Adam Cairns

Chief Executive

15 January 2014

Mr David Rees AM

Health and Social Care Committee

National Assembly for Wales

Cardiff Bay

Cardiff

CF99 1NA

Dear Mr Rees

Inquiry into the Availability of Bariatric Services

Thank you for giving me the opportunity to comment on the Inquiry into the availability of bariatric services. I am writing in my capacity as Chief Executive of Cardiff and Vale University Health Board. The role of the UHB is to provide day to day health services to a population of around 472,400 people living in Cardiff and the Vale of Glamorgan who need emergency and scheduled hospital treatment and mental health care, as well as delivering care in people's own homes and community clinics. We are also responsible for the delivery of NHS primary care services in Cardiff and the Vale of Glamorgan, including general practitioners, community pharmacists, dentists and optometrists. Additionally, we serve a wider population across South and Mid Wales for specialties such as paediatric intensive care, specialist children's services, renal services, cardiac services, neurology, bone marrow transplantation and medical genetics.

In Cardiff and the Vale, the levels of overweight and obesity are currently at 54%, and obesity is at 20%, according to the Welsh Health Survey. These are the lowest levels of the Welsh Health Boards. However, there are an estimated 7,200 people with a Body Mass Index (BMI) over 40; and an estimated 800 people with a BMI over 50.

The eligibility criteria for specialised bariatric services are stipulated on the Welsh Health Specialised Services Committee (WHSSC) internet pages and are set out below (individuals must satisfy all elements of the access criteria for assessment and treatment to proceed):

a. The individual is aged 18 years or over;

b. The individual has been receiving intensive weight management, medical management, in specialised hospital obesity clinic or a community-based equivalent;

c. The referring clinician and the patient are in agreement about the referral; and

d. The individual has a BMI of 50 or greater in the presence of a serious co morbidity which may be amenable to treatment if obesity is modified through specialised obesity services. In practice this means that the patients have either:

i. Severe and uncontrolled hypertension

ii. Severe and uncontrolled obstructive sleep apnoea

iii. Uncontrolled diabetes despite maximal therapy.

These criteria serve as accepted guidance to the MDT Welsh Institute of Metabolic & Obesity Surgery (WIMOS), Morriston Hospital. Patient suitability is ultimately a clinical decision made by the MDT.

Across Wales there are currently 128 cases allocated for bariatric surgery per annum in 2013/14. This was an increase from the allocation of 80 cases per annum in the previous financial year. The decision to increase the allocation followed on from the ‘Review of Bariatric Surgery Provision and Access Criteria in the Context of the All Wales Obesity Pathway’ paper.

In line with the recommendations of this paper, the Cardiff and Vale Public Health team led a national workshop on Level 3 Obesity Services on 26 November 2013. Following on from this a nationally agreed common access policy and service specification for Level 3 Obesity services will be produced by Spring 2014.

In Cardiff and Vale UHB Level 3 Obesity Services are non-existent due to funding constraints. Level 3 services are critical as a gateway into bariatric services, and will therefore negate the need for bariatric services in the future. Level 3 services are therefore critical to the All Wales Obesity Pathway going forward. Levels 1 to 3 need to be in place prior to looking at Level 4 services.

Yours sincerely

Adam Cairns

Chief Executive