct NHSE to establish and operate a system for the collection or analysis of information. These are functions exercisable in relation to the development or operation of information systems in connection with the provision of health services or of adult social care in England. Under section 13ZC of the 2006 Act, the SoS may give NHSE directions as to the exercise of any of its functions. The Directions are issued by the SoS to NHSE under these provisions and are functions which have been transferred to NHSE from NHS Digital (NHSD) under the Health and Social Care Information Centre (Transfer of Functions, Abolition and Transitional Provisions) Regulations 2023.

Purpose of the Direction

2. The Directions require NHSE to develop and operate the National Obesity Audit information system. The purpose of these Directions is to establish the National Obesity Audit (NOA), which will support the implementation of the NHS Long Term Plan which aims to provide better outcomes for the patient.

3. The NOA is part of the National Clinical Audit and Patient Outcomes Programme. The aim of the audit is to drive improvement in quality of care available to those living with overweight and obesity in England. The NOA will follow the patient journey across primary to secondary care, looking at all areas of adult and child weight management care, interventions and outcomes to support current and future services to deliver efficient, effective and equitable prevention and care. The NOA will be a patient-level data set which will cover all people living with overweight and obesity in England, all aspects of weight management services and interventions that are publicly funded and all short and long-term outcomes.

4. The NOA information asset will not collect any additional data from providers, but instead will re-use (analyse and link) data, which is already collected by NHS England, for NOA purposes. This is to avoid burden on the healthcare system therefore the audit will analyse and link data which NHS England already holds as a Controller under the UK GDPR, rather than collect bespoke data. It is expected that the audit will analyse and link the following key data sources:

a) Data from general practices which is collected via the Cardiovascular Disease Prevention (CVDPrevent) Audit (CVDP) through the General Practice Extraction Service (GPES) under the Cardiovascular Disease Prevention Audit Directions 2020 *. GP data will also be retrieved for any new relevant people identified from the Community Services Dataset or the Hospital Episode Statistics mentioned below. 

b) Community Services Dataset (CSDS) collected under the Community Services Dataset Directions 2020 **. This includes data from private providers who have been publicly funded to deliver these services.

c) Hospital Episode Statistics (HES) / Admitted Patient Care (APC) data collected under the Spine Services (No.2) 2014 Directions*** to collect data relating to Tier 4 obesity related bariatric surgery interventions. This includes data from private providers where procedures have been funded by the NHS. 

d) Other data sources NHS England holds where there is a clear lawful basis for the linkage and it meets the purpose of the NOA. Additional linkage will be subject to prior approval by the information governance team and in accordance with information governance procedures and controls, including where required, advice from the Advisory Group for Data.

* Establishment of information systems: Cardiovascular disease prevention audit Directions 2020. The Directions were given by NHS England to the Health and Social Care Information Centre (NHS Digital) on 13 October 2020. NHS Digital was abolished, and its functions transferred to NHS England, with effect from 1 February 2023, by the Health and Social Care Information Centre (Transfer of Functions, Abolition and Transitional Provisions) Regulations 2023 (S.I. 2023/98.). By virtue of regulation 3, those Directions have effect as if given by the Secretary of State to NHS England.

** Community Services Data Set Directions 2020. The Directions were given by the Secretary of State to NHS Digital on 25 January 2021. (See footnote 1 as to the abolition of NHS Digital and the transfer of its functions to NHS England).

*** Spine services (no 2) 2014 Direction. The Directions were given by the Secretary of State to NHS Digital on 5 December 2014. (See footnote 1 as to the abolition of NHS Digital and the transfer of its functions to NHS England).

Publication

5. NHS England has a duty to publish information obtained as a result of complying with the Directions in accordance with section 260(1) of the 2012 Act. NOA data will be published at named provider level to enable individual providers to monitor performance and outcomes across their organisation. This is to aid strategic planning across NHS funded providers so that resources can be focused on improvements that benefit patient care.

6. It is intended that NHS England will also publish an annual report and quarterly dashboards of NOA data and will continue to publish aggregate anonymous statistical data in the manner agreed by DHSC, excluding any information that might make individual patients identifiable. All published data will have disclosure control applied including small number suppression and rounding.

Effect and requirements of the Direction

7. From the date of signature of the Directions, NHS England will have a legal duty to comply with the Directions, which will require it:

a) to establish and operate such systems for the analysis and linkage of information as are necessary to meet the above Purpose of the Directions; and

b) to analyse the information, including linkage to other data lawfully held by NHS England, as NHS England determines is necessary, to achieve the above Purpose.

8. These functions are to be exercised in accordance with the Requirements Specification attached to the Directions (as they may be updated from time to time). Also in accordance with the service levels, support and monitoring requirements, and the reporting and governance requirements notified by the SoS in writing to NHS England. The exercise by NHS England of the functions set out in the Directions is also subject to the statutory guidance issued by the SoS to NHS England under section 274A of the 2012 Act: NHS England’s protection of patient data, 23 May 2023 which is guidance that NHS England has a duty to have regard to when discharing its functions under these Directions.

Approval of acceptance of Directions and publication

9. The National Director of Transformation and National Medical Director approved acceptance of the Directions on behalf of the Accounting Officer as set out in the NHS England Scheme of Delegation. The Directions have been published on the NHS Digital website.

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