The Malnutrition Task Force Dr Ailsa Brotherton Member of the National Task Force

The Malnutrition Task Force Independent group of experts across health, social care and local government united to address the problem of preventable malnutrition in older people, with ministerial support.

Our mission To ensure the prevention and treatment of malnutrition is embedded in all care and community support services and awareness is raised amongst older people and their families

Malnutrition Devastating consequences Declining mobility - due to muscle wasting Decreased resistance / delayed healing Dizziness, leading to falls Depression Deteriorating quality of life Death! 3 million people malnourished or at risk Older people are more vulnerable affecting 1:10 (0ver a million) 36% already malnourished or at risk on admission to hospital

Our ageing population

Commitment to Act: Pledges

Malnutrition Task Force – Salford Pilot Site Background and Introduction Kirstine Farrer Consultant Dietitian Salford Royal NHS Foundation Trust

Malnutrition Task Force – Salford Pilot Site Background and Introduction Kirstine Farrer Consultant Dietitian Salford Royal NHS Foundation Trust

PHYSICAL Disease related malnutrition Feeding Swallowing Low activity Decreased organ reserve Specific disease Multiple drugs (taste) SOCIAL Isolation Poverty PSYCHOLOGICAL Depression/bereavement Dementia Alcohol Mobility Malnutrition in the UK Vulnerability

Poor breathing and cough from loss of muscle strength Psychology – depression & apathy depression & apathy Poor Immunity and infections Decreased Cardiac output Hypothermia – decline in all functions Renal function – limited ability to excrete salt and water and water Loss of muscle and bone strength - falls and fractures Loss of muscle and bone strength - falls and fractures Impaired gut integrity and integrity and immunity immunity Impaired wound healing and susceptibility to pressure ulcers Liver fatty change, functional decline necrosis, fibrosis Consequences of Malnutrition (within days)

Inadequate food intake is common in hospital European Nutrition Day survey* found that of patients aged >75 years only 1 : – 46% ate all of breakfast – 34% ate all of lunch – 35% ate all of dinner Older inpatients in a hospital elderly care unit in the UK were judged to be eating inadequately and only 67% had assessments 2 * 748 units in 25 countries, total n=16455, aged >75 years n= Schindler KE, Schuetz E, Schlaffer R, Schuh C, Mouhieddine M, Hiesmayr M. NutritionDay in European hospitals: risk factors for malnutrition in patients older than 75 years. Clin Nutr 2007; 2:10. 2.Patel MD, Martin FC. Why don’t elderly hospital inpatients eat adequately? J Nutr Health Aging 2008; 12(4):

Prevalence of malnutrition HospitalsCare HomesMental Health Units Centres (n=) Patients (n=) Centres (n=) Resident s (n=) Centres (n=) Patients (n=) 2007 Autumn Summer Winter Spring Prevalence 25-34%30-42%18-20%

93% 5% 2% 3 million malnourished Individuals at risk of malnutrition

The Malnutrition Carousel HOSPITAL NURSING HOME CARE HOME Malnutrition PRIMARY CARE   dependency   GP visits   prescription costs   hospital admissions SECONDARY CARE   complications   length of stay   readmissions   mortality

We know what excellent nutritional care looks like

Nutrition support in adults 2006 February 2006

The effectiveness of Nutrition Support 30 RCT, n = 3258 RR 0.59 (CI 0.48 to 0.72) 10 RCT, n = 494; RR 0.29 (CI 0.18 to 0.47) Complications % Mortality % Controls Treatment

The Cost of Malnutrition Public expenditure associated with <3 million individuals in UK who are malnourished or at risk of malnutrition >£7.3 billion p.a >£13 billion p.a ?? >£15 billion p.a. NICE Cost Saving Guidance places effective treatment of malnutrition as 3 rd in ranking of potential biggest cost savers to the NHS

Making it happen ‘’This guide is easy to use since we have defined the top three priority actions for each level of the care system. Simply go to the part that relates to your organisation and take action’’

Reliable systems of nutritional care Good nutritional care for every individual, in every setting, on every day

Salford Integrated Care Programme: Malnutrition Launch Event, May 2014 Jack Sharp Executive Director Service Strategy and Development Salford Royal NHS Foundation Trust

