1. Malnutrition Prevention Programme Chris Bryant Programme Director - NHS Elect

2. Malnutrition – A serious health issue It is common: Over a million older people (1:10 ) It has serious consequences Decreased resistance to infection Delayed recovery Falls It is costly to NHS …yet much overlooked

3. Some interesting Facts! Support the campaign by downloading, posting and tweeting these infographics:

4. Malnutrition Prevention Programme The Programme is part of the Government’s response to the Francis Report into the failings at the Mid Staffordshire Foundation Trust (see ‘Recommendation 241‘ on the Department of Health website). The report revealed that patients, many of them older, had been unable to eat or drink properly and that nutrition was not treated as a priority (Mid Staffordshire NHS Foundation Trust Public Inquiry, Volume 3‘ p. 1600). This programme is guided and supported by the Malnutrition Task Force, the Malnutrition Prevention Programme is a Department of Health funded scheme to help the 1 million plus older people in England who are suffering from or at risk of malnutrition. NHS Elect are proud to support this programme by providing change management and facilitation skills in order to support the five Pilot Sites across the UK.

5. The Founders Founders –Age UK –apetito –Bapen –Nutricia –Royal Voluntary Service (WRVS) Set up in June 2012 Under the Dignity in Care Partnership

6. 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

7. Programme Steering Group Dianne Jeffrey Chairman – Age UK Caroline Abrahams Age UK Marie Batey NHS England Karl Demian Royal Voluntary Service Andrew ForsterWrightington, Wigan and Leigh NHS FT Paul Freestonapetito Kate HallNutricia Des Kelly National Care Forum Ruth RoseService User Representative Mike StroudBapen Jude Thorling DH

8. Task Force 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

9. Task Force developed ‘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

10. Guidance Guides for Food and beverage providers Hospitals Care homes Local communities Commissioners Available to download from www.malnutritiontaskforce.org.uk

11. Task Force Recommendation for Dissemination May 2013: MTF final recommendation: Test out a model for whole communities working together Summer 2013: proposal to DH –to pilot process in five areas –Develop a social marketing campaign Government response to Francis Report Funding secured for 2013/14 Age UK is the grant holder on behalf of MTF Late 2013 - NHS Elect/AqUA appointed as ‘Change Facilitators’ for the Programme, reporting & accountable to MTF through Age UK

12. The Malnutrition Prevention Programme Jan 2014 – March 2015 The Programme: A. The Pilot Programme in 5 areas B. Dissemination of learning from A. C. The Social Marketing Campaign D. Evaluation of A-C * Evaluation - by Chester University

13. The Social Marketing Campaign Focus groups with public and professionals Posters and leaflets for older people and for carers Posters for hospital and for care home staff Local campaign led by community organisations Knowledge, Attitude and Practice (KAP) surveys: before, in the middle and after the intervention

14. Local Launch Events Helping Pilot Sites to:- Identify a local Team Understand their ‘current’ state and identify a ‘future’ state by:- –understanding the current problems and issues –Agreeing a shared purpose and vision Making it happen! –Prioritise issues, develop and implement action plans –Measure, monitor and embed change

15. The Five Pilot Sites Lambeth and Southwark Salford Kent Gateshead Purbeck/Dorset Each of the Pilot Sites face many challenges!

16. Gateshead The latest estimated resident population of Gateshead is 200,153, with approximately 36,500 aged 65 or over, accounting for 18% of the population. Gateshead’s population is also growing older; between 2011 and 2012 the number of people aged 65 to 74 increased by 800, whilst the number of those 75+ increased by 250. Levels of social disadvantage in Gateshead are markedly higher than England overall; over one third of the population of Gateshead live in areas that are among the 20% most disadvantaged across England.

17. Salford Based on the demographics from the ‘Integrated Care for Older People in Salford‘ document, Salford has a population of 35,000 over 65 years of age. The BAPEN commissioning toolkit suggests 14% of this age group may be at risk of malnutrition – this is almost 5,000 people in Salford. The ‘Integrated Care…’ document further states that in excess of £100 million per annum of health and social care expenditure in Salford relates to older people, which will increase substantially as the population becomes older. The number of older people is forecast to rise by 28% by 2030, from 35,000 to 43,300.

