Nutrition expert warns many UK health services 'settling for inadequacy'

A leading nutrition expert at Southampton’s university hospitals has warned many health services in the UK are fuelling malnutrition by settling for “inadequate standards”.

Professor Marinos Elia, a consultant physician at Southampton General Hospital, said although the condition affected more than three million people in Britain and cost an estimated £13 billion per year or more, it continued to be under-detected and under-treated.

“Malnutrition is a common and costly problem that leads to detrimental effects on individuals in hospitals and in the community and it needs to be taken more seriously,” he explained.

“At present we have too many services settling for inadequate standards – the Care Quality Commission has recently confirmed that about a fifth of hospitals and nursing homes are not meeting at least one basic or essential standard in nutrition and hydration – and that is unacceptable.”

The condition, which occurs when a person’s diet does not contain enough or the right balance of nutrients, leaves sufferers vulnerable to illness, delays recovery and weakens the effects of medical treatments. 

In an attempt to tackle the problem and raise standards among healthcare professionals, Prof Elia has overseen the development of five statements for best nutritional practice – known as a quality standard – on behalf of the National Institute for Health and Clinical Excellence (NICE).

He explained: “Although malnutrition is a threat to millions of people in the UK, health services have struggled to develop clearly defined, simple and implementable plans that aim to achieve best practice.

“There is often a lack of continuity of care for individuals between care settings but, by making a documented nutrition care plan which is transferred with a patient when they move a requirement, we may start to see steady change.”

In addition to a transferable care plan, the quality standard sets out the need for malnutrition screening using a recognised tool – the ‘Malnutrition Universal Screening Tool’ (‘MUST’), which was developed by Prof Elia and his team – for everyone who accesses health services.

Prof Elia, a professor of clinical nutrition and metabolism at the University of Southampton, said: “These are aspirational but achievable standards for supporting appropriate nutritional practice in routine clinical and social care in adults of all ages, but may be especially relevant to the elderly, who are vulnerable to malnutrition, and those with severe diseases requiring specialised care.”

He added: “If used fully and correctly, the simple quality statements will define what high quality nutritional care is and will give healthcare professionals the chance to uplift routine practice into best practice. 

“We simply must move from the mindset of adequate practice to best practice using simple, rational methods – we owe it to our patients. 

“By doing simple things well, we will reduce duplication of effort, miscommunication and inequalities in services, and ensure fewer people suffer the consequences of failing to detect and treat malnutrition.” 

The quality standard also includes full documentation of screening results and goals communication of them with patients within and between settings, training patients and carers to manage artificial support systems and nutrition reviews at planned intervals.

Peter Austin, a senior pharmacist in the nutrition support team at University Hospital Southampton NHS Foundation Trust and a member of the specialist NICE group chaired by Prof Elia, said: “I am pleased the new standard on nutritional support includes the use of artificial nutrition such as feeding through a tube into the gut or feeding directly into a vein.

“It is essential these are done well and they involve care from a number of people, including pharmacists, nurses and dietitians, which means communication between settings is essential.” 

National surveys indicate that 29% of adults admitted to hospital, 18% in mental health units and 35% in care homes are malnourished or at risk of malnutrition.

Posted on Monday 8 April 2013