Good nutrition and hydration: essential for patients - and for improving health and care
Earlier this month it was Nutrition and Hydration Week – from 13th to 19th March. The week aims to focus minds on improving the provision of nutrition and hydration “locally, nationally and globally”, as adequate food and drink is essential for health and well-being - wherever people live.
Whilst we are, sadly, all too aware of the inadequate availability of food and water in developing countries, the problem can, and does, manifest itself much closer to home. In fact, it is estimated that malnutrition affects at least three million people in the UK (1), around 98% of whom are living in the community. Malnutrition and dehydration are both causes - and usually consequences - of illness, so ensuring that patients receive adequate nutritional intake is critical for improving their overall health outcomes.
"Malnutrition affects at least three million people in the UK (1), around 98% of whom are living in the community"
Management of malnutrition supports not only positive health outcomes, but it also reduces the health cost to the NHS. The public health expenditure associated with malnutrition is estimated to be £19.6 billion per year in England alone (2), and the National Institute for Health and Care Excellence (NICE) has recognised that the delivery of better nutritional care could represent the sixth largest area of potential cost-savings to the NHS (3). Consequently, the management of malnutrition – and those at risk of malnutrition - should be integral to all care pathways.
"The public health expenditure associated with malnutrition is estimated to be £19.6 billion per year in England alone" (2)
NICE has been active in the area of patient nutrition. The NICE Quality Standard on Nutrition Support in Adults (QS24) (4) recommends that people who are malnourished, or at risk of malnutrition, have a management care plan which aims to meet their complete nutritional requirements, whilst NICE Clinical Guideline 32 (CG32) (5) supports healthcare professionals to identify malnourished people, helping them to choose the most appropriate form of support. NHS England’s Commissioning new Guidance on Nutrition and Hydration (6) also recognises that malnutrition and dehydration have a large impact on the health economy, resulting in increased demand for GP and out-of-hours services and increased rates of transition across pathways of care. Unfortunately, however, all too often these guidelines and standards are forgotten or ignored, even though NHS England’s 10 Key Characteristics of 'Good Nutrition and Hydration Care' (7) require that “all care providers have a nutrition and hydration policy centred on the needs of users, [which is] performance managed in line with local governance, national standards and regulatory frameworks”.
High quality nutritional care should be at the heart of patient care and mandatory routine screening for malnutrition and its risk factors should be introduced, using a relatively simple screening tool such as ‘MUST’ (8), developed by the British Association for Parenteral and Enteral Nutrition (BAPEN). Patients who are malnourished, or at risk of malnutrition, should be provided with care plans that are appropriate to their specific needs, including the use of food for special medical purposes, such as oral nutritional supplements (ONS), designed to meet the specific nutritional needs of malnourished patients.
Malnutrition is not confined to the community. After the Mid-Staffordshire Public Inquiry, the Hospital Food Standards Panel was set up to try to ensure better quality food and drink for patients on the wards; they reported in 2014 (9). However, a 2015 report by the London School of Economics on hospital stays, (albeit based on data collated in 2012/13), concluded: “patient experiences of inconsistent or poor standards of dignity, and help with eating, do not appear to be limited to isolated “outlier” providers. Rather, this appears to be a significant general problem affecting thevast majority of NHS acute hospital trusts.” (10). More recent research by the Malnutrition Task Force - set up in 2012 to address avoidable and preventable malnutrition in older people - found in a commissioned study, that only 51 per cent of health professionals thought malnutrition was a priority in their organisations (11). There is clearly some way to go before good nutrition and hydration are perceived to be right at the heart of patient improvement and recovery.
"Only 51 per cent of health professionals thought malnutrition was a priority in their organisations" (11)
A 2013 report by the British Dietetic Association (BDA) and the British Specialist Nutrition Association (BSNA) concluded that improving nutrition “can help to prevent health problems, improve functional status, and increase quality of life and wellbeing for people living with long-term conditions, in addition to providing cost savings to the NHS.” (12)
Surely, now is the time to ensure that high quality, accessible feeding and hydration of patients is a top priority in health and social care settings.
- Malnutrition Task Force website
- The cost of malnutrition in England and potential cost savings from nutritional interventions, British Association for Parenteral and Enteral Nutrition and National Institute for Health Research Southampton Biomedical Research (2015)
- Nutrition Support in Adults (32) Cost Saving Guidance (2011), NICE, 2011
- Nutrition support in adults, Quality standard [QS24], NICE, 2012
- Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition, Clinical guideline [CG32], NICE, 2006
- Commissioning Excellent Nutrition and Hydration 2015-2018, NHS England, 2015
- Ten key characteristics of ‘good nutrition and hydration care’, NHS England, 2015
- Malnutrition Universal Screening Tool (MUST), British Association for Parenteral and Enteral Nutrition
- The Hospital Food Standards Panel’s report on standards for food and drink in NHS hospitals, Department of Health and Age UK, 2014
- Older people’s experiences of dignity and nutrition during hospital stays: Secondary data analysis using the Adult Inpatient Survey, London School of Economics Centre for the Analysis of Social Exclusion, Report 91, June 2015
- Experiences of Patient Malnutrition, DODs Research, 2016
- The Value of Nutritional Care in Helping the NHS to Deliver on the NHS Outcomes Framework, British Dietetic Association and British Specialist Nutrition Association, 2013
The British Specialist Nutrition Association is an associate member of the All-Party Parliamentary Health Group (APHG), which, along with fourteen other companies, provides the APHG with an independent source of funding. This article is the opinion of the author and it does not in any way reflect the views of the All-Party Parliamentary Health Group or its Officers or Members.