Millions could be cut from NHS bill by tackling silent malnutrition epidemic
A new report identifies more than £200 million of annual savings for health and social care services through simple steps to tackle the nation’s multi-billion pound malnutrition burden.
The report, published by the National Institute for Health Research Southampton Biomedical Research Centre (NIHR Southampton BRC) and the British Association for Parenteral and Enteral Nutrition (BAPEN), says that the estimated cost of malnutrition in both adults and children in England in 2011-12 was £19.6 billion and is only set to increase with an aging population and the rising cost of health and social care.
However, it estimates savings to health and social care of between £172 and £229 million per annum through full implementation of appropriate high quality pathways of nutritional care, as recommended by the National Institute for Health and Care Excellence (NICE)*, for various groups of malnourished adults.
Marinos Elia, Professor of Clinical Nutrition and Metabolism at the University of Southampton and BAPEN Malnutrition Action Group and lead author of the report, comments: “This is an issue that cannot be ignored. We are spending extremely large amounts of money on this problem – a problem which could be readily helped by doing simple things well.”
Malnutrition is a serious and common condition, affecting adults** and children with all types of diseases and in all care settings. Although it is estimated to affect only about five per cent of the general population, affecting older adults more than in younger adults and children, such individuals access expensive health and social care services considerably more than non-malnourished subjects.
Malnourished adults account for about 30 per cent of hospital admissions and with prolonged length of hospital stay, 35 per cent of care home admissions, 15 per cent of outpatient clinic attendances and 10 per cent of those presenting at their GP. Overall the cost of treating a malnourished patient is two to three times more than treating a non-malnourished patient.
“Malnutrition is a burden to a wide range of care services operating in multiple settings,” Professor Elia, who is also a consultant physician at Southampton General Hospital (recently retired), explains: “It is found on every ward, in every specialty, and in every type of care home. It detrimentally affects the function of all body tissues, predisposing to disease, as well as increasing complications after an injury, and delaying recovery from an illness. It also makes day-to-day activities more difficult to complete, and increases the likelihood of dependency, especially in the elderly. That is why it costs so much. We need to ensure a systematic approach to identifying and treating it so we not only improve the health and wellbeing of those at risk of malnutrition, but make economic savings too.”
By using an evidence-based approach and different models of treatment in the groups of malnourished adults targeted by the Malnutrition Universal Screening Tool (‘MUST’), the report estimates that appropriate pathways of nutritional support for medium and high-risk people could produce a potential annual net saving of up to £229 million. This cost saving would arise from a combination of effects, including reduced hospital admissions and length of hospital stay.
“It’s very simple,” continued Professor Elia, “These treatment pathways are available now and should be used as a matter of routine. At present not all malnourished patients are identified and treated. We are not routinely screening all patients that should be screened, and even if they are identified they are not always given a proper care plan that carries over from the first care setting in which they are seen to other settings they may go to, for example from hospital to GP surgery or care home.
“We recognise that there is some cost attached to more screening, more care plans and more nutritional support, but these interventions will ultimately produce a net saving even after initial costs are considered. It is necessary to invest some resource before the financial benefits can be reaped. Coordinated use of malnutrition guidance within and between health and social care settings will maximise both clinical and economic benefits.”
Commenting on the launch of the new report Jane Cummings, Chief Nursing Officer for England said: “The link between nutrition and a person’s health is a fundamental part of any stage of life, but all the more so for the sick or vulnerable. Malnutrition can be both a cause and a consequence of illness, and have a significant impact on health outcomes and wellbeing.
“Person-focused, quality compassionate care involves looking at what matters to a person as a whole, not only concentrating on their specific medical condition. Therefore I hope that this report will stimulate thinking and discussion about the vital role of nutrition as part of caring for people, and the importance of developing strategies to identify and address malnutrition.
“I would also encourage NHS commissioners to use the information within this report to support the implementation of the recently-published ‘Commissioning Excellent Nutrition and Hydration guidance’***.”
To access full and short copies of the report visit:
Full version - http://www.bapen.org.uk/pdfs/economic-report-full.pdf
Short version - http://bapen.org.uk/pdfs/economic-report-short.pdf
Notes for editors
1. The report is entitled: The cost of malnutrition in England and potential cost savings from nutritional interventions
2. *Recommended pathways can be found at https://www.nice.org.uk/guidance/qs24
3. ** In adults, risk of malnutrition (medium and high risk) is determined using the Malnutrition Universal Screening Tool (‘MUST’), a validated screening tool based on body mass index (BMI), weight loss and acute disease effect. ‘MUST was developed by BAPEN and is the most widely used nutrition screening tool in in the UK, both within and outside the hospital setting. Further information and a copy of ‘MUST’ can be viewed and downloaded from www.bapen.org.uk. In children somewhat different criteria are used to determine risk of malnutrition, which take into account growth.
4. ***Guidance is found at https://www.england.nhs.uk/2015/10/08/guidance-nutritional-care/
5. The models of treatment include:
Oral Nutrition Support (ONS): Alterations in food and/or fluid intake with a view to increasing dietary intake or avoiding problems due to an underlying disease. The support may include: dietary advice on how to increase intake or exclude certain food items or constituents; fortification of food with nutrients; provision of snacks and oral nutritional supplements; changes in the texture of food and fluid; and change in the frequency and pattern of meal ingestion.
Oral: ONS and other oral treatment including diet modification and diet counselling.
Enteral Tube Feeding: Use of tube to deliver a feed directly into the stomach or gut.
Parental Nutrition: Nutrition provided through a drip.
6. BAPEN is a Charitable Association that raises awareness of malnutrition and works to advance the nutritional care of patients and those at risk from malnutrition in the wider community.
BAPEN brings together the strengths of its Core Groups to raise awareness and understanding of malnutrition in all settings and provides education, advice and resources to advance the nutritional care of patients and those at risk from malnutrition in the wider community. For more information visit www.bapen.org.uk
7. The NIHR Southampton Biomedical Research Centre is the nation’s centre for translating nutrition research into better health and care. It is funded by the National Institute for Health Research (NIHR) and is a partnership between University Hospital Southampton NHS Foundation Trust and the University of Southampton.
8. Through world-leading research and enterprise activities, the University of Southampton connects with businesses to create real-world solutions to global issues. Through its educational offering, it works with partners around the world to offer relevant, flexible education, which trains students for jobs not even thought of. This connectivity is what sets Southampton apart from the rest; we make connections and change the world. http://www.southampton.ac.uk/