NHS England launch

new Guidance on

Commissioning

Excellent Nutrition and

Hydration

2015 – 2018

• Malnutrition is estimated to be associated with costs to the UK health economy of more than £20 billion per annum (BAPEN,2015) .

• Improving the identification and treatment of malnutrition is estimated to have the third highest potential to deliver cost savings to the NHS. (NICE, 2011)

A Shared Vision

‘All people will receive safe and high quality nutrition and

hydration support when required, through the

commissioning of person-centred and clinically

Effective integrated services in the community and

in health care commissioned settings’.

Background to the Commissioning Document

NIHR/BAPEN full cost/benefit

analysis (2015) – £300 to 400K

savings per 100,000 population by

implementing simple NICE

nutritional measures in hospitals and

care homes (largest savings in

hospital)

NICE Guidance on Nutrition

Support- 3rd highest cost

savings compared to

savings calculated for all

NICE guidance

Total UK costs of approx

£20 billion associated

with malnutrition across

health and social care

Community – people with little or no contact

with services

Community – people in contact

with services

Care Homes

Hospital

93

%

5%

2

% 3

mill

ion

maln

ou

rishe

d

The Costs of Malnutrition: there is a robust case for change

• Measurement of nutritional care has lagged behind

other areas e.g. VTE, because of lack of standardised

quality measurement

• Little attention is paid to standards of nutritional care by

clinicians and management

• Current audits have been tick box exercises reliant on

retrospective examination of nutritional screening with

little focus on:

Quality and implementation of care plans

Patient experience of nutritional care

Nutritional outcomes

• In a recent survey of frontline staff only 16%

reported support from senior nurse leaders at

mealtimes

Measurement of Nutritional Care

1) To identify a local senior/executive champion who

can drive the work forward and influence key

stakeholders.

2) Understand the local burden of malnutrition and

hydration and commission services as appropriate.

3) Review existing service provision and benchmark

performance.

The key outcomes for commissioners to be achieved by March 2018

4) Commission services that :

• Identify ‘at risk’ populations

• Implement appropriate interventions and evaluate their

effectiveness;

• Develop and implement strategies to prevent

malnutrition and dehydration;

• Connect hospital and community services to deliver an

integrated nutritional and hydration pathway of care

across the health economy;

• Strengthen families and patients resilience by learning

about prevention, maintenance and management of

nutrition and hydration.

The key outcomes for commissioners to be achieved by March 2018

5) Commission a workforce that has the necessary skills to

undertake identification, prevention and intervention to

reduce burden of malnutrition and dehydration.

6) To increase public awareness of the importance of good

nutrition and hydration and of the local services available to

provide support if needed.

7) Maximise opportunities for working across health and social

care using the Care Act (2014) and outcomes and ensure

the sustainability of any interventions that are

commissioned.

8) Consider how data systems can be optimised to permit

monitoring and evaluation.

9) To ensure patient/service user involvement in service

development and quality assurance of commissioned

services.

The key outcomes for commissioners to be achieved by March 2018

“I understand first-hand the impact

nutritional care has on many other

areas of an individual’s health care.

Implementing an effective monitoring

process will potentially have a positive

impact on the patient’s journey

throughout the whole healthcare system

which is surely a good thing!”

Steve Brown, Secretary of PINNT

Patients need us to change

Organisational

details

• Organisation name

• Ward/unit

• Speciality

• Date of collection

• Professional group undertaking the survey

Demographics • Age group

• Feeding route

• Setting

• Diagnosis

Type of care • Food, ONS, ETF, PN (tick all that apply)

Nutritional

Screening & Care

plans

• Screening (score on admission and time of audit)

- Objective (weight, height, preceding wt loss, disease effect)

- Subjective

- Barriers to nutritional screening

• Nutritional care plan – documented and implemented (yes, no, in part)

• Re-screening

Patient Experience

questions

• Have you received all the food and drink or nutritional care you have needed?

• Have you received assistance to eat and drink when you have needed help?

The Guidance signposts commissioners to the new nutritional care tool developed

by BAPEN

What does the tool collect?

Commissioners have been asked to measure the quality of nutritional care delivered

Nutritional Care Dashboard

• Frequent web-based data collection

• Swift, extensive analytics with

nutrition dashboard, data tracking over

time, funnel plots etc.

0

10

20

30

40

50

60

70

80

2007 (N=175)

2008 (N=90)

2010 (N=141)

2011 (N= 147 )

%

C

e

n

t

r

e

s

0-25% patients

26-50% patients

51-75% patients

76-100% patients

•Data collection was paper

based

•One week annual Nutrition

Screening Weeks

Pre-Tool

Post Tool

A shift from standalone audits to continuous quality improvement

What can the BAPEN measurement tool deliver?

http://data.bapen.org.uk

Step 1

Agree participation with Chief Nurse, MD or Nutrition Steering Committee

Step 2

Agree administrator and register on website

Step 3

Create an account: set a username and password

Step 4

Decide wards or areas to participate, timing of data collection and who will collect the data

Step 5

Select starting date

Step 6

Review analytics and dashboard

Steps to using the tool?

1. National

data collection

weeks

• 4 separate weeks of data collection, mirroring the approach taken in NSW

• Minimum - at least 1 day in each week on every patient in 4 wards

• Maximum: data on every adult patient in your care on 1 or more days during each week (as per NHS Safety Thermometer data collection)

2. Monthly

data Collection

• As well as the 4 national data collection weeks, mirror NHS Safety Thermometer and collect data on a monthly basis on selected wards

Sign up to participate at two levels

Robust assurance to Trust Board (& Commissioners) through a nutritional care dashboard

Immediate repeatable and current point of care measures

Voluntary – you decide the frequency and scale of use

Highlights areas of excellent practice and areas where improvements are needed

Free to UK NHS and Social Care Organisations

Contains patient experience questions, as well as screening, care planning and outcomes

The first tool nationally available that will enable you to measure the

quality of nutritional care delivered to your patients and to track

improvements over time

What are the benefits of using the new Nutritional Care Tool?

Questions?