Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether he has made an assessment of the implications for his policies of the 2015 British Association for Parenteral and Enteral Nutrition and NIHR report entitled The Cost of Malnutrition in England and potential cost savings form nutritional interventions which found that half the £19.6 billion annual cost of malnutrition relates to care for people over 65.

The Government has made no such assessment.

The NHS England guidance ‘Commissioning Excellent Nutrition and Hydration (2015-2018)’ supports commissioners to develop strategies and address issues related to improvements in delivery and commissioning of nutrition and hydration needs in acute services and the community. The guidance has been developed in conjunction with key partners including the British Dietetic Association and the British Association for Parenteral and Enteral Nutrition.

In addition, the National Institute for Health and Care Excellence (NICE) is responsible for publishing clinical guidelines for the National Health Service. ‘Nutrition support for adults: oral feeding, enteral tube feeding and parenteral nutrition’ (NICE Clinical Guideline 32) provides advice to the NHS to help identify patients who are malnourished or at risk of malnutrition and was most recently reviewed by NICE in July 2017. Further information is available at the following link:

https://www.nice.org.uk/guidance/qs24

Building on this guidance, further steps have been taken to support screening and recording of malnutrition in hospitals and other healthcare settings.

A 'Malnutrition Universal Screening Tool' ('MUST') has been developed by the Malnutrition Advisory Group. The tool is supported by governmental and non-governmental organisations, such as the Royal College of Nursing, and is the most commonly used screening tool in the United Kingdom. Further information is available at the following link:

http://www.malnutritionselfscreening.org/self-screening.html

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards of care, which must be met by all providers of health and adult social care. Regulation 14 of that Act relates specifically to meeting nutritional and hydration needs. During inspections of health and adult social care services, the Care Quality Commission (CQC) asks five key questions of all care services: are they safe, are they effective, are they caring, are they responsive to people’s needs and are they well-led?

Under the Effective key question, the CQC seeks to understand how services support people to ensure that they eat and drink enough to maintain a balanced diet. If a malnourished patient presents at hospital, the CQC would expect a hospital trust to record it as a primary or secondary diagnosis in the Hospital Episode Statistics database and a safeguarding alert to be made, as well as a referral to a dietician.