1. Malnutrition Prevention Programme Liz Weekes and Lenny Kinnear Lambeth and Southwark

2. Contents Five principles LAMP aims and objectives Pilot site launch event Workstreams Older People’s Information Directory Testing models of dietetic care

3. The Five Principles Raising awareness of malnutrition among staff and older people Working together within and across organisations Identifying malnutrition and malnutrition risk early Providing personalised care, support and treatment Monitoring and evaluating the impact of the interventions and the individual outcomes

4. Lambeth and Southwark Action on Malnutrition Project (LAMP) Two years funding from Guy’s & St Thomas’ Charity Phase 1 April 13 – March 14– Mapping and scoping of current service provision Phase 2 April 14 – March 15– Model development and MTF Project Academic and clinical collaboration across King’s Health Partners –Dietetic managers (GSTT, KCH, SLAM, UHL) –Diabetes and Nutritional Sciences (KCL) –Health Economists (KCL) –Southwark and Lambeth Integrated Care Programme (SLIC) –Southwark and Lambeth Councils –Local voluntary groups e.g. Age UK Lambeth Page 4

5. Governance = embedded for delivery & sustainability Southwark and Lambeth Integrated Care Programme LAMP Advisory Board MTF Pilot Project Team Trust Nutrition Steering Committees

6. Lambeth and Southwark Action on Malnutrition Project (LAMP) Phase 1 2013 - 2014 Quantify the extent of malnutrition across Lambeth and Southwark To determine the proportion of at risk patients whose nutritional management complies with NICE guidelines To characterise the services malnourished currently access across the boroughs and explore local variation in service provision and access to care To characterise the knowledge, expertise and training needs of those who currently manage malnutrition in the community Phase 2014 - 2015 To identify and critically appraise alternative service models in use across the UK To identify and collect baseline data on KPIs and outcomes to enable future service provision in this area to be evaluated and managed To develop an alternative model for the clinical and cost effective management of malnutrition across Lambeth and Southwark To prepare a bid for funding to evaluate the effectiveness of a novel malnutrition care pathway To raise awareness within the community of malnutrition as an issue and what can be done to tackle it

7. Project Launch Event Contacts developed as part of LAMP –Commissioners, CQC, community health and social care professionals, voluntary sector Aims –Raising awareness of malnutrition in community, encouraging cross-boundary partnership working Methodology –Quiz, workshops, posters Result –Malnutrition: everyone’s responsibility

8. Raising awareness

9. Outcome: 3 Work-stream remits Screening, assessment and care planning in care homes Coordination of information across settings Raising awareness through better information

10. 10 Context Audit of screening and care planning in Lambeth and Southwark care homes has shown that screening using the MUST tool and associated care planning is often incomplete or inaccurate. Objectives and Scope Staff within a defined care home(s) will recognize the importance of screening and care planning in the detection and management of malnutrition; measured through staff feedback Standard training package to be tested in a small number of care homes in Southwark LAMP will provide access to BAPEN e-learning package in Lambeth Based on the learning, a consistent approach to screening, assessment and care planning will be developed, generalizable across the 2 boroughs. Scope: Care home residents and staff in selected care homes in Lambeth and Southwark. The Local Authority. Guys & St Thomas’, 3 rd sector: Age UK Lambeth and Southwark. Deliverables Undertaken a root cause analysis in 1 -3 care homes Produced options for education interventions and test feasibility Monitor impact Sustainability plan for any potential education model to accommodate staff turnover Produce 2 borough plan Success Measures (See Metrics Sheet) Training Improvement science and project management skills Resources for the production of any communications and education materials Team structure and roles Project lead – Liz Weekes Age Uk lead – Lenny Kinnear Coach – Lisa Godfrey The Team TBC Purpose Outputs Resources Others to involve TBA (Potential) WORKSTREAM 1 : Screening and Care planning

11. 11 Model 1 – Educator/Facilitator Southwark DietitianHCP Training Screening Assessment Action Plan Monitor Review Onward Referral Model 2 – Direct dietetic care Lambeth DietitianHCP Training Screening Assessment Action Plan Monitor Review Onward Referral Testing models of care

12. 12 Context Dieticians are visiting patients at home and are finding they don’t have the ‘right’ information on patients, or the referral is Inappropriate. This results in a poor patient experience, and wasted time for the dietician; a scarce resource in the system. Objectives and Scope Scope the issue further then take a decision re: the relative value of focusing on this as a project. Scope: Care home residents and staff in selected care homes in Lambeth and Southwark. The Local Authority. Guys & St Thomas’ 3 rd sector: Age UK Lambeth and Southwark. Deliverables Agree the dataset as to what information should be available in advance of a visit Track referrals prospectively or audit retrospectively to identify issues Success Measures See metrics sheet Training Improvement science and project management skills Resources for the production of any communications and education materials Team structure and roles Project lead – Liz Weekes Age Uk lead – Lenny Kinnear Coach – Lisa Godfrey The Team TBC Purpose Outputs Resources Others to involve (Potential) WORKSTREAM 3 : Coordinated care for dieticians home visits

