Number of deaths from malnutrition has risen by more than 30% in the last decade - new research
The increasing number of cases of malnutrition in hospital and associated deaths reflect a system-wide failure to consistently screen and manage patients who are either malnourished or at risk of malnutrition, according to new research released today by the British Specialist Nutrition Association (BSNA). Katherine Sykes calls for urgent to tackle ‘unacceptable’ situation.
Malnutrition continues to be a serious problem in modern Britain, with more than three million people in the UK estimated to be either malnourished or at risk of malnutrition. The number of deaths from underlying malnutrition or where malnutrition was named as a contributory factor is also increasing, having risen by more than 30% from 2007 to 2016. This is unacceptable in any modern healthcare system.
The increasing number of cases of malnutrition in hospital and associated deaths reflect a system-wide failure to consistently screen and manage patients who are either malnourished or at risk of malnutrition. New research commissioned by BSNA for Nutrition and Hydration Week has found that more than half the hospital Trusts in England are significantly under-reporting malnutrition rates compared to accepted national estimates. This means that the overall incidence of malnutrition is likely to be significantly under recorded, pointing to a much more significant problem than the available data suggests.
A recent inquiry into malnutrition amongst the elderly by the All Party Parliamentary Group (APPG) on Hunger has recognised this problem and recommended that “Public Health England and its equivalent bodies in Wales, Scotland, and Northern Ireland, should regularly record and publish up-to-date data on the extent of malnutrition amongst older people”.
It costs more not to manage malnutrition than to do so
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 resulting cost to the public purse is significant. In England alone the costs arising from malnutrition have been estimated at £19.6 billion. This represents approximately 15% of overall health and social care expenditure.
It is estimated that £5,000 could be saved per patient through better nutrition management. The provision of nutritional support to 85% of patients at medium to high risk of malnutrition would lead to a cost saving of £325,000 to £432,000 per 100,000 people.
On average it costs £7,408 per year to care for a malnourished patient, compared to £2,155 for a well-nourished patient
Comprehensive, effective screening, prevention and treatment, and the introduction of incentives, are essential across all settings to protect those at risk of malnutrition and reduce costs to taxpayers.
What needs to be done?
Malnutrition remains a significant problem in Britain. But our research finds that malnutrition is increasingly overlooked – and in some cases ignored completely – despite the enormous burden it places on our healthcare system.
This is an unacceptable situation. NICE and NHS England guidelines already exist to improve the identification, recording and management of malnutrition across clinical settings, but it seems that these are frequently not followed in practice. It costs more NOT to treat malnutrition than to do so. It is estimated that £5,000 could be saved per patient through better nutrition management.
This is Nutrition and Hydration Week, when clinicians across the country are doing what they can to highlight the problems that malnutrition causes both patients and the NHS. There is no better time to call for action to be taken to ensure that Trusts are given all the support they need to accurately record malnutrition risk, thus reducing its incidence over time. Today we are recommending the following changes that would both improve outcomes for patients and deliver savings to the public purse:
NICE and NHS guidelines must be implemented and followed in all healthcare settings. NICE Clinical Guideline 32 (CG32) and NICE Quality Standard 24 (QS24) on nutrition support in adults, and NHS England’s Guidance on Commissioning Excellent Nutrition and Hydration 2015-18 should all be followed as a matter of course.
Introduction of a new comprehensive jointly developed and delivered clinical care pathway, which would initially focus on at-risk groups, such as the frail elderly.
Introduction of incentives, such as a QOF or its equivalent for malnutrition, could transform how malnutrition is identified, recorded and managed.
Recognition of the integral role of oral nutritional supplements (ONS). Early intervention, through dietetic support, and use of ONS where appropriate, can ensure that patients receive the best support for their specific clinical conditions and circumstances.