This year is the fourth UK Malnutrition Awareness Week and with a theme of ‘Ask, Look and Listen’, there is a huge amount of activity to raise awareness of the risk of malnutrition among patients in health and care settings and for everybody to work together to support those at risk of malnutrition.

It is a vital first step to identify those at risk of malnutrition and this year’s MAW focusses on ways for both healthcare professionals and the wider community to make sure people who might be struggling to maintain a healthy and sustaining diet are supported.

This is done by asking someone who might be vulnerable either through old age, by being isolated or because they have health problems, if they are eating and drinking well, or unable to prepare food and drink; by being on the look out for tell tale signs of unplanned weight loss or other signs of issues such as empty fridges or cupboards; and by listening to people who are telling you about their life and any indicators of how they might be struggling to eat or drink properly.

Having a health and care system that is also able to go through these steps – effectively identifying individuals at risk and screening them to assess their nutritional status - is vital to tackle malnutrition -securing better health outcomes for those individuals as well as reducing the impact on the wider health economy. A suitable nutritional care plan must be based on this assessment and delivered by appropriate health and care professionals within a multidisciplinary team.

The Health and Care Bill, and its provision to introduce hospital food standards, are an important opportunity to improve nutritional care for patients, using these principles to ensure patients are screened, assessed and a care plan developed and delivered.

While the proposal to introduce hospital food standards will undoubtedly improve nutrition provision to hospital patients, there is a greater opportunity to embed optimum nutrition into our health and care system.

The emphasis on Integrated Care Systems (ICSs) enables us to join up primary and community, secondary (hospital) and local government care creating a holistic view of the health and care system but also of the care of the patient. It is for the whole system to ask, look and listen to the patient and ensure those at risk are supported to maintain or improve their nutritional status.

This is particularly important as most of those affected are living in the community (about 93% or 2.8 million people). It is also prevalent across other settings such as sheltered housing (14%), mental health units (18%) and 10% of adults in primary care. (1)

Malnutrition can often be very difficult to recognise, particularly in patients who are overweight or obese to start with. Malnutrition can happen very gradually, which can make it particularly difficult to spot in the early stages. The Bill allows the opportunity to place a duty on each ICS to develop a system wide strategy for effectively supporting patients at risk of malnutrition or who are malnourished, including screening, developing and delivering a care plan and ensuring appropriate care on discharge back to the community. Each ICS should also have an identified lead for nutritional care at Board level to ensure the delivery of and accountability for the strategy

This is a vital step in ensuring those in health and care work together across each local system to ‘Ask, Look and Listen’ to people at risk of malnutrition and improved nutritional care is delivered for all patients in every setting.

(1) Stratton R, Smith T, Gabe S, (2018) Managing malnutrition to improve lives and save money, BAPEN website.