18. Kent Kent is a large county with a population of approximately 1.5 million. Its population has been steadily increasing in recent years, suggesting that the proportion of those in need of nutritional support will increase also. Kent has a number of large towns, but the majority of the county is rural which in turn brings its own challenges when addressing malnutrition and social isolation

19. Lambeth and Southwark Lambeth and Southwark are two densely populated boroughs in south London with a combined population of nearly 600,000. Lambeth has nearly 303,000 residents and Southwark around 294,000. Both boroughs have relatively high levels of deprivation. The 2010 Index of Multiple Deprivation (IMD) places Southwark as the 41st most deprived local authority in England (out of 326) and the 12th most deprived borough in London (out of 33). Lambeth meanwhile was placed 29th in England and is the 9th Highest in London.

20. Purbeck In 2009, the total population of Purbeck was estimated at 45,300, with more than 24% of these people coming from the 65+ age group, significantly higher than the national average of 19.5%. Life expectancy – around 81 years for males and 86 years for females – is around two years longer than the national average. Along with an older population, Purbeck is predominantly rural and suffers from limited access to services. Purbeck is one of the 20% most deprived in England for access to services. Currently, 68% of villages have no general store, and since 2005, three rural post offices and one urban one together with two rural petrol stations have closed.

21. NHS Elect - Who we are and what we do! An NHS members’ network –founded in 2002 and working directly with 58 + sites as members Provide support to members in the following areas: –Service improvement –Business of healthcare –Marketing, branding and patient experience Led major national improvement programmes

22. Our relevant experience NHS Elect: –Leads the national Ambulatory Emergency Care (AEC) programme Working with 60 + systems on spread of AEC –Supported the national delivery of 18 week waiting times Including, early adopter communities and MSK coaching –Diabetes Programme of Improve – London –Malnutrition Programme –Frailty AQuA: –Advancing Quality initiative Delivering measurable improvements across sites Both teams use only senior, experienced leaders to support colleagues in local improvement programmes

23. Better Care Better Value Indicators Provider Indicators – Acute Trusts –Managing variation in length of stay –Day case rate for procedures –Reduction in wasted bed days as a result of admission prior to operation –Reducing DNA rates –Reducing New to Follow Up rates –Reducing Emergency Re-admissions at 14 days Commissioner Indicators - PCTs –Admission rates for selected procedures where surgery is recognised as unnecessary –Reduction of avoidable emergency admissions against 19 recognised diagnoses –Managing variation in Outpatient Attendances GP Practice Indicators –Admission rates for selected procedures where surgery is recognised as unnecessary –Reduction of avoidable emergency admissions against 19 recognised diagnoses –Managing variation in Outpatient Attendances

24. NHS Elect/AQuA partnership Common aims, staff and model of engagement with members Currently work together on areas of common interest to support our members to excel Split national programmes on geography –AQuA supports the North and NHS Elect supports the South –NHS Elect taking role of Project Director

25. We use a collaborative approach Typically - Short-term (6 to 15 month) learning system that brings together a number of teams from health communities to seek improvement in a focused topic area Teams attend Learning Sessions (face-to-face or virtual meetings over the course of the collaborative) and work on improvements locally, often supported by expert facilitators Teams in collaborative’s have achieved dramatic results It is a well-established model for improving services in the NHS and fits well with the structure of the Malnutrition Prevention Programme

26. Using the IHI Model for Improvement

27. PDSA Cycles – Small Steps can create big changes! SOMETHING BIG! SOMETHING BIG! How can we achieve this? AP DS Continuous Improvement Small Steps Continuous Improvement Small Steps © NHS Institute for Innovation and Improvement 2010. All rights reserved.

28. Support for Pilot Sites Named coach for each locality Coaches provide support and facilitation for anything from a 1:1 coaching session to supporting the set up of Launch Events etc. Support Pilot Sites with the development of Case Studies Provide access to visual media resources to share learning with other Pilot Sites Publish regular Newsletters for stakeholders

29. Much of the source material found in this presentation is taken from the Malnutrition Task Force Website, please click on the link below to access the site, which contains lots of information! http://www.malnutritiontaskforce.org.uk/

30. Christine@nhselect.nhs.org.uk Any questions?