NHS customer case · Nottingham

Extending specialist support across a high-demand regional service

Nottingham University Hospitals NHS Trust is an NHS England Complications from Excess Weight hub, supporting children and young people across Nottinghamshire, Derbyshire and Lincolnshire.

The team has publicly documented how it adapted its multidisciplinary pathway as demand grew, through flexible appointments, home and community support and new approaches to engagement.

Evira adds connected home monitoring and digital communication around that specialist model.

East Midlands CEW hubPublished service evaluationRegional specialist care

Nottingham University Hospitals NHS Trust

At a glance

176

referred patients included in Nottingham's 2025 analysis of the period between referral and first specialist appointment

79%

gained weight before their first appointment, among the referred cohort studied

48%

of that cohort were from the most deprived quintile

12–18 months

typical wait between an accepted referral and the first clinic appointment, as stated by NUH

Nottingham CEW / BSPED 2025 and current NUH pathway information

The 79% figure describes weight trajectory between referral and first appointment. It does not establish that waiting caused the weight gain.

The challenge

Demand for specialist care exceeds available capacity

Demand for the Nottingham CEW service has grown rapidly since it launched, and clinicians have publicly documented the challenge of increasing capacity while maintaining multidisciplinary, personalised care for children with significant medical and social complexity.

Current NUH guidance states that accepted referrals typically wait 12 to 18 months before being seen in clinic.

That makes access, engagement and continuity important parts of the pathway, not simply the treatment delivered once a family reaches clinic.

Source 3

Who the service supports

Severe obesity alongside wider clinical and social complexity

Nottingham's published service evaluations describe the population the team treats and how the multidisciplinary model needed to evolve as demand increased.

+4.2

mean BMI SDS in the 2024 Nottingham service cohort

50%

had one or more weight-related complications

20%

had a recorded neurodiversity diagnosis

62%

lived in the two most deprived deciles

These figures describe the Nottingham service cohort reported at the 2024 UK Congress on Obesity. They are not Evira-specific outcomes.

View the published abstract ↗

Before specialist care begins

What happens between referral and first appointment?

A BSPED 2025 study examined 176 children and young people referred to the Nottingham service between 2021 and 2024, looking at weight trajectories before specialist intervention.

79%

gained weight between referral and first appointment

16%

lost weight during the same period

maintained broadly stable weight

Among those who gained weight, the median rate of gain was 10.69 kg per year.

Nearly half the cohort lived in the most deprived quintile, and 22% already had one or more obesity-related complications at the point of referral.

This retrospective analysis describes changes observed before the first specialist appointment. It does not demonstrate that waiting time itself caused weight gain.

Read the BSPED 2025 abstract ↗

The regional service

One specialist hub serving a wide geography

The East Midlands North CEW service accepts referrals from Nottingham and Nottinghamshire, Derby and Derbyshire, and Lincoln and Lincolnshire.

Families may travel significant distances to Nottingham Children's Hospital, so the pathway brings together tertiary expertise while maintaining links with referring clinicians and local services.

Nottinghamshire

Referrals from Nottingham city and the wider county.

Derbyshire

Referrals from Derby and across Derbyshire.

Lincolnshire

Referrals from Lincoln and across Lincolnshire.

How care is delivered

A flexible multidisciplinary pathway

Specialist MDT

The Nottingham CEW team includes paediatric doctors, specialist nurses, dietitians, physiotherapy, family support, social work and psychotherapy.

Personalised care

Following assessment, families receive an individual plan and appointments with the professionals relevant to their needs.

Home and community support

The service uses home visits and has developed community-based activities including cooking sessions and family-focused interventions.

Flexible contact

NUH describes a mixture of face-to-face, video, telephone and online interactions during the treatment journey.

Families currently have contact with the service approximately every six to eight weeks over a typical 12 to 18 month intervention.

Service redesign

Adapting the service as demand increased

At the 2024 UK Congress on Obesity, Nottingham's clinical team described how the CEW pathway evolved with increasing demand. A 35% increase in funding accompanied an increase in expected patient numbers.

Rather than simply expanding the existing model, the teams tested new approaches to improve capacity, access and engagement.

Staffing models

Reviewing how the multidisciplinary team is staffed to support higher activity.

More clinic capacity

Additional clinics, with cancellations filled at short notice.

More home visits

Upskilling existing staff so more care can be delivered at home.

Community delivery

Cooking sessions and family-focused interventions outside the hospital.

Remove access barriers

Proactive contact about travel support and access or language barriers.

Hybrid access

A mixture of virtual and in-person care to suit family circumstances.

These adaptations allowed the service to meet higher activity targets, while demand continued to exceed available capacity.

Read the UK Congress on Obesity abstract ↗

Working together

Adding continuity between scheduled interactions

Nottingham's pathway already combines hospital appointments, remote consultations, home visits and community-based support.

Evira adds another digital layer around that model.

It complements the multidisciplinary pathway. It is not a substitute for specialist appointments, and it is not a solution to the waiting list.

At home

Families can take measurements with a connected device that does not display daily weight numbers.

Between contacts

Progress remains visible between scheduled multidisciplinary appointments.

With the MDT

Digital communication supports personalised feedback and encouragement from the team.

Independent national evidence

Digital support as part of specialist CEW care

Independent evidence from the national ENHANCE evaluation identifies Evira as the digital weight management system available to CEW services for weighing and communication with patients and families.

Early evaluation findings describe the communication tool as providing day-to-day contact and additional clinician support.

NHS England has described the national CEW digital model as connected hidden-digit scales used at home, with measurements transferred to clinical teams and personalised feedback delivered through the app.

Home monitoring

NHS England describes connected hidden-digit scales used at home as part of the national CEW digital model.

Clinical visibility

Measurements are transferred to clinical teams supporting the family.

Ongoing communication

Early ENHANCE evaluation findings describe the communication tool as providing day-to-day contact and additional clinician support.

These are national CEW findings. They are not Nottingham-specific Evira outcomes.

Source 8Source 9

Why this matters

Specialist care cannot depend on individual appointments alone

Nottingham's published experience illustrates a national challenge: high clinical need, long treatment journeys and demand that exceeds specialist capacity.

NHS England's 2026 commissioning guidance states that services with waits exceeding 18 weeks should have plans to support children while they wait, and recommends flexible access through clinic, virtual and community appointments, proactive engagement strategies and remote contact through digital engagement tools.

Evira fits within that broader direction of travel.

Source 7

Public evidence

What the evidence tells us

UK Congress on Obesity 2024

Setting up a weight management clinic for children and young people living with severe obesity: an MDT approach and lessons learnt

Nottingham-specific evidence on service growth, patient complexity, capacity, engagement and pathway redesign, presented by Pooja Sachdev.

Read the abstract ↗

BSPED 2025

Weight trajectory in children and young people from referral to first appointment

Analysis of 176 referrals and the weight trajectories observed before specialist treatment began.

Read the abstract ↗

Nottingham University Hospitals

Current CEW patient and healthcare professional information

Public information on waiting times, geographical coverage, treatment duration, appointment formats and the multidisciplinary team.

View Nottingham CEW service ↗

NHS England / ENHANCE

National CEW evaluation and commissioning guidance

Independent context on digital support, service accessibility, waiting-list management and the national specialist care model.

View national evidence ↗

Sources and references

Nottingham has not published Evira-specific clinical outcomes. The published figures describe the Nottingham CEW service and the population it treats. Evira is presented as a digital continuity layer around that specialist pathway.