The increasing number of cases of malnutrition in hospital and associated deaths reflect a system-wide failure to consistently screen and manage patients who are either malnourished or at risk of malnutrition, according to new research released today by the British Specialist Nutrition Association (BSNA).
Malnutrition continues to be a serious and growing problem in modern Britain, affecting more than three million people. Costing £19.6 billion every year in England2 alone, it represents 15% of overall health and social care expenditure.
The research indicates that the problem is more significant than the available data suggests.
Recognised difficulties in the collection of data on malnutrition, and inconsistencies in the way that data are collected and reported by individual Trusts, mean that the overall incidence of malnutrition is likely to be significantly under recorded. A spike in recent parliamentary activity has highlighted wider concern about this area.3
BSNA's research, Forgotten not Fixed: a blueprint to tackle the increasing burden of malnutrition in England, analysed admittances to 221 English NHS Trusts in 2015/16. The data revealed that:
- 91 Trusts currently categorise fewer than one in 2,000 patients as showing signs of malnutrition
- This compares to 2011 Nutrition Screening Week data, which found that malnutrition affects 1 in 4 adults on admission into hospital4
- Implying that the true scale of malnutrition is hidden within the hospital system.
This issue is consistent across England, with all regions performing poorly. It implies a system-wide failure to correctly screen and identify those patients with, or at risk of, malnutrition, or a failure to correctly record the data.
Declan O'Brien, Director-General of BSNA, said: "Malnutrition remains a significant problem in Britain. But our research finds that malnutrition is increasingly overlooked – and in some cases ignored completely – despite the enormous burden it places on our healthcare system.
This is an unacceptable situation. The National Institute for Health and Care Excellence (NICE) and NHS England guidelines already exist to improve the identification, recording and management of malnutrition across clinical settings, but it seems that these are frequently not followed in practice. It costs more NOT to treat malnutrition than to do so. It is estimated that £5,000 could be saved per patient through better nutrition management.
This is Nutrition and Hydration Week when clinicians across the country are doing what they can to highlight the problems that malnutrition causes both patients and the NHS. There is no better time to call for action to be taken to ensure that Trusts are given all the support they need to accurately record malnutrition risk, thus reducing its incidence over time. We are recommending changes that would both improve outcomes for patients and deliver savings to the public purse."
- NICE and NHS guidelines must be implemented and followed in all healthcare settings. NICE Clinical Guideline 32 (CG32) and NICE Quality Standard 24 (QS24) on nutrition support in adults, and NHS England's Guidance on Commissioning Excellent Nutrition and Hydration 2015-18 should all be followed as a matter of course.
- Introduction of a new comprehensive jointly developed and delivered clinical care pathway, which would initially focus on at-risk groups, such as the frail elderly.
- Introduction of incentives, such as a QOF or its equivalent for malnutrition, could transform how malnutrition is identified, recorded and managed.
- Recognition of the integral role of oral nutritional supplements (ONS). Early intervention, through dietetic support, and use of ONS where appropriate, can ensure that patients receive the best support for their specific clinical conditions and circumstances.
The report and the summary will be available on BSNA's website: https://bsna.co.uk/
BSNA is the voice of the specialist nutrition industry in the UK. We represent the manufacturers of high-quality foods designed to meet the needs of people with specific nutritional requirements. Our members' products range from formula milks to medical nutrition products for diagnosed disorders and medical conditions, including parenteral nutrition and gluten-free foods on prescription. We believe that good nutrition is at the heart of patient care.
Our mission is to ensure that all patients have access to high quality specialist nutrition whenever they need it.
References: 1. Office for National Statistics (2016) Deaths from selected causes, by place of death, England and Wales, 2014 to 2015. [Accessed: January 2018].; 2. Elia, M (on behalf of the Malnutrition Action Group of BAPEN and the National Institute for Health Research Southampton Biomedical Research Centre) (2015) The cost of malnutrition in England and potential cost savings from nutritional interventions.; 3. http://www.independent.co.uk/news/health/malnutrition-deaths-uk-high-level-eating-diet-food-poverty-banks-welfare-benefits-support-a8195716.html [Accessed: 27 February 2018].; 4. http://www.bapen.org.uk/resources-and-education/publications-and-reports/nsw-reports/nsw11 [Accessed: 15 January 2018]