Calls to eliminate avoidable malnutrition

Malnutrition is reported to affect around 5% of the UK population (approximately 3 million people), yet many patients, carers, healthcare professionals, commissioners, senior managers and chief executives are unaware of how common it is. As a result, malnutrition continues to go unrecognised and untreated, leading to worse health and clinical outcomes in all social and NHS care settings. At the 2012 Digestive Disorders Federation Conference, held in Liverpool, The British Association for Parenteral and Enteral Nutrition (BAPEN) called for improved awareness of the problem and highlighted the need for a national, integrated strategy to improve nutrition across all healthcare and community settings. In a commissioning toolkit (Malnutrition Matters – Meeting Quality Standards in Nutritional Care, May 2010), BAPEN previously commented that ‘improved nutritional care could result in substantial financial returns’ for the health service – calculating that even a 1% saving could amount to an estimated £130 million per year. The organisation pointed out that malnourished individuals go to their GP more often, are admitted to hospital more frequently, stay on wards for longer, succumb to infections, and are at greater risk of being admitted to longterm care and of dying unnecessarily.

Nutritional care for hospital patients

Earlier this year, Andrew Lansley, the previous Health Secretary, announced plans to tackle the issue of ‘patients leaving hospital malnourished’ and promised that ‘NHS hospital food will improve’. However, BAPEN warned that hospital food is only part of the problem and pointed out that a national malnutrition and hydration strategy is required to improve all aspects of nutrition provision across the NHS and social care. The organisation reported that: “The high prevalence of ‘malnutrition’ on admission to hospital and during a hospital stay is not a trivial problem that can be ignored and is not, as commonly cited, a problem caused by ‘hospital food’.” Dr Ailsa Brotherton, BAPEN’s honorary secretary, said: “There is a clear need for system-wide approaches and improvement to detect malnutrition early in both community and acute settings and to ensure that individuals who are ‘at risk’ receive appropriate nutritional care. In addition to appropriate, good quality hospital food, good nutritional care includes: nutritional screening (and repeat screening as appropriate), a detailed nutritional assessment for ‘at risk’ patients and the development and implementation of an appropriate personalised nutritional care plan, which may include oral nutritional supplements, enteral tube feeding or, in some cases, parenteral nutrition. “Developing highly reliable systems of integrated nutritional care has become a priority focus for BAPEN and we are developing a number of resources, including a Nutrition Improvement Guide that will help NHS and Social Care organisations to deliver improved care. “However, to deliver improvements at pace and scale, BAPEN recognises the importance of the Department of Health developing a national nutrition and hydration strategy and the appointment of a National Clinical Director for Malnutrition to lead this work for the NHS.” Dr Mike Stroud, chair of BAPEN’s quality improvement committee and chair of the NICE guidance development groups for both nutritional support in adults and IV fluids, stated: “The Department of Health is fully aware of the importance of nutrition and is currently considering the improvements required. Nevertheless, we are now asking the Health Secretary to take responsibility for eliminating avoidable malnutrition in the NHS. In order to achieve this, good nutritional care must become a priority for the Department of Health, with approaches including all elements of good nutritional care rather than simply focusing on hospital food. “We also need the new executive agency, ‘Public Health England’, to make malnutrition among patients, the elderly and the vulnerable, the focus of an early awareness campaign, and the National Commissioning Board to develop clear outcome measures to monitor prevalence of malnutrition and the quality of nutritional care that is provided.” Anne Holdoway, chair of the Parenteral and Nutrition Group of the British Dietetic Association, welcomed the Government’s acknowledgement of the importance of good food and nutrition for patients in hospital, ensuring that patients get the right nutrition and that it is ‘personalised’. She said: “Registered dietitians are leading on many initiatives across the UK and collaborating with catering teams and healthcare professionals to ensure that hospital diets are nutritious and appropriate for the diverse patient groups. “Sadly patients are still denied access to individual advice as a result of lack of resources and low numbers of dietitians employed in the hospital and community sector. With less than 7,000 dietitians working to fulfil the needs of the entire UK population, patients are unable to receive the education and information that would empower them to improve and self-manage their nutrition in the long-term.” Chair of the National Nurses’ Nutrition group, Liz Evans agreed, adding: “It must be acknowledged that BAPEN screening week reports show the prevalence of malnutrition in the community and it is therefore vital that vulnerable patients are not further nutritionally compromised during their stay in hospital. While I am pleased that the Government acknowledges the importance of good, nourishing food as a key part of recovery, it is also important that there is recognition of the role that nurses play in the delivery of this part of treatment. “Food provision should not be seen as a ‘hotel service’ but as an integral part of a person’s recovery from illness. As such, organisational routines in hospitals should be arranged so that nurses can participate fully in feeding and hydrating patients. Sadly, despite innovations such as Protected Mealtimes and Red Trays, this is still not happening in many areas.”