Health Service Focus

10-Point Plan – Feeding Better Outcomes

Source: NHE Nov/Dec 19 

Johnny Skillicorn-Aston, director of Engagement and communication, Conclusio

 A recent roundtable event attended by academics, nutrition experts and health and industry leaders brought into sharp focus the issue of malnutrition and its consequences for health and wellbeing. 

Meeting at St Anne’s College, Oxford at the end of October, the panels focus was the recent report ‘Feeding Better Outcomes’ authored by James Roach of Conclusio and sponsored by the British Specialist Nutrition Association. The report has at its core a 10-point plan, calling for action and a new integrated health and care service framework for malnutrition.

Malnutrition among vulnerable people is growing as a result of a threefold impact of poor health screening, disparity of approaches within multi-disciplinary health care and the effects of ‘opportunities missed’.

Addressing the event, report author, James Roach of Conclusio, said: “We need practical solutions to tackling malnutrition and it needs to start at the top. The plan recommends a leadership approach that permits every health and social care professional to operate at the top of their license.

“Positive nutrition is the foundation for good health and where we have systemic barriers to this, we need to act now to remove them. We believe that ‘Feeding Better Outcomes’ and its 10-point plan will provide a blue-print for effective service planning across health and social care.”

Being well-nourished is a basic requirement for personal wellbeing, good health and securing the efficacy of interventions and treatments for disease and sickness when health fails. Despite this, there is a significant variance across the country, and across health sectors, over how nutrition, and its monitoring and support, is managed. This, and how a new service framework can be implemented, has been framed within a blue-print for better care.

Dr Anant Jani, research fellow at Nuffield Primary Health Science Unit, Oxford University and roundtable chair, added: “The most disadvantaged and vulnerable in our communities are experiencing ill-health as a result of malnutrition, which is an access-point for poorer health. Malnutrition drives negative outcomes, exacerbates pre-existing illnesses and long-term conditions and contributes to health inequalities across our communities.

“By getting our fundamental design of communities and services right, we will address the wider determinants of malnutrition, bring effective change in how we manage it and support people to become more independent in managing their own nutrition and health.”

Looking at the current situation across the health estate, it is clear that a number of factors militate against establishing the right state for positive change in how nutrition is managed. There is significant variance in analysis to identify service optimisation opportunities and increase access to sustainable nutrition regimes.

It is an area ripe for increasing the profile of the impact of malnutrition and the benefits associated with proactive management. In addition, a ‘real world evidence’ and population health framework is needed to generate patient and carer service experience combined with operational and financial data.

‘Feeding Better Outcomes’ builds a credible case for change that leaders of local health and social care systems can understand and from which they can determine an optimal care pathway. The benefits to patients are known but the benefits in terms of cost savings may not be so acutely appreciated. 

“It costs more not to treat malnutrition than to not do so and it is estimated that £5,000 could be saved per patient per annum through better nutritional management and care.” That is according to data from the Malnutrition Action Group of BAPEN and the National Institute for Health Research Southampton Biomedical Research Centre.

While there is no magic solution, Feeding Better Outcomes and its 10-point plan demonstrate that there are practical steps that can be taken to ensure the impact of malnutrition is recognised, understood and managed. 

The British Specialist Nutrition Association said: “Malnutrition continues to be a serious problem with more than three million people in the UK estimated to be either malnourished or at risk of malnutrition.

“Malnutrition results in various adverse health outcomes for patients, including high numbers of non-elective admissions, greater dependency on hospital beds for longer and progression to long term care sooner. Managing patients in a crisis situation results in high levels of inefficiency, which could be avoided or minimised if more focus were placed on prevention and early intervention.”

The 10 -point plan programme tested its service improvement framework for nutrition and hydration in three health and social care systems. The aim was to improve the management of malnutrition across health and care systems.

The framework was used to review current service and clinical pathways for malnutrition and applied in live clinical and operational services. It was tested in real time to establish the value of such interventions and the impact they have on improving the overall service offer for patients with malnutrition. The existing patient pathway was mapped and patient/user experience was evaluated through a range of patient pathway reviews and case studies.

The test areas had already invested in redesigning community services, had a high incidence of frail elderly patients, and a prevalence of long-term conditions, such as Chronic Obstructive Pulmonary Disease (COPD).  Organisations that deliver a range of services across primary, community and social care settings were also involved, so a new pathway-wide solution could be built to tackle malnutrition at source.

A look at the typical person at risk of, or experiencing, malnutrition was taken and found the following characteristics (see information box):

Patients with these characteristics experience many interactions with, and interventions from, health and social care services and associated professionals. This raises numerous opportunities to engage with those who are, or at risk of becoming, malnourished and it has to be recognised that any missed opportunity to tackle malnutrition and its causes has a negative impact on the independence and wellness of vulnerable patients.

In each of the three areas, the development and test phases were undertaken in partnership with a range of subject matter experts and enjoyed the involvement and participation of patient groups, primary, community and secondary care, community pharmacy, social care and reablement, health and care commissioners, the medical nutrition industry, the third sector and national policy and regulatory bodies. This diverse approach ensured that every fraction in the nutrition equation could operate.

Mr Roach added: “A pan-sector, comprehensive approach engaged with organisations that understood the issues, were prepared to test and pilot new approaches and hold themselves to account in the process. In each pilot area the work was led by system leaders, staff and organisations from across the patient pathway and the wider health service supply chain.”

The field-test phases informed the final ‘Feeding Better Outcomes’ report, which scoped the extent and nature of the work in the test areas, evaluated the results and outcomes and concluded that the approach was sound and concluded a number of recommendations in the areas of leadership and assurance. It was this, and the desire to move the plan off the page, that inspired and informed the round table discussion.