Promote independence for older people, delivering: 1.Better health and social care outcomes 2.Improved experience for services users and carers 3.Reduced health and social care costs Integrated Care for Older People

“Integrated health and social care for older people has demonstrated the potential to decrease hospital use, achieve high levels of patient satisfaction, and improve quality of life and physical functioning” Curry and Ham, Clinical and Service Integration – The Route to Improved Outcomes King’s Fund, 2010 High levels of need National and international evidence Significant population growth Significant cost of care Poor experience of care Service duplication 27

WORK IN PROGRESS - DRAFT 14/11/1328

Salford’s approach System shift from reacting to anticipating Personalised, shared care planning; ‘Sally’ at the centre Tell your story once, one assessment, one key worker, supported by one integrated system Outcomes driven support

2020 improvement measures Emergency admissions and readmissions 19.7% reduction in NEL admissions (from 315 to 253 per 1000 ppn) Reduce readmissions from baseline Cash-ability will be effected by a variety of factors Permanent admissions to residential and nursing care 26% reduction in care home admissions (from 946 to 699 per 100,000 ppn) Savings directly cashable but need to be offset by cost of alternative care (especially increased domiciliary care) Quality of Life, Managing own Condition, Satisfaction Maintain or improve position in upper quartile for global measures Use of a variety of individual reported outcome measures Flu vaccine uptake for Older People Increase flu uptake rate to 85% (from baseline of 77.2%) Proportion of Older People that are able to die at home Increase to 50% (from baseline of 41%) 30

Partnership approach*  Age UK  Care Homes (multiple)  Chamber of Commerce  Citizens Advice Bureau  City West Housing Trust  Community Pharmacy  Domiciliary Care Providers  General Practice  Helping Hands * includes, but not limited to  Inspiring Communities Together  Mature persons group  Salford Community Leisure  Salford CVS  Salford Multi-Faith Forum  Unlimited Potential  Your Housing Group  Other third sector organisations

Summer 2012Sign up by partners and formation of ICP October 2012Engagement events and co-design February 2013Launch of Neighbourhood Collaborative December 2013Salford Chosen to be one of the national pilot sites to tackle malnutrition under the auspices of Age UK on behalf of the Malnutrition Task Force January 2014City-wide roll-out of ICP agreed March 2014 Summit Event to celebrate success so far and forward planning including MTF aims Journey so far

What will be different for Sally Ford and her family? 33 Greater independence Able to live at home longer Reduced isolation Increased opportunities to participate in community groups and local activities Confidence in managing own condition and care Sign-off own care plan and agree who it should be shared with Support to monitor own health Know who to contact when necessary One main telephone contact number for advice and support Increased community support, specialist care when necessary Access to a named individual to coordinate care and support Support to plan for later stages in life Agreed plan for last year in life

Sally Friendly City: raising awareness across the city to, both the public and food and beverage providers, about malnutrition and where to go for help Centre of Contact: signpost people who identify themselves as at risk of Malnutrition to get appropriate help Multidisciplinary Groups: discussing people who are malnourished or are at risk and supporting them with food and drink diaries, supplements, and onwards referral if required Wellbeing/Care Plan: will contain best guidance on supporting good nutrition and hydration Integrated Care Standards: that all service providers will sign up to, will include requirements around education, training an monitoring of malnutrition, by GPs, health and social care practitioners and care homes Opportunities to align with MTF priorities

Do you think it’s normal for people to lose weight as they get older? More than half thought losing weight in older age was normal

Over the winter do you think you may have lost weight without intending to? A quarter said they had lost weight over the winter without intending to

Over the past week do you think you have been eating enough? 16% felt they had not been eating enough over the previous week

Have you had a smaller appetite lately? 32% said they had a smaller appetite lately

Reasons people gave for not eating enough

What people said they’d do if they found themselves losing weight without intending to

GROUP EXERCISE 1 On your Table is an extract from the Malnutrition Task Force Guides This shows the 5 Principles and some important interventions needed to ‘reduce preventable malnutrition and dehydration in older people’ We would like you to help us better understand how we are currently doing in Salford Please share your views on what you think is happening now, where there are gaps, and what more we need to do.