13. Co-ordinated care Number of electronic record systems –RiO Lambeth and RiO Southwark –EPR (acute Trusts) –Carefirst (social care) Levels of access –Individual versus team access Transmigration to new systems

14. 14 Context Through the scoping and mapping of malnutrition and its management in Lambeth and Southwark over the past year, it has been identified that professionals don’t know how to access a dietician, or how to manage post- assessment; and the public don’t know how to access information and support on nutrition. Objectives & Scope Agree and produce clear, accessible information on how to access a dietician in a range of formats/channels available to all Lambeth and Southwark healthcare professionals Launch a directory or updatable resource of the support and services available to Lambeth and Southwark citizens (May 14) All Lambeth and Southwark citizens, all healthcare professionals, all NHS organisations, the Local Authority, 3 rd sector: Age UK Lambeth and Southwark. Deliverables Directory deployed and hosted by Age UK Lambeth – May 14 Suite of information produced; with the first being a signposting guide to dieticians – Sept 14; Mar 15 Communications plan to launch new materials Sustainability plan to ensure the resources are kept up- to-date Success Measures Number of hits on the directory Number of referrals to the dietician via the correct route Risks: Materials become out of date because of the challenge in tracking when services/support change Support from the Age UK communications team for campaign elements of the project Improvement science and project management skills Team structure and roles Project lead – Liz Weekes Age Uk lead – Lenny Kinnear Coach – Lisa Godfrey The Team TBC Purpose Outputs Resources Others to involve (Potential) WORKSTREAM 1 : Raising awareness through better information

15. Malnutrition roadshows Collaboration between Age UK Lambeth and LAMP team More than 20 roadshows in various venues including across the borough Age UK leaflets, activities, information giving ?? Of people interacted with

16. Older People’s Information Directory A simple way to access comprehensive, accurate information Helps the public and health and social care professionals to understand the services available Aids efficient referrals to prevent crises for older people and their carers

19. Page views and number of organisations Number of organisations increased from 216 to 1356 since April 2014

20. PROGRESS: Working Together Facilitated communication and documentation around nutritional care from hospital to the community (and back?) Working with commissioning managers and contract monitors (and CQC) e.g. care homes and community meal provision Working with Age UK Lambeth, Southwark & Lewisham on Safe and Independent Living (SAIL) training Including “MUST” in Holistic Health Needs Assessment and on RiO and EMIS (and providing training)

21. Progress: Identifying Malnutrition Conducted baseline audits of nutritional care in care homes, mental health and intermediate care Focus groups to determine how staff currently detect and manage malnutrition Focus groups with citizens to determine how they perceive current nutritional care Audit of discharge documentation at GSTT, KCH and SLAM Validated screening tool with clear actions

22. Progress: providing personalised care Designed and testing two models of care: –Direct dietetic care (Lambeth) –Educator/facilitator (Southwark) Clear care pathways i.e. the community malnutrition pathway www.malnutritionpathway.co.ukwww.malnutritionpathway.co.uk Consistent messages e.g. “MUST” Training health and social care staff in the community and care homes

23. Progress: measuring the impact Designed outcome measures and data collection tools for each of the two test models (and for individuals) Started to collect outcome data Analysis of preliminary data starts in new year Remit to feed back to funding body (Guy’s & St Thomas’ Charity), Trust Boards, commissioning managers, CCGs, voluntary sector partners

24. Our Challenges Who do you talk to about what? Re-inventing the wheel Competing priorities Increasing demand Integration of services Culture change Short-term funding

25. Our Greatest Achievements So Far! Established cross-boundary partnerships and collaborations for future work e.g. council tender specifications and contract monitoring, MDT training Baseline audit of documentation of nutritional care in care homes, intermediate care and mental health Focus groups exploring how malnutrition is currently detected and managed in the community Consistent messages and clear pathways of care Funding for a new dietetic team to test two models of dietetic care Online directory and road shows

26. Any Questions?

27. Key Data Organisations Added (2014)Pre-AprilAprMayJunJulAugSepOctNovYTD Added by Age UK Lambeth 24112410314934416615494481423 Added through Directory 0001501029 Removed 25591215631076 Total2161199413833416015293501356 Entry VerificationMayJunJulAug SepOctNov YTD Initially Contacted for Verification97473241240 15510768 1381 Re-prompted for Verificationn/a 280150 143188321 1082 Responses Received (Email)159152111 99109153 783 Corrections/Feedback through Directory411014 732 41 Responses Actioned164162125 106112155 824 Proportion of Entries that have been Verified26.5%34%41% 44%50%59%