31July2014

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You are here: Home Tackling Malnutrition What have others done to combat malnutrition? Governments and National Bodies

Governments and National Bodies

ENGLAND

Department of Health

1995

Nutrition Guidelines for Hospital Catering

“We cannot overemphasize the importance of providing food of the appropriate nutritional content in a form and manner that patients will enjoy. Food can help increase the effectiveness of medical treatments and aid patients’ recovery, and has to be seen as essential in creating patient comfort and well-being.”

This quote shows that the importance of nutrition in the care of patients was recognised long ago and yet we are still fighting the same battle.

Department of Health

2000

Care Homes for Older People. National Minimum Standards. Care Homes Regulations. This includes standards relating to nutritional assessment, appropriate food provision and assistance with food.

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Department of Health

2000

NHS Plan. A plan for investment. A plan for reform. This promised to deliver: a 24 hour catering service with a new hospital menu, a national franchise for NHS catering, housekeepers on half of all wards by 2004, dietitians to advise and check on the nutritional values of hospital food, unannounced inspections of the quality of hospital food, a minimum menu framework and standard for meals and 24 hour availability of food with a new website to provide information and resources for the NHS team (Better Hospital Food).

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Better Hospital Food programme aimed to:

  • produce a comprehensive range of tasty, nutritious and interesting recipes that every NHS hospital could use
  • redesign hospital printed menus to make them more accessible and easier to understand
  • introduce 24-hour catering services to ensure food is available night and day
  • ensure hot food is available in hospitals at both midday and early evening mealtimes.

The website contains a wealth of information on the delivery of hospital catering services, including the national dish selector and links to many useful resources.

The programme was disbanded in 2006, but the resources are now hosted on the Hospital Caterers Association website.

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National Patient Safety Agency (NPSA)

2000

Patient Environment Action Teams (PEAT) annual inspections established. PEAT is self assessed and provides a framework for inspecting standards to demonstrate how well individual healthcare organisations believe they are performing in key areas including:

  • Food
  • Cleanliness
  • Infection control
  • Patient environment

Assessments are carried out by NHS staff (nurses, matrons, doctors, catering and domestic service managers, executive and non-executive directors, dieticians and estates directors). Patients, patient representatives and members of the public are also part of this assessment process. NHS sites and NHS trusts are each given scores from 1 (unacceptable) to 5 (excellent) for standards of environment, food and dignity and privacy within buildings).

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Department of Health

2001

National Service Framework for Older People. This included the development of a single assessment process for health and social care for older people, with nutrition screening and assessment as a key part of this process.

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Department of Health

2005/06-2007/08

Department of Health issued "National Standards, Local Action: Health and Local Care Standards 2005/06 - 2007-08." This included nutritional care as a core standard.

Standard C15 states:

 'Where food is provided, healthcare organisations have systems in place to ensure that:

a) patients are provided with a choice and that it is prepared safely and provides a balanced diet and

b) patients' individual nutritional, personal and clinical dietary requirements are met, including any necessary help with feeding and access to food 24 hours a day'

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National Institute for Clinical Excellence (NICE)

2006

NICE Clinical Guideline 32 Nutrition Support in Adults. This guideline covers the care of patients with malnutrition or at risk of malnutrition in hospital and in the community. It sets out some key recommendations in relation to screening for malnutrition, the need for nutritional support and the organisational structures that needed to be in place to support this.

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2011

NICE identifies nutrition as one of the most cost effective investments. The conservative estimate of a saving of £28,472 per £100,000 is based on the implementation of the recommendation in Clinical Guideline CG32 "Nutrition Support in adults". Costs arising from this guideline included improving systematic screening, assessment and treatment of malnourished patients. If this was fully implemented and resulted in better nourished patients then this would lead to reduced complications such as secondary chest infections, pressure ulcers, wound abscesses and cardiac failure. Conservative estimates of reduced admissions and reduced length of stay for admitted patients, reduced demand for GP and outpatient appointments indicate significant savings are possible.

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2012

NICE Quality Standard CG 138 Patient experience in adult NHS services. This quality standard include the following statement relating to nutrition and hydration: "Patients have their physical and psychological needs regularly assessed and addressed, including nutrition, hydration, pain relief, personal hygiene and anxiety."

