The Malnutrition Task Force

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

2. 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.

3. 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

4. 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

5. Our ageing population

7. Commitment to Act: Pledges

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

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

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

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

12. Inadequate food intake is common in hospital • European Nutrition Day survey* found that of patients aged >75 years only1: • 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 assessments2 • *748 units in 25 countries, total n=16455, aged >75 years n=4799. • 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. ClinNutr 2007; 2:10. • Patel MD, Martin FC. Why don’t elderly hospital inpatients eat adequately? J Nutr Health Aging 2008; 12(4):227-231.

14. Prevalence of malnutrition

15. 93% 5% 2% Individuals at risk of malnutrition 3 million malnourished

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

17. We know what excellent nutritional care looks like

18. Nutrition support in adults 2006 February 2006

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

20. The Cost of Malnutrition 2014 - ?? >£15 billion p.a. Public expenditure associated with <3 million individuals in UK who are malnourished or at risk of malnutrition 2003 - >£7.3 billion p.a 2007 - >£13 billion p.a. NICE Cost Saving Guidance places effective treatment of malnutrition as 3rd in ranking of potential biggest cost savers to the NHS

21. 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’’

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

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

26. Integrated Care for Older People • Promote independence for older people, delivering: • Better health and social care outcomes • Improved experience for services users and carers • Reduced health and social carecosts

27. National and international evidence Significant population growth Poor experience of care Service duplication High levels of need “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 OutcomesKing’s Fund, 2010 Significant cost of care

28. WORK IN PROGRESS - DRAFT 14/11/13

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

30. 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%)

31. 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 • Inspiring Communities Together • Mature persons group • Salford Community Leisure • Salford CVS • Salford Multi-Faith Forum • Unlimited Potential • Your Housing Group • Other third sector organisations * includes, but not limited to

32. Journey so far • Summer 2012 Sign up by partners and formation of ICP • October 2012 Engagement events and co-design • February 2013 Launch of Neighbourhood Collaborative • December 2013 Salford 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 2014 City-wide roll-out of ICP agreed • March 2014 Summit Event to celebrate success so far and forward planning including MTF aims

33. What will be different for Sally Ford and her family?

34. Opportunities to align with MTF priorities 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 • 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

36. 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

37. 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

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

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

40. Reasons people gave for not eating enough

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

43. 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.