1. Welcome Penny Bond/Programme Lead Improving Nutritional Care Programme
I’m Michelle Miller, Programme Manager for the Improving Nutritional Care Programme, and I’m just going to give you a brief background to the Programme. Apologies to those who have been involved in the programme and so understand the background.
3 million people in the UK suffer from malnutrition
Costs exceed 13 billion pounds per year
NICE predict nutrition to be the largest cost saving area in the NHS
Penny Bond/Programme Lead
Improving Nutritional Care Programme

2. Improving Nutritional Care Programme overview Michelle Miller
10.00
Welcome
Penny Bond
10.05
Improving Nutritional Care Programme overview
Michelle Miller
10.15
Introduction to Improvement Methodologies
Jane Murkin
11.00
Coffee
11.15
Improvement Methodologies continued
12.15
Lunch
13.00
Making Meals Matter and Volunteers
Making Communication Matter
Wallace Monument
Ochil Room
15.00
15.15
Feedback and next steps
16.00
Close
I’m Michelle Miller, Programme Manager for the Improving Nutritional Care Programme, and I’m just going to give you a brief background to the Programme. Apologies to those who have been involved in the programme and so understand the background.
3 million people in the UK suffer from malnutrition
Costs exceed 13 billion pounds per year
NICE predict nutrition to be the largest cost saving area in the NHS

3. Improving Nutritional Care Programme
I’m Michelle Miller, Programme Manager for the Improving Nutritional Care Programme, and I’m just going to give you a brief background to the Programme. Apologies to those who have been involved in the programme and so understand the background.
3 million people in the UK suffer from malnutrition
Costs exceed 13 billion pounds per year
NICE predict nutrition to be the largest cost saving area in the NHS
Michelle Miller/Programme Manager
Improving Nutritional Care Programme

4. Building on good practice
Audit Scotland Report 2003
Best practice Statements 2002
Care Standards 2002
Eating Well in Care Homes for Older People 2009
We’re not starting with a blank canvas in Scotland. Good work has already been happening at a national and local level.
FFN standards
Best Practice Statements
Food in Hospital report
Improving Nutritional Care Practice Development Network
Nutrition Champions
You will be aware of the major developments in nutritional care that have taken place across NHS Scotland in recent years. Food Fluid and Nutritional Care in Hospitals Standards (NHSQIS) have been developed and reviewed, a practice development toolkit has supported implementation of the standards. The Improving Nutritional Care Programme (NHS QIS) is undertaking targeted improvement and implementation support with Nutrition Champions and Nutritional Care Teams driving changes locally. NHS Education for Scotland are supporting education of doctors and healthcare support workers in nutritional care. NUTMEG has been introduced to assist with menu analysis and compliance reporting in accordance with the National Catering and Nutritional Services Specification is underway through Health Facilities Scotland. All of this work is contributing to improving nutritional care in Scotland but we do not yet have a national picture of the scale of malnutrition in Scotland. We do know, however, that despite all of this activity and progress, malnutrition does remain a problem. The Scottish In-patient Survey (September 2010) carried out by Better Together shows that 11% of patients who said they needed help to eat and drink in hospital said they did not receive it.

5. But despite a lot of good work going on, we’re still not getting it right for every person every time.

6. Aim: Ensuring adults at risk of malnutrition receive appropriate and safe nutritional care and the assistance they require to eat and drink
Supporting self-management of nutritional care
Person Centred
Effectiveness
Safety
Efficiency
Improving meal processes: reducing waste
Preventing re-admission
Managing transitions between hospital and care home
Ensuring people get the support they need to eat and drink

7. 3 Priority areas: rationale
Food Fluid and Nutrition Standards
Better Together: assistance with eating and drinking statistics
Making Meals Matter
30% of people admitted to hospital from care home at risk of malnutrition
13,000 discharges from hospital to care home in Scotland (ISD)
Variation in communication re: nutritional care
Food fluid and nutrition standards – area for improvement
Improving transitions (care home/hospital)
3 million people in UK: COPD
5th Leading cause of death in the UK
NHS Costs: 600 million/year
Supporting self-management of nutritional care
Self-Management (LTC/COPD)

