Nutrition and Hydration Week 14-20 March – Why malnutrition should be a priority for Integrated Care Systems

With an estimated three million people at risk of malnutrition in the UK[1], raising awareness of the value of good nutrition and hydration is a vitally important message for health and social care. BSNA welcomes Nutrition and Hydration Week, which takes place this week to promote good practice in preventing malnutrition and dehydration with health and social care professionals.

The NICE Clinical Guideline on nutrition support for adults (NICE CG32)[2] recognises that malnutrition is both a cause and an effect of ill health and that ‘good nutrition support services’ are crucial in treating a number of other conditions.

The guideline requires that all care services take responsibility for the identification of people at risk of malnutrition and provide nutrition support for everyone who needs it, and that an integrated approach to the provision of services is fundamental to the delivery of high-quality care to adults who need nutrition support.

As the Health and Care Bill completes its passage through Parliament, and the formal structures of integrated care are finally put in place, BSNA calls on ICSs to recognise malnutrition as a condition that demonstrates the value of integrated care.

With 93% of malnutrition existing in the community (largely in people’s own home), but the highest cost incurred in secondary care (2% of prevalence occurs in hospitals[3]), managing risk effectively to reduce malnutrition incidence in the community and minimise hospital admissions is key.

Yet, in the last decade admissions to hospital with malnutrition have increased from 4,657 (2010/11) to 10,109 in 2020/21.[4] The growing older population also suggests that the burden of community malnutrition will increase in the long term.

The estimated cost of malnutrition in England is £19.6 billion per year and the healthcare cost of malnutrition is dominated by secondary care rather than primary care.[5]

The NICE guideline was published in 2006 and points to the poor level of knowledge of the causes, effects and treatment of malnutrition among healthcare professionals in the UK. It aims to help healthcare professionals to correctly identify people in hospital and the community who need nutrition support and enable them to choose and deliver the most appropriate nutrition support at the most appropriate time.

However, in 2021, NHS England/NHS Improvement’s ‘Get it right first time’ (GIRFT) programme review of gastroenterology services[6], found that provision of nutrition support varied across trusts, with 16.7% of trusts having no nutrition support team at all, and 25% of trusts with no dedicated nutrition specialist nurses. This is despite the NICE guideline recommendation that all acute hospital trusts should employ at least one nutrition specialist nurse.

The review also found variation in how trusts screen patients to identify those who are suffering from or at risk of malnutrition and recommended that trusts carry out screening more consistently.

The formal structure of an Integrated Care System represents a significant opportunity for each local health and care system to implement NICE CG32 across all settings, to ensure that patients are properly screened for under nutrition, that care plans for those who are malnourished or at risk of malnutrition are developed and that the care plan is delivered, including the use of food for special medical purposes (FSMP), such as oral nutritional supplements (ONS), where appropriate.

BSNA fully supports Nutrition and Hydration Week in raising awareness of good nutritional care across health and care services, and welcome seeing the examples of best practice from local areas to tackle malnutrition, whether patients are in hospital, a care home or in their own homes.

[1] Elia M. The cost of malnutrition in England and potential cost savings from nutritional interventions (full report): A report on the cost of disease-related malnutrition in England and a budget impact analysis of implementing the NICE clinical guidelines/quality standard on nutritional support in adults: Malnutrition Action Group of BAPEN and the National Institute for Research Southampton Biomedical Research Centre, 2015. https://www.bapen.org.uk/pdfs/...

[2] National Institute for Health and Clinical Excellence (NICE). Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition (Clinical guideline [CG32]). London, National Institute for Health and Clinical Excellence (NICE). 2006 https://www.nice.org.uk/guidan...

[3] Elia M, Russell CA, editors. Combating malnutrition: recommendations for action. A report from the advisory group on malnutrition led by BAPEN. Redditch: BAPEN; 2009 https://eprints.soton.ac.uk/15...

[4] NHS Digital Hospital Admitted Patient Care Activity 2020-21 https://digital.nhs.uk/data-an...

[5] Elia M. (2015) https://www.bapen.org.uk/pdfs/...

[6]NHS England/Improvement: The GIRFT national report on gastroenterology 2021 https://www.gettingitrightfirsttime.co.uk/medical-specialties/gastroenterology/