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Department of Health

2007

Improving Nutritional Care: A joint Action Plan from the Department of Health and Nutrition Summit stakeholders. The Nutrition Action Plan outlines how nutritional care and hydration can be improved and suggests five key priority areas through which managers and staff working in health and social care can address this. BAPEN and NNNG were stakeholders in this important publication. The Nutrition action plan was launched in October 2007 by Ivan Lewis, MP, Under Secretary of State for Care Services, as part of the Dignity in Care campaign.

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National Patient Safety Agency (NPSA)

2007

Ensuring safer practice for adults with learning disabilities who have dysphagia. The report highlights best practice and provides resource materials to give practical help.

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2009

NPSA Nutrition Fact Sheets launched. These factsheets identify the issues that healthcare staff need to consider for each of the10 Key Characteristics of Good Nutritional Care. They provide information on what the issues are, what actions can be taken and the resources available. The factsheets draw together current guidance, evidence base and best practice examples.

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2011

NPSA Rapid response report "Reducing the harm caused by misplaced nasogastric feeding tubes in adults, children and infants"

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2011

NPSA Dysphagia Expert reference group launch Dysphagia Diet Food Texture Descriptors

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2012

NPSA rapid response report "Harm from flushing of nasogastric tubes before confirmation of placement "

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NHS Core Learning Unit

(Skills for Health)

2008 to date

The online training programme “Food, Nutrition and Hydration and Social Care” launched. This is a learning programme aimed at nurses, carers, health care assistants and volunteers in the Health and Care sector. There are also other modules covering nutrition and hydration basics, dysphagia and feeding at the end of life.

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Department of Health

2010

Essence of Care. Benchmarks for Food and Drink.

Essence of Care 2010. Benchmarks for food and drink. This guide details 10 benchmarks for the provision of food and drink. These comprise: 1. Promoting health, information, availability, provision, presentation, environment, screening and assessment, planning, implementation, evaluation and revision of care, assistance and monitoring.

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NHS Institute for Innovation and Improvement

2012

Chief Nurses make nutritional care one of their eight "High impact actions". The High Impact Actions for Nursing and Midwifery were developed following a ‘call for action’ which asked frontline staff to submit examples of high quality and cost effective care that, if adopted widely across the NHS, would make a transformational difference. The Essential Collection, including 'Keeping nourished - getting better' aims to highlight just some of the stories behind those submissions by providing details not only of what was done, but also ‘how they did it’. These examples are intended to provide illustrations of good practice which you may not already have seen. Most importantly they are examples of how real people have made a real difference. The Essential Collection is not designed to be tell you ‘how to’ make the changes; but it does signpost you to some of the many excellent resources already available that relate to the areas identified within the High Impact Actions.

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Care Quality Commission (CQC)

2011

CQC Registration Standards - Outcome 5 - Meeting Nutritional Needs.  The essential standards of quality and safety are central the regulation of health and social care. Each standard has an association outcome that CQC expects all people who use the services to experience as a result of the care they receive. The CQC website includes a number of resources to support providers in ensuring that they meet these outcomes. CQC also undertakes regular inspections and publishes reports of their findings. The “Dignity and Nutrition for Older People” review was a targeted inspection programme of NHS hospitals that showed that of the 100 hospitals inspected, 45 met the standards, 35 needed to improve in one or both standards and 20 did not meet one or both of the standards. In terms of nutrition, the issues raised were patients not being given the help they needed to eat and being interrupted at mealtimes and leaving their food unfinished.

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NPSA and Patient Safety First

2012

NPSA and Patient Safety First Nutrition and Hydration week. On 23 January 2012 the National Patient Safety Agency (NPSA) and Patient Safety First hosted a week focused on nutrition and hydration: 'A taste of patient safety'. The website has a range of useful resources, including Webex sessions with presentations that can be viewed on line.

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NORTHERN IRELAND

Department of Health, Social Services and Public Safety

2007

Get your 10 a day! The Nursing Care standards for Patient Food in Hospital. Department of Health, Social Services and Public Safety. Northern Ireland. This document is based on the 10 Key Characteristics of Good Nutritional Care and translates them into a framework for action.

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Department of Health, Social Services and Public Safety

2011-2016

Promoting Good Nutrition – a strategy for good nutritional care for adults in all care settings in Northern Ireland. This strategy aims to build on “Get Your 10 a Day!” to include all health and social care settings including peoples own homes. This will be achieved through the adoption and translation of the Council of Europe Alliance UK’s 10 Key Characteristics which form the basis of good nutritional care.

