Addressing the hidden health problem of malnutrition
Kirstine Farrer Consultant Dietitian
Salford Royal NHS Foundation [email protected]
Communities - little or no contact with services
Communities in contact with
services
Care Homes
Hospital
93
%
5%
2
%
3 m
illio
n m
aln
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rish
edWho is at risk?
The Cost of Malnutrition
Public expenditure associated with <3 million individuals in UK who are malnourished or at risk of malnutrition
2003 - >£7.3 billion p.a
2007 - >£13 billion p.a.
2014 - >£15 billion p.a.
NICE Cost Saving Guidance places effective treatment of malnutrition as 3rd in ranking of potential biggest cost savers to the NHS
Salford
• Total population is 218,000• Eight neighbourhoods• Although there are diverse levels of affluence, Salford is ranked as
one of the most deprived local authority areas in England with life expectancy lower than the England average
• Population of people aged 65 and over is 35,000 • Number of older people is forecast to rise by 28% by 2030• Large Orthodox Jewish community• 14% (nearly 5000) of people aged 65 and over may be at risk of
malnutrition (using BAPEN commissioning toolkit)
0
5
10
15
20
25
30
35
40
45
May10/apr11 May11/apr12 May12/apr13 May13/apr14
Ra
te p
er
10
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Hospital admissions relating to malnutrition, Salford,May 2010/April 2011 - May 2013/April 2014
Salford Greater Manchester England
0
50
100
150
200
250
300
0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90 plus
Ra
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er
10
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Age band
Hospital admissions with malnutrition as a diagnosis by age band, Salford and Greater Manchester
Apr10/May11 to Apr13/May14 (4 year pooled)
Salford Greater Manchester
5 Pilot sites:Salford, Lambeth, Dorset, Gateshead and Kent
Raising awareness Working together
Identifying malnutritionPersonalising care and support
Monitoring and evaluating
Aims
• To share the work of the MTF and drum up enthusiasm
• To understand the current state and identifying gaps
• To help shape the priorities for taking the work forward
On the day
• Over 80 people in attendance
• Presentations – understanding the scale of the problem
• Interactive group work – scenario planning
• Video – developed for the event: https://www.youtube.com/watch?v=SFIzFMw6iJ8
• Pledge Tree
Outcomes
• Great evaluation
• Learning developed into workstreams
• Pledges
• Film clip – developed at the event: https://www.youtube.com/watch?v=Z7tH6Z91mKs&feature=youtu.be
Project Launch Event
Work Stream Remits
1. ICP Standards of Nutritional Care Across Organisations to reflect the NIHCE Quality Standards
2. Nutrition and Dysphagia Education for Staff across Salford ICP
3. Raising Awareness
4. Working with Community and Primary Care
Diet sheets developed for acute and community settings written by older adults, dietitians and speech and language therapists
Raising Awareness
Shopping Trip
Progress
• First shopping trip took place in November – six people in attendance
• Preparation included:• Targeting appropriate older people to attend• Discussions with ASDA regarding preparation for the day• Pull up poster purchased to have on show at the event
to encourage others to find out more• Leaflets available • Development of floor plan for ASDA in Swinton• Information on what to look out for in each aisle• Attendees rewarded with a cup of tea and biscuit for
participating.• Staff on hand to support (community dietitians, dietetic
assistants, AgeUK etc)• Film clip developed:
http://communityreporter.net/videos/malnutrition-task-force-trip-asda
The Salford Together Nutrition ArmbandSalford Royal NHS Foundation Trust ©
Patient Information Displays
Progress
• 10 practices identified as part of their high sip feed prescribing
• Poster developed by dietitian and Age UK Salford
• Leaflets previously outlined will be included
• Floor plans and isle information for both ASDA and Morrisons
Nutrition and Dysphagia Training
Paper written to outline the need for malnutrition and hydration to become mandatory across the integrated care programme.
Care homes and care home providers
• NICE standards and Salford Together Standards in relation to nutrition have been included in the development of the Quality Assurance Framework – go live date to be confirmed
Progress
Residential and Nursing Care Homes and Home Care Provider Contracts.
Local provider contracts have been revised to include Key Performance Indicators about nutrition
Progress
Evaluation and Dissemination of Pilot Programme
After a thorough evaluation there will be written reports for
each of the five sites assessing the change management
process and how successful the pilot programme has been
along with lessons learnt
Sharing the learning of the projects to wider stakeholders
Salford Steering Group MembershipName Job Title Place of work
David Haynes Chief Executive Age UK, Salford
Jean Rollinson Director of Service Development Age UK, Salford
Kirstine Farrer Consultant Dietitian Salford Royal NHS FT
Brenda Blackett Lead Nutrition Nurse Salford Royal NHS FT
Katie Foster/Tony Ward Team Leader, Community Dietetics Salford Royal NHS FT
Sarah Cleverly Project Manager (supports the care home/mental health agenda)
Greater Manchester West Mental Health Trust
Stephanie Webb Project Manager (supports community agenda)
Integrated Care Programme
Claire Vaughan Head of Medicines Management Salford Clinical Commissioning Group
Paul Walsh Integrated Commissioning Manager Salford City Council
Julia Wood AQuA Affiliate
Governance Reports to Salford Integrated Care Programme on a monthly basis