Progress in the fight against malnutrition since BAPEN won the

MNI Grant Ailsa Brotherton

Honorary Secretary, On behalf of BAPEN

A reminder of our national challenges in 2008

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Raising the profile of nutrition and hydration

Persuading the Government and the Department of Health to focus on malnutrition

Developing national policy and system levers

Creating a shift from professional bodies and charities working in isolation with different visions, different campaigns and different messages to working together to develop ‘one voice’ with a strong ‘call to action’

Patients and the public did not have easy access to the information and services

Lack of awareness of malnutrition amongst both public and professionals

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What have we done since BAPEN won the award?

We set a clear strategy and vision

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1

2

3

4

5

Prevention of malnutrition and dehydration

Screening Identify malnutrition/ risk of malnutrition early through screening and assessment e.g. the ‘MUST’ Tool

Treatment - ‘individualised’ care pathways

Education and training for all care staff appropriate to setting, profession and responsibilities

Management systems and structures to facilitate multidisciplinary nutritional care

We have aimed to embed 5 principles of good nutritional care in all settings

We described the problem, measured the prevalence and made clear recommendations for action

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Hospitals Care Homes Mental Health Units

Centres (n=)

Patients (n=)

Centres (n=)

Residents (n=)

Centres (n=) Patients (n=)

2007 Autumn

175 9336 173 1610 22 332

2008 Summer

130 5089 75 614 17 185

2010 Winter

185 9668 148 857 20 146

2011 Spring

171 7541 78 523 67 543

Prevalence 25-34% 30-42% 18-20%

Data kindly supplied by Christine Russell, Chair of NSW

Change in screening practice on admission in hospitals

0

10

20

30

40

50

60

70

80

2007 (N=175)

2008 (N=90)

2010 (N=141)

2011 (N= 147 )

%

Centres

0-25% patients26-50% patients51-75% patients76-100% patients

Key finding: Majority subjects at risk admitted to hospital are from home and could be identified earlier Data kindly supplied by Christine Russell, Chair of NSW

We provided a toolkit for key decision makers: commissioners and providers

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Tools 1) Assessment of population at risk of malnutrition

2) Assessment of current screening and provision of nutritional care

3) Development of nutritional screening, assessment and care pathways

4) Education and training: knowledge skills and competencies of staff

5) Service specifications and management structures for nutritional care

6) Quality frameworks for nutritional care

7) Quality indicators, monitoring and review

...based on the best available evidence

... and began to work with the DH national improvement programme to design highly reliable systems of nutritional care

IDENTIFY Design systems to screen

all patients using a validated screening tool Operating Frameworks /

CQUINs/CQC

TREAT Develop a personal

nutritional care plan

Outcomes Framework /CQCTREAT

TRAIN

BAPEN e-learning modules

E-learning for

Health

STRUCTURES AND PATHWAYS

Continuity across

boundaries Senior Leader

Support

PREVENT Work with Public

Health, Local Government and Social

Services

Aiming for good nutritional care for every patient, on every ward, on every day

....and the commissioners to further develop eBANS and HIFNET

We thought differently about Clinical Guidance and Education Life Long Learning (LLL) programme in Clinical Nutrition and Metabolism BAPENs annual conference at UK DDF in 2012

http://www.bapen.org.uk/about-bapen/committees-and-groups/clinical-guidance-and-education?tmpl=component&print=1&page=http://www.bapen.org.uk/component/mailto/?tmpl=component&template=ja_nex&link=718e070ff47da7a686583c44376a2a9782c76e39

How have we done it?

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Government & DH

We convinced DH of the problem: they now accept that quality, safety and the financial benefits from improved nutritional care are ‘a given’ and created a sense of urgency

Quality Improvement

Worked with Quality Improvement Scientists to embed nutrition and hydration in DH QIPP work stream (Safe Care)

Nutrition contributes to all 5 domains of the Outcomes Framework

Networking and collaboration

We have worked with multiple partners: charities, professional bodies, industry

Spoken with one voice

The Government/DH recognise BAPEN as a leading multidisiplinary charity for tackling malnutrition in the UK

We have started to work differently

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What How

Convince people there is a problem

Convince them there is

a solution

Invest in data collection

and feedback systems

Have the right kind of leadership

Overcoming challenges to improving quality

.... and to communicate differently

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We have discovered the potential of Social Media

..................

