The UK's number 1 malnutrition screening tool for health and social care professionals

HMP Berwyn is a Category C prison in North Wales. It has capacity to hold 2,106 men, making it one of the largest prisons in Europe. On average a minimum of eight new men arrive at the prison each day. Each prisoner goes through a healthcare screening on arrival to the prison to assess their physical and mental health needs. Until now, this screening process has neglected nutritional risk factors. Luckily, HMP Berwyn has a dietitian on site to advocate for these nutritional needs. After deliberation, it has been decided that BAPEN’s Malnutrition Universal Screening Tool (‘MUST’) will be added to the initial first day physical health screen, from June 2022.

Two percent of the prison population are underweight (low body mass index) on arrival to the prison, and these all get referred to on-site dietetics. Unfortunately, prisoners that appear ‘’healthy’’ or ‘’overweight’’ can be overlooked despite potentially scoring at high risk of malnutrition. A recent example of this was a prisoner that had gastric surgery prior to sentencing and lost 50% of his body weight in a two-year period, unintentionally.

Drug and alcohol abuse is highly prevalent in prisoner populations, and is often associated with increased risk of malnutrition. Having a ‘MUST’ screen on initial arrival will help ensure that patients receive equitable, timely care from the multi-disciplinary team (MDT) to prevent risk of further weight loss and health decline and identify need for further intervention and investigations. Dietetic referrals are expected to significantly increase as a result of implementing this screening process, and it is hoped that the patient doesn’t have to become ‘’bad enough’’/ underweight before being seen. The addition of this screen will evidence that malnutrition is prevalent across the BMI spectrum. ‘MUST’ will help to identify risk and ultimately significantly improve patient care and health outcomes. Implementing ‘MUST’ in a prison setting can only benefit this population group, it will be used as a pilot to identify best practice and I hope it will be the pioneer for improving nutritional care across all prisons in the UK.

Francesca Allsop
HMP Berwyn Registered Dietitian

It is really fantastic to see this initiative to implement malnutrition screening with ’MUST’ in prison. ‘MUST’ was always developed with the intent of being ‘universal’, which included its application for adults in all settings. Although it is often thought of in the context of healthcare, it is really encouraging to see the introduction of malnutrition screening in prison. It will be interesting to see the prevalence of malnutrition in this population and to ascertain the impact of dietetic intervention on these individuals. Well done Fran for your leadership in this area and highlighting the importance of nutrition and malnutrition awareness and screening in prisons, a topic that has typically been overlooked. We look forward to hearing more and seeing how this best practice can be rolled out further across the UK.

Dr Rebecca Stratton
Chair Malnutrition Action Group (MAG), BAPEN 

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