Commissioning of Tier 3 Obesity Services by Integrated Care Boards in England: An Analysis of Responses to Freedom of Information Requests

This research surveyed Tier 3 (specialist, multidisciplinary) adult weight management services in England commissioned for the National Health Service (NHS) by Integrated Care Boards (ICBs) across England in financial year 2022-2023. A survey of public health services commissioned by ICBs gathered via freedom of information requests. All 42 ICBs in England surveyed between September and December 2023. Outcome measures were: whether or not there was Tier 3 provision, the type of Tier 3 services provided, the estimated number of patients referred and treated, and the relation of referral rates to measures of deprivation. We had a 100% response rate; five reported no Tier 3 provision. Using regional data and estimates of eligibility for referral to Tier 3 management, only 0%-1.1% of those eligible were referred. Referral rates exclusively to Tier 3 services showed no correlation with the Index of Multiple Deprivation IMD (R ² = 0.27; p = 0.21). Four services commissioned appeared not to meet the definition of a Tier 3 service. Provision of Tier 3 services in England is inadequate and variable and currently fails to meet the needs of the population. Many areas with high levels of deprivation provide the most limited access. Even where commissioned, some services do not meet commissioning guidelines. Action is required to implement Health Service Policy and to ensure obesity services conform with clinical need and national guidelines.