Christine Russell
Other healthcare professional Rank: Newbie
Posts: 2
Join Date: 16/08/11
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Dear Dr Livingstone
Your article in Chemist and Druggist suggesting that Bob Geldof could in some way help save the starving NHS drugs budget prompted us to respond to some of the points raised.
Whilst it is true that we do not encounter such severe cases of starvation as those shown in countries affected by extreme famine, the UK does have a serious problem of malnutrition – more often associated with disease than simply lack of food, but certainly not confined to the dying.
Based on national surveys using consistent criteria to identify malnutrition / risk of malnutrition, it has been estimated that at any one time there are more than 3 million people in the UK at risk of malnutrition – 93% of whom live in the community. Around 5% are in care homes and just 2 % in hospital1. Furthermore, around 1 in 3 adults are at risk on admission to hospital and more than 1 in 3 residents recently admitted to care homes2. Not only is malnutrition in the UK common, it costs the health and social care budget at least £13billion per annum1 - far more than obesity.
Most malnutrition originates in the community and GPs play an important role in identifying and treating it before it becomes too late. In 2006, NICE published guidance on Nutritional Support in adults3 that confirmed that oral nutritional supplements (ONS) were a cost effective, life and complication saving treatment and since then, NICE has calculated that significant cost savings could be made by implementing this guidance4. This was then demonstrated in a study in care homes in Peterborough which showed a significant reduction in admission to hospital with associated cost savings through training and implementation of a nutritional screening programme using the ‘Malnutrition Universal Screening Tool’ (‘MUST’) – the most commonly used screening tool in the UK, and through appropriate use of ONS5,. This study was posted on the NICE shared learning website as an example of good practice 6.Surely it is better to adopt a more holistic approach to nutritional care than to focus on reducing the use of ONS per se.
Whilst we agree that some ONS prescription may be inappropriate, we would urge GPs to ensure that evidence based care pathways are in place for the management of malnutrition in their locality so that when asked to “just sign this” they can feel confident that any prescriptions for ONS are appropriate and their use well monitored.
Prof Marinos Elia (Chair Malnutrition Action Group of BAPEN)
Christine Russell (Chair BAPEN’s Nutrition Screening Week)
References
1. Elia M, Russell CA (Eds). Combating Malnutrition: Recommendations for Action. A report led by the Advisory Group on Malnutrition, led by BAPEN, 2009
2. Russell CA, Elia M. Nutrition screening survey in the UK and Republic of Ireland in 2010. A report by BAPEN, 2011
3. National Institute for Health and Clinical Excellence, Nutrition Support in Adults: oral nutrition support, enteral tube feeding and parenteral nutrition. Clinical Guideline 32. 2006. http://guidance.nice.org.uk/CG32
4. NICE. Cost saving guidance. 2011. at http://www.nice.org.uk/usingguidance/benefitsofimplementation/costsavingguidance.jsp
5. Cawood Al, Smith, A., Dalrymple-Smith, J., Bolch, R., Pickles. S., Church, S., Stratton, R.J. Effectiveness of implementing ‘MUST’ into care homes within Peterborough Primary Care Trust. Clinical Nutrition, 2009;4, suppl 2:81
6. NICE shared learning see: http://www.nice.org.uk/sharedlearning
BAPEN, the British Association for Parenteral and Enteral Nutrition, is the multi-professional registered charity, committed to combating malnutrition & to improving nutritional care and treatment in hospital, care & community.
BAPEN is Registered Charity No. 1023927 www.bapen.org.uk
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