Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, how many patients died of malnutrition in NHS hospitals in each of the last 10 years.
NHS Digital has provided a count of finished discharge episodes1 for in-hospital deaths2 where the cause of death3 was malnutrition4, split by independent and National Health Service providers for the years 2008-09 to 2017-185. This information is provided in the following table.
Activity in English NHS hospitals and English NHS commissioned activity in the independent sector | ||
Provider type | NHS | Independent |
2008-09 | 50 | - |
2009-10 | 50 | - |
2010-11 | 40 | - |
2011-12 | 50 | - |
2012-13 | 50 | - |
2013-14 | 45 | * |
2014-15 | 50 | * |
2015-16 | 50 | * |
2016-17 | 55 | - |
2017-18 | 65 | - |
Source: Hospital Episode Statistics (HES) data linked to Office for National Statistics (ONS) death registrations data
Notes:
1A finished discharge episode is the last episode during a hospital stay (a spell), where the patient is discharged from the hospital or transferred to another hospital. Discharges do not represent the number of patients, as a person may have more than one discharge from hospital within the period.
2HES records the circumstances under which a patient left hospital. For the majority of patients this is when they are discharged by the consultant and it is only recorded for the last episode in a spell.
3Cause of death has been obtained through linkage to ONS data. These data do not provide enough information to link the deaths to poor care. It is not possible to determine from these figures how or where the condition originated. There are many explanations as to why someone becomes malnourished: for example they may have cancer of the digestive tract, which means they can not eat properly or can not absorb nutrients; they may have suffered from a stroke or have advanced dementia which can cause difficulties chewing and swallowing; or they may abuse alcohol and so not eat properly. The deceased may have been malnourished before they went into hospital (for any of the reasons mentioned previously), and perhaps only have been in hospital a very short time and the malnutrition may have nothing to do with not being fed properly in hospital. Also, in the majority of deaths in hospitals from falls, it is likely the fall occurred elsewhere, not in the hospital. It is possible that poor care may have been a factor in some of the deaths, but ONS data does not provide enough evidence to draw this conclusion.
4ICD-10 Codes used to define malnutrition are:
E40 Kwashiorkor
E41 Nutritional marasmus
E42 Marasmic kwashiorkor
E43 Unspecified severe protein-energy malnutrition
E44 Protein-energy malnutrition of moderate and mild degree
E45 Retarded development following protein-energy malnutrition
E46 Unspecified protein-energy malnutrition
5HES figures are available from 1989-90 onwards. Changes to the figures over time need to be interpreted in the context of improvements in data quality and coverage (particularly in earlier years), improvements in coverage of independent sector activity (particularly from 2006-07) and changes in NHS practice. For example, apparent reductions in activity may be due to a number of procedures which may now be undertaken in outpatient settings and so no longer include in admitted patient HES data. Conversely, apparent increases in activity may be due to improved recording of diagnosis or procedure information.
It should be noted that HES include activity ending in the year in question and run from April to March, e.g. 2012-13 includes activity ending between 1 April 2012 and 31 March 2013.
Disclosure Control
In order to protect patient confidentiality '*' appears in the table above for all sub-national breakdowns, where it is possible to calculate a value between 1 and 7 from the data presented. All other sub-national data has been rounded to the nearest 5.
If the national total is between 1 and 7 (inclusive), no sub-national breakdown will be displayed.
If the national total is greater than or equal to 8;
a. Sub-national counts between 1 and 7 (inclusive) will be displayed as ’*’.
b. Zeroes will be unchanged.
c. All other counts will be rounded to the nearest 5.