NHS customer case · Lancashire

Bringing specialist obesity care closer to home

Lancashire Teaching Hospitals NHS Foundation Trust provides specialist Complications from Excess Weight care through Royal Preston Hospital as part of the North West CEW network.

The service connects local paediatric care with specialist expertise from Manchester and Alder Hey, helping children and families across Lancashire and South Cumbria access multidisciplinary obesity care closer to home.

Evira adds connected home monitoring and digital communication around this regional model.

North West CEW spokeCare closer to homeRegional MDT

Lancashire Teaching Hospitals NHS Foundation Trust

At a glance

North West CEW spoke

Lancashire Teaching Hospitals is currently listed by NHS England as a spoke within the North West CEW network

Royal Preston Hospital

the local CEW service is based within Royal Preston Hospital’s paediatric and endocrine services

28 new + 33 follow-up

patients reported by the trust during implementation of the hub-and-spoke pathway (September 2024 improvement reporting)

Higher than expected demand

the ICB reported that the two-year CEW pilot had experienced higher demand and required review of impact, outcomes and future commissioning (2025/26 commissioning intentions)

The pathway challenge

Specialist expertise across a large geography

Children and young people living with severe obesity may require input from multiple specialist disciplines, but families across Lancashire and South Cumbria can live a considerable distance from the major North West children’s hospitals.

The North West CEW model was therefore developed as a network rather than a single centralised clinic. Royal Preston Hospital provides a local specialist spoke, working with the regional hubs at Royal Manchester Children’s Hospital and Alder Hey Children’s Hospital.

The aim is straightforward: provide specialist multidisciplinary care closer to where families live while maintaining access to regional expertise when it is needed.

The North West model

Local care connected to regional expertise

Royal Manchester Children’s Hospital

CEW hub

Alder Hey Children’s Hospital

CEW hub

Royal Preston Hospital

CEW spoke

Positioned closer to families across Lancashire and South Cumbria, drawing on specialist expertise from the regional hubs.

Public NHS documents describe the three-centre model as an integrated CEW pathway designed to provide care closer to home.

Lancashire Teaching Hospitals has reported that multidisciplinary integration was established and the hub-and-spoke model implemented locally.

Implementing the spoke model

From regional pathway to local specialist care

Lancashire Teaching Hospitals has publicly documented the implementation of its paediatric CEW pathway as part of its health-inequalities improvement work.

The stated aim was to develop an integrated CEW service and referral pathway with Manchester, Alder Hey and Preston to provide specialist care closer to home.

MDT integration

established

Hub + spoke model

implemented

28 new + 33 follow-up

patients reported during the implementation period

These figures demonstrate service implementation and activity. They are not published clinical outcome measures.

View the Lancashire Teaching Hospitals report ↗

In practice

Specialist support without always travelling to a tertiary centre

Local specialist care

Royal Preston provides specialist paediatric care within Lancashire rather than requiring every interaction to happen at a major regional children’s hospital.

Regional MDT links

The service works within the North West CEW network, with links to specialist expertise at Manchester and Alder Hey.

Multidisciplinary support

The national CEW model combines medical care with nursing, dietetic, psychological and wider support according to individual need.

Escalation when needed

The spoke model allows care to remain local where appropriate while retaining access to tertiary expertise for more complex needs.

Public NHS recruitment material describes the Lancashire CEW team as led by a consultant paediatrician with a specialist interest in endocrinology, working with specialist nursing, dietetics, physiotherapy and access to clinical psychology, and serving children and young people across Lancashire and South Cumbria.

Source 4

A growing need

Demand exceeded initial expectations

Lancashire and South Cumbria ICB identified the CEW service as an area requiring review in its 2025/26 commissioning intentions.

The ICB stated that the CEW pilot had been operating for two years and had experienced higher demand.

Its review was intended to understand the service’s impact and outcomes and determine future commissioning arrangements.

2 years

of pilot delivery reported by the ICB

Higher demand

than anticipated during the pilot

Future commissioning

subject to review of impact and outcomes

This describes the ICB’s position in its 2025/26 commissioning intentions. It should not be read as a negative assessment of the service.

Source 2

Why location matters

Access is part of the treatment model

Lancashire and South Cumbria includes communities with substantial differences in deprivation, health outcomes and access to services.

Lancashire Teaching Hospitals identifies obesity, physical inactivity, mental health conditions and wider socioeconomic factors among the health challenges affecting its local population.

For children requiring specialist obesity treatment, a regional spoke model can reduce the need to concentrate every stage of care at distant tertiary centres.

Where Evira fits

Extending the local pathway into the home

A hub-and-spoke model brings specialist care geographically closer to families. Evira extends the same principle beyond the clinic.

Connected home measurements allow progress to be followed without requiring every measurement to take place in hospital, while digital communication creates another way for families and clinical teams to remain connected between scheduled interactions.

At home

Families can collect regular measurements using a connected device without daily weight numbers being displayed.

Between appointments

Progress remains visible during periods between scheduled clinical contacts.

With the clinical team

Measurement data and digital messaging give clinicians another route for monitoring and personalised support.

Digital CEW care

Specialist support beyond hospital appointments

NHS England has been piloting connected smart-scale technology across CEW services to enable specialist teams to monitor and support children at home.

The national model uses hidden-digit connected scales, visual progress feedback and automatic transfer of measurements to the clinical team.

Clinicians can then provide personalised feedback and communicate with families between hospital appointments.

Home monitoring

Connected measurements can be collected outside hospital.

Clinical visibility

Measurement data is transferred to the specialist team.

Ongoing support

Digital communication allows personalised feedback between scheduled contacts.

These are national CEW programme findings and should not be presented as Lancashire-specific Evira outcomes.

Source 5

The role of distributed care

Specialist care does not have to mean centralised care

Children with severe and complex obesity need access to specialist multidisciplinary expertise. But that expertise does not require every element of treatment to take place at the same hospital.

Lancashire’s spoke model demonstrates how specialist services can connect local care with regional expertise.

Digital support can extend that model further — helping clinical teams remain connected with families during the periods when care is taking place at home.

Source 6

The wider direction

Towards more care closer to home

Lancashire and South Cumbria’s commissioning strategy increasingly emphasises community-centred care, prevention, digital innovation and delivery in people’s homes or as close to home as possible.

Its 2026–2031 clinical strategy continues this direction, highlighting integrated care, personalised support and digital infrastructure as important enablers of future service models.

The CEW spoke at Royal Preston is a practical example of that shift within specialist paediatric care.

This is strategic context. The strategy does not specifically endorse Evira.

Source 7

Public evidence

What Lancashire has reported

Lancashire Teaching Hospitals

Health inequalities improvement reporting, September 2024

Primary local evidence that CEW MDT integration was established, the hub-and-spoke model implemented, and 28 new plus 33 follow-up patients reported.

View Trust report ↗

Lancashire & South Cumbria ICB

Commissioning intentions 2025/26

Public evidence that the CEW pilot had been running for two years, had experienced higher demand and was being reviewed for impact, outcomes and future commissioning.

View commissioning intentions ↗

NHS England

Complications from Excess Weight clinics for children

Current national source identifying Lancashire Teaching Hospitals as a North West CEW spoke.

View the CEW network ↗

NHS England

National CEW digital technology programme

Describes connected home scales, remote clinical monitoring and digital communication across CEW services nationally.

View national digital programme ↗

Sources and references

Lancashire has not published Evira-specific clinical outcomes. The 28 new and 33 follow-up patients are implementation activity reported by the trust in September 2024 and are counted separately. Evira is presented as a digital layer around the distributed specialist pathway.

Part of the North West network