But we still have lots to do to complete the challenge and are keen to learn from ESPEN colleagues

Next steps......

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Working together across the UK towards an integrated national nutrition strategy

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•BAPEN

•BDA and PENG

•BPNG

•NNNG and RCN

•RCGP

•RCP

•NHS Trusts – acute, community, mental health

•Care Homes

•Sheltered Housing

PINNT: Supporting people on artificial nutrition

Patient Association: CARE Campaign

Carers UK: Care about Nutrition

AGE UK

•Food Industry

•Clinical Nutrition

•Catering

Integrated Nutrition Strategy

Building a blue print for an integrated strategy and learning across the home countries

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Outline the Problem

Develop shared ownership for the vision

Focus on Prevention

Focus on self management including self screening

Accessibility of information

Early diagnosis and treatment

Developing person centred pathways of care

Putting patients and the public first

Excellent use of patient stories

Increased public awareness

Describe how this can be delivered

The case for change

The campaign

Raising awareness

Define the challenge

Outline the purpose of the Strategy

Outline the scope and structure

Text in red = working towards/ future development

Building a blue print for an integrated strategy

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Improving Outcomes

How does DRM differ from other forms of malnutrition

How to treat DRM effectively

The case for change

Collation of the evidence (ONS Dossier)

How can we deliver it

Treatment of Disease related malnutirtion

Commissioning nutritional services – at national commissioning board level

Commissioning specialised nutrition services

Incentive payments for nutrition (national CQUIN)

Commissioning & Levers

National outcome measures

NICE Quality Standards

Building the case for further improvement

The value of early screening and treatment

Role of GPs

Role of community services

Text in red = working towards/ future development

1) Malnutrition Task Force Older People (primarily England)

Two New Initatives

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2) Nutrition and Hydration Action Alliance (UK)

Some of the Partners: Abbott Nutrition , Apetito, Baxter , BDA , BSG BSPGHAN , Danone , Focus on Under-nutrition, Fresenius Kabi, Hydration Forum, ILC (UK) Mappmal (HospitalFoodie), NACC, NNNG, Nutricia, PINNT, RCN, RCP, Sustain

How will we structure and organise our work?

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Planning patient and public engagement

Currently under discussion

Person centred

care

Malnutrition Task Force

Focus on older people

Forming a strong wider coalition of committed partners

‘To ensure excellent nutritional care and hydration for every individual

in every setting on every day’

Nutrition and Hydration Action Alliance

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...but what has really made the difference

My personal view....

Three critical factors for success

1) Visionary Chairs

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Professor Marinos Elia Dr Mike Stroud Dr Tim Bowling

.......Committed to action

2) highly committed, capable people with capacity to contribute Having fun as well as working hard....

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3) ... and never losing sight of the reason for our work

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On behalf of BAPEN I would like to thank the MNI for the grant and I urge other Associations to apply

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BAPEN’s Core Groups

Progress in the fight against malnutrition since BAPEN won the MNI GrantA reminder of our national challenges in 2008Slide Number 3�We set a clear strategy and visionWe described the problem, measured the prevalence and made clear recommendations for actionChange in screening practice on �admission in hospitalsWe provided a toolkit for key decision makers:�commissioners and providers... and began to work with the DH national improvement programme to design highly reliable systems of nutritional careHow have we done it?�We have started to work differently.... and to communicate differentlyBut we still have lots to do to complete the challenge and are keen to learn from ESPEN � colleagues�Slide Number 13Working together across the UK towards an integrated national nutrition strategyBuilding a blue print for an integrated strategy and learning across the home countriesBuilding a blue print for an integrated strategyTwo New InitativesHow will we structure and organise �our work?Slide Number 19�Three critical factors for success2) highly committed, capable people with �capacity to contribute3) ... and never losing sight of the � reason for our workOn behalf of BAPEN I would like to thank the�MNI for the grant and I urge other Associations to apply