EASO is delighted to partner with ASOI and colleagues within the HSE at the 2023 European Congress on Obesity and are pleased to share the HSE Model of Care for the Management of Overweight and Obesity in Ireland with ECO2023 delegates.
The model of care, launched on World Obesity Day, 2021:
- sets out how healthcare for children, young people and adults living with overweight and obesity in Ireland should be organised and resourced, now and in the future.
- describes the service required, who should provide it, and where the service should be delivered across the healthcare system.
- takes a population health approach to managing obesity, recognising the wider drivers of obesity such as genetics, environment and socioeconomic status.
The model encompasses policy, legislation & cross-sectoral action to support healthy environments. Since its launch, implementation of obesity services have commenced, which is the beginning of the journey to establish services for people with overweight and obesity that will meet the future healthcare needs of the Irish population. Publication of the model was also welcomed by the Irish Coalition for People Living with Obesity, who were integral to the writing of the document through their membership in the working group of the Obesity National Clinical Programme.
Development of a model of care for specialist obesity services was a key action in the Healthy Weight for Ireland Obesity Policy and Action Plan 2017-2025. When programme colleagues began drafting the document, it was clear that an integrated approach was needed included end-to-end services that addressed prevention and treatment across all levels of healthcare. This approach would align with Sláintecare, the governments ten-year programme to transform Ireland’s health and social care services. The obesity model of care aligns with a number of Sláintecare priorities by putting patients at the center of care, improving access in community, and addressing long waiting list for specialist services, promoting self-management and prevention of disease progression, and supporting a well-resourced, skilled workforce. Aligning the model for obesity management with the existing framework for the management of chronic disease in Ireland was also a priority for the programme.
This paves the way for obesity to be included within this framework in the future. As with other chronic diseases, including type 2 diabetes, respiratory disease and heart diseases, people with obesity should be supported to live well within the community with easy access to GP review, diagnostics, multidisciplinary input and specialist opinion as required. Furthermore, obesity is often a common denominator in complex chronic diseases and treating obesity can in turn improve many other conditions. This model represents a significant milestone for the National Clinical Programme for Obesity and the Healthy Eating and Active Living Programme in HSE Health and Wellbeing.
While the model of care is not a clinical guideline, it was important that international clinical guidance was considered in its development. The Canadian Adult Obesity Clinical Practice Guidelines (CPGs) were launched in August 2020, as the model of care document was nearing completion; this timing was fortuitous. The CPGs provide much needed evidence and experience based patient centered framework, and represented the extensive review of published evidence to date. The complex nature of obesity requires that the health services take a holistic, integrated approach to identification, early intervention and treatment. The model of care was designed to ensure services were equipped to deliver on the recommendations of these CPGs.
What does Phase One Implementation look like?
- Funding has been grated via an HSE Access to Care fund to enhance two existing specialist medical management teams (one adults and one children and young people), and to set up one new medical management team to address waiting lists for specialist services.
- Through the same funding, two existing bariatric services have been enhanced to increase access to bariatric surgery.
- A community based behavioural obesity programme has been funded to be delivered in local health care networks (average population 50,000), providing access to behavioural treatment in the community
- Two specialist teams for management of overweight and obesity in children and young people are serving patients via funding to support increased health and wellbeing services in local areas. Learnings from these teams will be used to develop services nationally.
- 120 annual places funded for health care professionals to access modular programme on delivering evidence based obesity care, which is based on the new Irish adapted Obesity Management Clinical Practice Guidelines for Adults.
This is just the beginning of the HSE journey to establish quality services for treatment of overweight and obesity that will meet the future healthcare needs of the Irish population. The model care will only reach it full potential when all levels of service are fully implemented. Partial implementation would result in:
- limited access to existing services
- growing waiting lists
- increased complexity presenting in community services
- increases medical tourism
- impacts staff wellbeing and motivation
- service fragmentation and inappropriate service delivery models
FULL IMPLEMENTATION OF THE MODEL OF CARE WILL ENSURE
An end-to-end approach is adopted, defining the way health services are developed over time.
The right care is delivered to individuals with overweight and obesity at the right time and in the right place, in line with Sláintecare health and social care service reforms. The focus here is on patient outcomes through monitoring and evaluation of service delivery, supported by quality training for healthcare staff.
KEY PRINCIPLES OF THE OBESITY MANAGEMENT CLINICAL PROGRAMME
Obesity is a complex, chronic, multifactorial disease that requires a comprehensive multidisciplinary, approach to care across the lifespan.
Appropriate and equitable treatment for overweight and obesity is required in addition to public health prevention measures.
Weight-based stigma and obesity discrimination will not be tolerated in the healthcare system.
Integration with academic institutions, professional bodies and regulatory agencies will ensure that formal teaching on the causes, mechanisms, and treatments of obesity are incorporated into standard training programmes.
OBJECTIVES OF THE MODEL OF CARE
To define specific services for the effective management of obesity and overweight in children, young people and adults across the life course incorporating prevention, early identification and treatment to prevent progression of disease and complications.
To ensure effective integration and support across levels of services, across the lifespan and with services for high risk groups.
The Model of Care for Obesity: https://www.hse.ie/eng/about/who/cspd/ncps/obesity/model-of-care/obesity-model-of-care.pdf (PDF, 95 pages, 5,574KB)
A Summary version of the Model of Care for Obesity is available: https://www.hse.ie/eng/about/who/cspd/ncps/obesity/model-of-care/obesity-model-of-care-highlights.pdf (PDF, 4 pages, 1,934KB)