Progress in the fight against malnutrition since BAPEN won the MNI - PowerPoint PPT Presentation

Progress in the fight against malnutrition since BAPEN won the MNI Grant Ailsa Brotherton Honorary Secretary, On behalf of BAPEN

A reminder of our national challenges in 2008 Raising the profile of nutrition and hydration  Persuading the Government and the Department of Health to focus on malnutrition  Developing national policy and system levers  Creating a shift from professional bodies and charities working in isolation with different visions, different campaigns and different messages to working together to develop ‘one voice’ with a strong ‘call to action’  Patients and the public did not have easy access to the information and services  Lack of awareness of malnutrition amongst both public and professionals Page  2

What have we done since BAPEN won the award? Page  3

We set a clear strategy and vision We have aimed to embed 5 principles of good nutritional care in all settings Prevention of malnutrition and dehydration 1 Screening Identify malnutrition/ risk of malnutrition early 2 through screening and assessment e.g. the ‘MUST’ Tool Treatment - ‘individualised’ care pathways 3 Education and training for all care staff appropriate to setting, 4 profession and responsibilities Management systems and structures to facilitate 5 multidisciplinary nutritional care Page  4

We described the problem, measured the prevalence and made clear recommendations for action Hospitals Care Homes Mental Health Units Centres Patients Centres Residents Centres (n=) Patients (n=) (n=) (n=) (n=) (n=) 2007 175 9336 173 1610 22 332 Autumn 2008 130 5089 75 614 17 185 Summer 2010 185 9668 148 857 20 146 Winter 2011 171 7541 78 523 67 543 Spring Prevalence 25-34% 30-42% 18-20% Data kindly supplied by Christine Russell, Chair of NSW Page  5

Change in screening practice on admission in hospitals Key finding: Majority subjects at risk admitted to hospital are from home and could be identified earlier Data kindly supplied by Christine Russell, Chair of NSW 80 70 % 60 0-25% patients C 50 e 26-50% 40 n patients t 51-75% 30 r patients e 20 76-100% s 10 patients 0 2007 2008 2010 2011 (N=175) (N=90) (N=141) (N= 147 )

We provided a toolkit for key decision makers: commissioners and providers Tools 1) Assessment of population at risk of malnutrition 2) Assessment of current screening and provision of nutritional care 3) Development of nutritional screening, assessment and care pathways 4) Education and training: knowledge skills and competencies of staff 5) Service specifications and management structures for nutritional care 6) Quality frameworks for nutritional care 7) Quality indicators, monitoring and review ...based on the best available evidence Page  7

... and began to work with the DH national improvement programme to design highly reliable systems of nutritional care Aiming for good nutritional care for every patient, on every ward, on every day TRAIN TREAT STRUCTURES AND PREVENT IDENTIFY PATHWAYS Develop a personal Work with Public Design systems to screen nutritional care plan BAPEN e-learning Health, Local all patients using a modules Continuity across Government and Social validated screening tool boundaries Services Outcomes Operating Frameworks / Framework Senior Leader E-learning for CQUINs/CQC /CQCTREAT Support Health ....and the commissioners to further develop eBANS and HIFNET We thought differently about Clinical Guidance and Education Life Long Learning (LLL) programme in Clinical Nutrition and Metabolism BAPENs annual conference at UK DDF in 2012

How have we done it?  We convinced DH of the problem: they now accept that quality, safety Government & and the financial benefits from improved nutritional care are ‘a given’ DH and created a sense of urgency  Worked with Quality Improvement Scientists to embed nutrition and Quality hydration in DH QIPP work stream (Safe Care) Improvement  Nutrition contributes to all 5 domains of the Outcomes Framework  We have worked with multiple partners: charities, professional bodies, Networking and industry collaboration Spoken with one The Government/DH recognise BAPEN as a leading  voice multidisiplinary charity for tackling malnutrition in the UK Page  9

We have started to work differently Overcoming challenges to improving quality Invest in data Convince Convince Have the collection people there them there is right kind of and feedback is a problem a solution leadership systems What How Page  10

.... and to communicate differently We have discovered the potential of Social Media .................. Page  11

But we still have lots to do to complete the challenge and are keen to learn from ESPEN colleagues Next steps...... Page  12

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Working together across the UK towards an integrated national nutrition strategy PINNT: Supporting people •BAPEN on artificial nutrition •BDA and PENG Patient Association: CARE •BPNG Campaign •NNNG and RCN Carers UK: Care about Nutrition •RCGP Integrated AGE UK •RCP Nutrition Strategy •NHS Trusts – acute, community, mental •Food Industry health •Clinical Nutrition •Care Homes •Catering •Sheltered Housing Page  14

Building a blue print for an integrated strategy and learning across the home countries Putting patients and the Outline the Problem Raising awareness public first  Excellent use of patient stories  Develop shared ownership  Define the challenge for the vision  Increased public  Outline the purpose  Focus on Prevention awareness of the Strategy  Focus on self management  Describe how this can  Outline the scope including self screening be delivered and structure  Accessibility of information  The case for change  Early diagnosis and  The campaign treatment  Developing person centred pathways of care Text in red = working towards/ future development Page  15

Building a blue print for an integrated strategy Treatment of Disease Improving Outcomes Commissioning & Levers related malnutirtion  National outcome  How does DRM differ  Commissioning measures from other forms of nutritional services – at malnutrition national  NICE Quality commissioning board Standards  How to treat DRM level effectively  Building the case for  Commissioning further improvement  The case for change specialised nutrition  The value of early  Collation of the services screening and evidence (ONS  Incentive payments for treatment Dossier) nutrition (national  Role of GPs  How can we deliver it CQUIN)  Role of community services Text in red = working towards/ future development Page  16

Two New Initatives 1) Malnutrition Task Force Older People (primarily England) Some of the Partners: Abbott Nutrition , Apetito, Baxter , BDA , BSG 2) Nutrition and Hydration BSPGHAN , Danone , Focus on Under-nutrition, Action Alliance (UK) Fresenius Kabi, Hydration Forum, ILC (UK) Mappmal (HospitalFoodie), NACC, NNNG, Nutricia, PINNT, RCN, RCP, Sustain Page  17

How will we structure and organise our work? Currently under discussion  Planning patient and public engagement Person centred care  Focus on older people Malnutrition Task Force  Forming a strong wider coalition of committed partners ‘To ensure excellent nutritional care and hydration for every individual Nutrition and Hydration Action Alliance in every setting on every day’ Page  18

...but what has really made the difference My personal view.... Page  19

Three critical factors for success 1) Visionary Chairs Professor Marinos Elia Dr Mike Stroud Dr Tim Bowling .......Committed to action Page  20

2) highly committed, capable people with capacity to contribute Having fun as well as working hard.... Page  21

3) ... and never losing sight of the reason for our work Page  22

On behalf of BAPEN I would like to thank the MNI for the grant and I urge other Associations to apply BAPEN’s Core Groups Page  23