Malnutrition and the NHS

Maggie Throup Excerpts

Monday 25th April 2022 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Maggie Throup)]

I congratulate the hon. Member for Linlithgow and East Falkirk (Martyn Day) on securing this important debate tonight. As he rightly said, we were expecting to be quite late, so it is good to be able to debate this matter while people might still be watching. I know that he has shown a keen interest in it, especially through his work on the Health and Social Care Committee.

Malnutrition is a common clinical health problem, affecting all ages and all health and care settings. However, it is also a complex issue and its root causes may be clinical, social or economic. I know from personal experience, and from the difficulties of those close to me, how critical it is for disease-related nutritional problems to be identified and treated early. I also appreciate how important it is for healthcare professionals to have a wide range of options available to meet each patient’s unique needs. Supplements can provide a lifeline to those already struggling with debilitating illness. Whether it was the nutritional supplement drink provided to me by a practice nurse when I could not swallow due to chicken pox, those that my mother could drink when severe breathing problems made eating a serious struggle, or the yoghurt-type products that sustained my father after his stroke, these treatments were not just life-saving; they relieved the worry of hunger at some of the most difficult times in the lives of ourselves and our loved ones.

The hon. Member has highlighted the significant cost of malnutrition in the NHS, as cited in the British Association of Parenteral and Enteral Nutrition report. The report indicates that malnutrition costs to the health and care system in the UK are estimated to be over £23 billion each year, including £19.6 billion in England, with the majority of those costs—some £15.2 billion—being in NHS secondary care settings, and around £4 billion in social care settings. It is therefore right that we hold the NHS and care services to the highest standards. It is essential that patients receive the right nutritional support to meet their needs.

We expect NHS services to be provided in line with the National Institute for Health and Care Excellence best practice guidelines. NICE has published guidance on “Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition”, which covers identifying and caring for adults who are malnourished or at risk of malnutrition in hospital, in their own home or in a care home. It offers advice on how oral, enteral tube feeding and parenteral nutrition support should be started, administered and stopped. It also aims to support healthcare professionals in identifying malnourished people and to help them to choose the most appropriate form of support. The Care Quality Commission also sets quality standards that the NHS and care settings must meet. Regulation 14 sets the quality standards for meeting nutritional and hydration needs. The standard requires that people must have their nutritional needs assessed, and food must be provided to meet those needs, including where people are prescribed nutritional supplements and/or parenteral nutrition.

We are implementing several initiatives to ensure that the highest nutritional standards are met. The Malnutrition Task Force—a partnership of Age UK, Apetito, BAPEN, Nutricia and the Royal Voluntary Service—has published a series of guides offering expert advice on the prevention of and early intervention in malnutrition in later life. These guides draw together principles of good practice to offer a framework developed to help those in a wide range of health and care settings to make the changes needed to counter malnutrition. This includes a guide for care homes on integrating good nutrition into daily practice.

We have published a comprehensive review of hospital food and are working to implement its recommendations. Every hospital has a responsibility to provide the highest level of care for its patients, and thar includes the quality and nutritional value of the food that is served and eaten. Hospitals must comply with five mandatory food standards, including a requirement to screen patients for malnutrition and covering the nutrition and hydration needs of patients. The Government have invested in primary care networks to ensure that the NHS has the specialist staff it needs to provide in-depth assessments of patients’ nutritional requirements. Through the primary care network direct enhanced service, primary care networks have recruited hundreds of additional health and wellbeing coaches and dieticians since March 2019.

The hon. Member raised concerns about medical nutrition for people who require clinical intervention to treat or address the risk of malnutrition. As he will be aware, foods for special medical purposes are developed to feed patients who are malnourished because of specific medical conditions that make it impossible or very difficult for a patient to satisfy their nutritional needs through the consumption of other foods. These products are developed in close co-operation with healthcare professionals and must be used under medical supervision.

We are working with stakeholders, including industry and the NHS, to update the processes and guidance of the Advisory Committee on Borderline Substances to support fairer, more accurate, more consistent and faster decisions. The ACBS works to assess malnutrition products to ensure they are both clinically effective and cost-effective for the NHS. With the ACBS recommending a total of 209 products available through prescription for the management of malnutrition, the current system offers a wide choice to patients and clinicians.

The hon. Gentleman talked about the rise in the number of people diagnosed with malnutrition, the reasons for which are complex. It is likely to be partly due to improved screening and reporting and an ageing population. The issue was probably there before, but we are now identifying it more because of the NICE and CQC guidelines. The evidence also suggests that the rise in malnutrition is worse in older age groups.

The ACBS is independent of the Department of Health and Social Care and has not yet informed the Department of when it will present the outcome of its consultation. I commit to informing the hon. Gentleman as soon as we are informed. The ACBS is also responsible for advising on the prescription of borderline substances, including food for special medical purposes for use in NHS primary care. The ACBS has authorised 209 products listed on the drug tariff for the management of malnutrition, providing plenty of choice for patients.

The CQC standard on nutrition and hydration clearly sets out that people must have their nutritional needs assessed and that food must be provided to meet those needs, including where people are prescribed nutritional supplements and/or parenteral nutrition. The NICE guideline on nutrition support for adults aims to assist healthcare professionals in identifying malnourished people and choosing the most appropriate form of support. If the NHS and care homes follow the CQC and NICE guidelines, they will help to reduce the number of people in this condition and help to reduce the cost to the NHS.

To address the many complex factors around malnutrition, we need effective strategies for managing malnutrition in health and care settings. The NICE and CQC guidelines and standards clearly set out the care pathways that should be in place to ensure that patients receive the best possible nutritional care. I also agree that, where patients require specialist clinical nutritional support, we must ensure they have access to the right treatments. We will continue to work with the medical nutrition sector to ensure that the most efficacious products are available in the NHS without undue delay.

I reassure the hon. Gentleman that my Department takes malnutrition extremely seriously, and it is an issue that we are determined to continue tackling.

Question put and agreed to.