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SCOTLAND

The Scottish Government

2000

The Scottish Government publishes its NHS plan "Our National Health: A plan for action, a plan for change". This plan cites the importance of nutrition for the well-being of its patients and population.

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The Scottish Government

2002

The Scottish Government published its “Promoting Nutrition for Older Adult In-Patients in NHS Hospitals in Scotland” by the National Nursing, Midwifery and Health Visiting Advisory Committee. This aim of the report was to support change and promote nutrition as a key element of patient care by providing professionals with practical guidance on how to implement the nutritional standards as set down in the Nursing Homes Scotland Core Standards for Nutritional Care, but applied to all NHS Care facilities.

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Healthcare Improvement Scotland

2003

Food, Fluid and Nutritional Care in Hospitals Standards. These standards were developed by NHS Quality Improvement Scotland and included sections on a strategic approach to food delivery and nutritional care, assessment and screening, food delivery in practice and training and education. The standards were used to assess performance in the provision of food, fluid and nutritional care in NHS Boards throughout Scotland.

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The Scottish Government

2008

"Food in hospitals. National Catering and Nutrition specification for Food and Fluid Provision in Hospitals in Scotland" published by the Scottish Government. This document recognises that it is fundamental that hospitals provide appropriate food, fluid and nutritional care to manage any nutritional risk, to improve health and well-being and optimise the wider clinical management of all patients.

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Consumer Focus Scotland and Community Food and Health (Scotland)

2011

Meals and Messages. A focus on food services for older people living in the community in Scotland.

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NHS Scotland

2011

Doctors Online Training System (DOTS) launched a Nutrition Training Module compulsory for all foundation doctors in Scotland

Healthcare Improvement Scotland

2012

Improving Nutrition… Improving Care final report. This report makes it clear that nutritional care must remain a national, local and individual priority. The report also details the next steps for ensuring the integration and alignment of nutritional care across Scotland.

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WALES

Welsh Government

2002

The All-Wales Catering / Nutrition Group for the Welsh Assembly Government published the "Nutrition and Catering Framework" setting out how it expects Trusts to deliver nutrition to all patients.

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Welsh Government

2003

Welsh Government publishes “Fundamentals of care: guidance for health and social care staff: improving the quality of fundamental aspects of health and social care for adults”. This includes practice indicators for eating and drinking, to ensure good nutritional care.

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All Wales Medicines Strategy Group (AWMSG)

2006

All Wales Medicines Strategy Group (AWMSG) publish a report on the key clinical and organisational priorities for the provision of sip feeds (updated May 2012)

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Welsh Consumer Council

2008

The Welsh Consumer Council convened a round table meeting to discuss how best to address malnutrition among older people in the community and produced a discussion paper. The Malnutrition Roundtable report calls for increased recognition of the problem and a co-ordinated national strategy for tacking this issue.  It recommends adequate resources, targeted awareness campaigns, training, nutrition screening and treatment to address the needs of those who are at risk of malnutrition.

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Aneurin Bevan Health Board

2010

Guidelines for the treatment of under nutrition in the community including advice on oral nutritional supplement (sip feeding) prescribing. This guideline was produced to standardise the management of malnutrition in the community.

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Welsh Government

2011

Nutrition in community settings. A pathway and resource pack for Health and Social Care Professionals, the Third Sector, Care Home Staff, Relatives and Carers. This web based resource includes All Wales food and fluid record charts, information leaflets on recognising the risk of malnutrition and advice on improving food intake.

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Welsh Government

2011

All Wales Nutrition and Catering Standards for Food and Fluid Provision for Hospital
Inpatients

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EUROPE

Council of Europe

2003

Resolution ResAP (2003)3 on food and nutritional care in hospitals (Adopted by the Committee of Ministers on 12 November 2003 at the 860th meeting of the Ministers' Deputies)

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The recommendations within the resolution (of which there were more than one hundred) were summarised into the “10 Key Characteristics of good nutritional care in hospitals”

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European Union

2007

Prague Declaration.

On 11th June the European Nutrition for Health Alliance (ENHA) joined with the Czech Presidency of the EU, EU health ministries, the European Society for Clinical Nutrition and Metabolism (ESPEN), health care professionals and health insurance groups to call for an end to malnutrition.

“Malnutrition, including disease related malnutrition are urgent public health problems and action need to be taken to prevent malnutrition continuing to compromise quality of life, cause unnecessary morbidity and mortality and continue to undermine the effectiveness of European health care systems.”

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