title: Bariatric psychology in the UK National Health Service: input across the patient pathway.
abstract: BACKGROUND
  Providers of bariatric surgery within the National Health Service (NHS) are required to provide psychological assessment and intervention, yet operational definitions regarding the purpose and scope of this input are lacking. This has led to significant variation in the provision of psychology, with some providing an assessment-only service and others providing a more comprehensive package of intervention throughout the patient pathway. The aims of this paper are to document the current psychology provision and service models of National Health Service (NHS) bariatric surgery services in the UK. Psychologists belonging to a bariatric psychology forum completed a survey. This focused on provision of psychological assessment and intervention throughout the bariatric pathway as well as the ratio between psychology resources and number of bariatric procedures per year. We obtained information from 22 NHS services which provide 3691 procedures per year.
  
  
  RESULTS
  There is significant variation in the ratio between psychology resources and number of bariatric procedures undertaken per service. Whilst all services offer pre-surgery psychology assessments, less than one-third routinely assess all potential bariatric surgery candidates. Over 90% of services offer pre-surgery individual interventions and 41% offer pre-surgery groups. None of the services routinely offer post-surgery assessments but 68% offer post-surgery assessment and intervention following referral. None offered post-operative structured psychological group interventions.
  
  
  CONCLUSIONS
  There are significant disparities and inconsistencies in the provision of psychology resources in relation to surgery volume in the NHS. Most of these resources are directed at pre-surgery assessment and this raises issues regarding the function of these assessments. Rather than focusing on assessing psychological (un)suitability for surgery, an evidence-based approach involves psychologists offering pre-operative interventions to improve readiness for surgery and post-operative interventions to address recurring or emerging difficulties which impact on outcomes.
authors.affiliation: Psychological Medicine Unit, CNWL NHS Foundation Trust, 1 Nightingale Place, London, SW10 9NG UK ; Bariatric Surgery Service, Chelsea & Westminster NHS Foundation Trust, London, UK ; Department of Clinical, Educational & Health Psychology, University College London, London, UK ; Phoenix Health, Chester, UK.
authors.forename: Denise
authors.initials: D
authors.lastname: Ratcliffe
authors.affiliation: Psychological Medicine Unit, CNWL NHS Foundation Trust, 1 Nightingale Place, London, SW10 9NG UK ; Bariatric Surgery Service, Chelsea & Westminster NHS Foundation Trust, London, UK.
authors.forename: Rukshana
authors.initials: R
authors.lastname: Ali
authors.affiliation: Psychological Medicine Unit, CNWL NHS Foundation Trust, 1 Nightingale Place, London, SW10 9NG UK ; Bariatric Surgery Service, Chelsea & Westminster NHS Foundation Trust, London, UK ; Department of Clinical, Educational & Health Psychology, University College London, London, UK.
authors.forename: Nell
authors.initials: N
authors.lastname: Ellison
authors.affiliation: Psychological Medicine Unit, CNWL NHS Foundation Trust, 1 Nightingale Place, London, SW10 9NG UK ; Bariatric Surgery Service, Chelsea & Westminster NHS Foundation Trust, London, UK.
authors.forename: Mahbuba
authors.initials: M
authors.lastname: Khatun
authors.affiliation: Psychological Medicine Unit, CNWL NHS Foundation Trust, 1 Nightingale Place, London, SW10 9NG UK ; Bariatric Surgery Service, Chelsea & Westminster NHS Foundation Trust, London, UK.
authors.forename: Jolyon
authors.initials: J
authors.lastname: Poole
authors.affiliation: Psychological Medicine Unit, CNWL NHS Foundation Trust, 1 Nightingale Place, London, SW10 9NG UK ; Bariatric Surgery Service, Chelsea & Westminster NHS Foundation Trust, London, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Coffey
keywords: Bariatric surgery; NHS; Provision; Psychology