Further memorandum by Abbott Laboratories
(WP 32)
INTRODUCTION
1. Abbott Laboratories is an international
healthcare corporation, which has been operating in the UK for
over 60 years. We welcome the opportunity to respond to the Committee's
new inquiry into the Government's Public Health White Paper.
2. Our obesity treatment Reductil (Sibutramine)
was positively appraised by NICE in October 2001. We submitted
a memorandum to the initial Health Select Committee Inquiry into
obesity, and supported the Dr Foster survey cited in the Choosing
Health White Paper (though incorrectly attributed to Roche).
3. We attach to this memorandum a soon to
be published new Dr Foster survey (2004) [not printed].
We have supported (via an unrestricted educational grant) the
research and subsequent production of this report, which contains
new data for 2004 on obesity management services in primary care
and comparisons with 2003 data.
Will the Committee's proposals enable the Government
to achieve its public health goals?
4. In relation to tackling obesity, we are
concerned that the proposals set out by the Government to date
in its response to the Committee's Report and in the Choosing
Health White Paper will not enable the Government to meet its
public health goals.
5. Physical activity and diet are central
to improving the health of the nation, but the third pillar of
a successful anti-obesity strategy (medical intervention and treatment),
has not been given due consideration in the Government's response.
6. We share the Committee's fear (para 394)
that, "the extent and seriousness of the obesity problem
will be lost by including obesity only as part of a wider umbrella
of general public health initiatives."
7. While we welcome the announcement of
a PSA target in obesity for under-11s, we think a corresponding
target for adults should have been introduced in light of the
extensive body of evidence that now exists on the costs of obesity.
8. We believe a PSA target for adults would
serve to focus PCOs and medical professionals upon the importance
of treating/preventing obesity and would enable service providers
to adequately meet local need for obesity services through releasing
funding where needed to meet the target. The Dr Foster 2004 survey
reports 55% of PCOs believe the treatment/prevention of obesity
is one of their top priorities for 2004-05. Given the central
importance of obesity to the Government and the general public,
we would like to see 100% of PCOs identify obesity as a top priority.
Are the proposals appropriate, will they be effective
and do they represent value for money?
9. In order for obesity services to be effective
they need adequate resources and as such we support the Committee's
call (para 63) for "funding for the large scale expansion
of obesity services in secondary care, underpinned by careful
management to ensure that the service provision is matched to
need."
10. We would like the Government to clarify
the amount of extra funding to be made available for PCTs from
2006, cited in the Government's response (p 24) and to state how
much of this will be directly tied to the provision of obesity
services. If this is general funding rather than obesity-specific,
we fear the ability to determine value for money would be limited,
likewise the effect on tackling obesity.
11. It is concerning that only 6% of responding
PCOs in the 2004 Dr Foster survey reported that it was possible
to identify the proportion of their annual budget allocated for
obesity. This in in-keeping with the Committee's finding (para
393) that, "obesity remains a low priority for the majority
of service commissioners and providers in the NHS." Those
PCOs which did respond reported a woefully small percentage of
their budgets as being allocated for obesity; on average just
0.33% of the budget baseline.
12. While there is no established figure
for the number of obese people in the UK, this level of funding
is clearly inadequate when an estimated 66% of people in England
are thought to be overweight or obese.
13. Only a very small percentage of respondents
(less than 3%) provided information on the percentage of budget
allocated to obesity. The Committee's assistance in gaining a
response from a larger number of PCOs would be welcome.
14. The Dr Foster 2004 survey highlights
a widespread failure to collect data on the provision of obesity
services. Just 25% of PCOs who responded had ever audited GP practices
to monitor the implementation of any obesity guidelines. As regards
monitoring the effectiveness of interventions, 19% monitor the
outcomes of surgery, 39% drug therapy and 45% weight management
programmes.
15. If we are to determine value for money
and ensure service provision is matched to need, a concerted effort
to collect more data will be needed.
16. The Government proposes monitoring obesity
under the umbrella of the public health domain in the new NHS
performance framework described in Standards for Better Health.
We welcome the new requirement to return local data on the prevalence
of obesity, but would like to establish that the obesity data
will be clearly distinguishable from other public health indicators
so as to enable a clear obesity evaluation by the Healthcare Commission.
17. We agree with the recommendation that,
"The Government's maximum waiting time targets must apply
to all of these services." and were disappointed to see no
specified commitment in the Government's response.
Do the necessary public health infrastructure
and mechanisms exist to ensure that proposals will be implemented
and goals achieved?
18. To enable the successful management
of obese patients requires a multi-disciplinary team with expertise
in diet, exercise and medical treatment.
19. In our previous memorandum to the Committee
we criticised the lack of clear strategic direction for SHAs and
PCTs on obesity, and the absence of a national framework against
which local progress on obesity could be measured.
20. The Dr Foster 2004 survey also found
49% of PCOs and a worrying 69% of general practices had not established
weight management clinics. Training of GPs and allied healthcare
professionals in the seriousness of obesity and strategies for
effective intervention and management is fundamental to this sort
of initiative. Given the importance of this tool in managing obese
patients, we call for efforts in this area to be recognised and
rewarded in the GP contract and for the Government to commit to
this position in its negotiations.
RECOMMENDATIONS FOR
ACTION
21. Inclusion in the forthcoming Delivery
Plan of specific measures to expand the provision of medical services
for obesity with commensurate funding and targets to ensure their
delivery.
22. A new PSA target on obesity for adults.
23. The application of maximum waiting time
targets to medical services for obesity.
24. The inclusion in the GMS contract of
obesity, in its own right.
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