"Because of Mum's injuries she struggled to manoeuvre herself around her bed, and wasn’t strong enough to properly feed herself to the completion of a meal. The team on the ward were aware of this, but still put Mum's food trays out of her reach, and didn’t offer to assist her with her feeding. If we were not there then she didn’t eat, and it was really distressing watching her fade away.”
Unfortunately the story we hear above is all too common on the Helpline. Too many callers tell us about how they - or a loved one - have suffered from malnutrition whilst in the healthcare system.
Over 3 million people are either malnourished or at risk of malnutrition in the UK. Of the 3 million people either malnourished or at risk of malnutrition, an overwhelming 93% of these individuals live in the community.
Malnutrition can have a severe effect on a patient’s health and wellbeing and general quality of life. Patients may have a reduced ability to fight infection, develop apathy and depression, and have impaired wound healing ability and reduced muscle strength and fatigue. Wider health and wellbeing effects may include a reduced quality of life and a reduced ability to work, shop, cook and self-care.
Patients who are under-nourished also use more NHS resources with more GP visits and hospital admissions as well as longer stays in hospital. It is now almost a year since the Coalition Government announced its plans to reform the NHS, but we are no clearer as to how these reforms will tackle the issue of malnutrition. This is a huge oversight - malnutrition not only affects patients, their families and carers but it costs the NHS over £13 billion a year. With the NHS asked to save £20 billion by 2014, tackling malnutrition would not only benefit individual patients but would go a long way to helping the NHS achieve these financial savings.
We decided to act.
We carried out a survey of over 500 patients via our weekly news to determine patients’ understanding of the issue of malnutrition and the information they feel is available to them. We found that:
- patients don’t think there is enough information on malnutrition available to them
- an overwhelming 80% of patients would welcome a self-assessment tool that tells them if they are at risk of malnutrition and what to do next
The Patients Association commissioned the largest survey of its kind in the UK on the issue of malnutrition in the community and hospital setting (5,018 respondents). The survey results informed our report ‘Malnutrition in the community and hospital setting’
, which was published over the summer. This report received a huge amount of media coverage and showed that there is a lack of awareness amongst patients as to the issue of malnutrition, whether they are at risk, how they can prevent malnutrition from developing and where to seek help and advice. We have produced a leaflet ‘Malnutrition – how to spot the signs and what to expect from treatment’
which we are in the process of sending to all the GP surgeries in the UK.
We have pulled together a list of recommendations and calls to action which include:
o The Department of Health must:
- provide information on basic nutrition and the importance of monitoring weight loss as an early warning sign of malnutrition to patients and healthcare professionals
- make nutritional screening across all healthcare and social care settings mandatory and healthcare professionals must be educated and trained to use a nutritional guide to the social risk factors associated with malnutrition and nutritional screening questions to ask on these factors
o GP consortia must:
- ensure information on malnutrition is tailored to local services and covers the whole ‘malnutrition journey’ from diagnosis to nutritional treatments that can be prescribed by the GP and also following up and monitoring in the community
- be educated as to the cost benefits of treating malnutrition
o GP consortia and Local Authorities must ring-fence funding for community-based dietetics services and treatment options if clinically required
o The new Public Health Directors who will sit within the Local Authority must have a role in promoting prevention of malnutrition and must see this as one of their public health duties
o The role of the community pharmacist in promoting good nutrition and screening for malnutrition must be considered by the Public Health Director
We are in the process of meeting with the Department of Health and other organisations to discuss our calls to action
To read the full report, please click here.
We will be carrying out a focus group of GPs and also a focus group of patients to ratify a self assessment tool for malnutrition. We will then go on to trial the tool in the South West.
We will be presenting the results of our survey of 5,018 patients, carers and their families, at the Annual Conference of the British Association for Parenteral and Enteral Nutrition in November 2011.