8. How to achieve our vision The improvement journey so far……….
SCOPING
Prioritisation Exercises(CAAP)
Nutrition Champion Scoping Workshop
Stakeholder Engagement
Showcase Advisory Event (2010)
Building Improvement Capacity
Learning Sessions – Building capacity and capability for improvement
Testing and Gathering data
Test sites identified
Prototypes developed; Testing
Collecting data; learning from data
Identifying spread opportunities

9. Developing resources & local testing
Making Meals Matter Resources to improve meal time processes (operational definition of protected meal times)
Volunteers at Meal times
Improving transitions (care home/hospital)
Communication tool and resources
Improving knowledge and understanding of nutritional care to allow people with long term conditions to manage their nutritional care
Self-Management (LTC/COPD)

10. Our outputs Tools/Prototypes Patient and Staff Experience Event Report
Interim Report
Posters and Story Boards
Making Meals Matter resources – a pack to assist in improving meal time processes
Communication Tool and Staff Questionnaire to improve transitions between hospital and care home
True, False, Justify Questionnaire – to assess peoples understanding and knowledge of how to manage their nutritional care
Patient, staff and carer experience – gathered through digital story and Talking Mats and interview techniques
Volunteers at Meal time resources – NHS A&A
Showcase Event 9 June Event at Murrayfield where we showcased the work of the programme
Posters (1 accepted for NHSScotland event and a poster accepted for BAPEN conference)
Event Report
Interim Report (case studies)

11. Spreading Improvements
Making Meals Matter Resources
Volunteers at Meal Times
Resources
Communication Tool and Staff Survey
prototypes, shared learning, experience and methodologies
Purpose of spread: Ensuring adults at risk of malnutrition receive appropriate and safe nutritional care and the assistance they require to eat and drink

12. Spread strategy
Where: Hospitals and care homes in Scotland (nomination process).
When: September March 2012
Target Population
Adults at high risk of malnutrition (particularly older adult)
Target Staff Groups
Ward Staff
Local Facilitator
Care home staff
Approach to spread
Hybrid of models
1. Diffusion
2. Active dissemination
3. Improvement Collaborative
Diffusion – dissemination of Making Meals Matter packs; showcase event on 9 June, today’s meeting
Active dissemination and Improvement Collaborative – spread events
Improvement clinics

13. HOW WE’RE Spreading (spread plan)
Aim of spread: Ensuring adults at risk of malnutrition receive appropriate and safe nutritional care and the assistance they require to eat and drink
Pre-work
Identification of Test Sites
Prototypes ready to spread
Spread strategy and plan
Prepare for implementation (spread event preparation)
Interim Report and Conference Report to share
Out-puts
Story Boards
Case Studies
Prototypes developed to fit with local culture and context
Final Report
Poster
Showcase event
Spread Session 1:
6 Sep 2011
Spread Session 2: 10 Nov 2011
Spread Session 3: 9 Feb 2012
Regular documentation and reporting on changes/improvements and results
Based on IHI breakthrough series
Ongoing shared learning and improvement support via Spread Events and Improvement Clinics (teleconferences)

14. Introduction to Improvement
I’m Michelle Miller, Programme Manager for the Improving Nutritional Care Programme, and I’m just going to give you a brief background to the Programme. Apologies to those who have been involved in the programme and so understand the background.
3 million people in the UK suffer from malnutrition
Costs exceed 13 billion pounds per year
NICE predict nutrition to be the largest cost saving area in the NHS
Jane Murkin
Associate Director of Quality Improvement

15. Next Steps – key questions
Who are you going to tell about today’s event?
Who is going to take forward the improvement activity?
Who else do you need support from locally, to help take this forward?
What are you going to do by next Tuesday?????

16. Next Steps Local engagement and start testing
Report back: Improvement Clinic 25 October 2011
Spread Session 2: 10 November 2011, Edinburgh
I’m Michelle Miller, Programme Manager for the Improving Nutritional Care Programme, and I’m just going to give you a brief background to the Programme. Apologies to those who have been involved in the programme and so understand the background.
3 million people in the UK suffer from malnutrition
Costs exceed 13 billion pounds per year
NICE predict nutrition to be the largest cost saving area in the NHS
Penny Bond/Programme Lead
Improving Nutritional Care Programme