Adult Safeguarding & Nutritional Care MQNF, 23rd September 2015 Wendy Anderson @Wendy_Dietetics Wendy.Anderson@ssotp.nhs.uk Professional Lead for Dietetics, SSOTP Liz Osburn elizabeth.osburn@staffordshire.gov.uk Training Officer, Adult Safeguarding, Staffordshire County Council

The History to this Piece of Work 2012-2013 -1927 cases of neglect 526 (27%) did not meet the threshold for investigation- Poor Care identified Nutritional issues identified were: Lack of food and drink Unexplained weight loss Inappropriate feeding methods Force feeding

What do I do with my concern What do I do with my concern? Let’s look at the safeguarding referral process and changes introduced with the Care Act 2014, before we move on to appropriate working with the dietician

Raise a Safeguarding Concern when: An adult who: Has needs for care and support Is experiencing, or at a risk of, abuse or neglect: and As a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect

Safeguarding –not as a substitute for Provider responsibilities Commissioner responsibilities CQC and compliance with fundamental standards Duties of Police and other statutory investigators

Section 42 Enquiries Local Authorities MUST make enquiries or cause others to do so if they reasonably believe an adult with care and support needs is being abused/or is at significant risk of abuse Person-centred and less prescriptive

Contact Numbers Staffordshire -0845 6042719 Stoke – 0800 5610015

“What did you eat and drink in the last 24 hrs?”

Why do we eat and drink? Taste Enjoyment /social interaction Nutrition and hydration: Fuel for our bodies (energy Kcal) Vitamins and minerals Essential macro-nutrients (protein, carbohydrates, fats) Fibre Health

‘Food Glorious Food, Colourful and Tasty’ Overview of malnutrition Staffordshire scrutiny review and CQC outcome 5 Staffordshire Nutrition Support Guidelines and helpful Resources

Malnutrition “A state of nutrition in which deficiency, excess or imbalance of energy, protein and other nutrients causes measurable adverse effects on tissue/body form (body shape, size and composition) and function and clinical outcome” Elia, 2000

What happens when we don’t eat and drink what we need? Physical changes to the body and deterioration in mental state

General Effects of malnutrition Make Every Mouthful Matter General Effects of malnutrition Tiredness and fatigue Muscle weakness – falls, immobility Low mood unwilling to engage Reduced immune system - increased illness and infections Confusion, reduced memory Feeling cold, difficulty getting warm Longer wound healing Development of pressure ulcers

How much of a problem is it? Make Every Mouthful Matter How much of a problem is it? Malnutrition is estimated to affect about 3 million people in the UK. BAPEN, 2014

How much of a problem is it in our care homes? Make Every Mouthful Matter How much of a problem is it in our care homes? 30-42% of people admitted to care homes are at risk of malnutrition (BAPEN, 2014). 51% of patients admitted to hospital from care homes are malnourished, (BAPEN, 2014). Public expenditure on disease-related malnutrition in the UK in 2007 was estimated at more than £13 billion.

Staffordshire Scrutiny Inquiry 2011 Make Every Mouthful Matter Staffordshire Scrutiny Inquiry 2011 Raise awareness and increase the profile of malnutrition Explore a multi-agency approach to prevention and management of community malnutrition. 10 recommendations for Care Homes: - ONS, MUST, education and Training

CQC – Outcome 5 Nutrition and Hydration Make Every Mouthful Matter CQC – Outcome 5 Nutrition and Hydration 1 in 6 six care homes did not meet this standard (CQC Nutrition and Dignity for Older People, 2012)

What is SSOTP doing to help? Make Every Mouthful Matter What is SSOTP doing to help? Staffordshire Nutrition Support Guidelines (SSOTP, August 2014). Clear guidance on: MUST Food First Approach to good nutritional care

Education and Training Make Every Mouthful Matter Education and Training 21st July – Malnutrition and Dysphagia Workshop in partnership with SCC. Training sessions on MUST and appropriate use of ONS in partnership with SCC and Abbott Nutrition. Nutrition Champions: - Opportunity for 10 care homes to nominate 2 Nutrition Champions :- Achieve QCF level 3 - Promote Nutrition and Hydration in Social Care Setting (Skills for Health Innovation Fund in Partnership with SCC and SSOTP). undertake a project aiming to improve nutrition long-term for the people they care for.

Make Every Mouthful Matter Summary Preventing and identifying malnutrition is key to good outcomes for older people Alert the Safeguarding Team When you have any concerns: Staffordshire -0845 6042719 Stoke – 0800 5610015 As partners lets work together to drive down the financial, health and emotional costs of malnutrition. Support the people you care for to enjoy their food and drink! http://www.carematch.org.uk/documents/mailing/FLYER%20Nutrition%20champion.pdf http://www.staffordshireandstokeontrent.nhs.uk/Services - Dietetics and Speech and Language Therapy undertake a project aiming to improve nutrition long-term for the people they care for.