Memorandum by Abbott Laboratories (WP
03)
1. This submission contains a review of
the Public Health White Paper Choosing Health and has been compiled
by Abbott Laboratories on the 25 January 2005 by Carole Glencorse
(Dietitian), Rachel Broughton (Dietitian), Dr Lucy Cook (Medical
Advisor), Len Gooblar (Government Relations & Public Affairs
Manager). Carole Glencorse would appreciate the opportunity to
supply supplementary oral evidence to the committee:
1.01 Abbott Laboratories is a global,
broad-based health care company devoted to the discovery, development,
manufacture and marketing of pharmaceuticals, nutritional, and
medical products, including devices and diagnostics. The company
employs approximately 70,000 people and markets its products in
more than 130 countries.
1.02 We welcome the publication of the
Public Health White Paper and are delighted to see that malnutrition
has been considered within the document. However we would like
to draw your attention to the fact that the definition of malnutrition
includes both over- and under-nutrition, and we are concerned
that this document only considers the issues relating to obesity
(overnutrition).
1.03 By not addressing under-nutrition
it is difficult to envisage how the Government will achieve its
public health goals, especially in keeping patients out of hospital,[14]
putting an increased unnecessary burden on health care at home[15]
with under-nourished patients costing in the region of £2-4
billion to care for, compared to an equal number of well-nourished
patients.[16]
Will the proposals enable the Government to achieve
its public health goals?
2. Regrettably, no, because although the
White Paper has made great moves forward with innovative thinking
in many areas of healthcare, unfortunately it has missed a major
contributing factor to the health of the population which in itself
is detrimental to health, well-being and contributing to the quality
of life that each individual strives for.
We therefore propose that undernutrition should
also be considered within the paper for the following reasons:
2.01 Malnutrition (undernutrition) is
a major public health issue in the UK and is estimated to affect,
at any one time, at least 2 million adults. The most vulnerable
are:
— the elderly;
— those with chronic diseases;
— those most recently discharged from
hospital. 16
2.02 12% of free living elderly are
at risk of being malnourished, rising to 20% for those living
in an institution.[17]
2.03 Malnutrition in patients aged 65
years or over costs £2-4 billion more annually than caring
for an equal number of patients who are well nourished. 16
2.04 Every 1% cost reduction secondary
to a decrease in interventions associated with malnutrition will
save £20-40 million annually. 16
2.05 Patients who are malnourished on
discharge from hospital are 2.5 times more likely to require health
care at home; 15 an additional burden on already over-stretched
resources.
2.06 Underweight patients need 9% more
prescriptions and visit their GPs more frequently (6%) than those
individual with a normal Body Mass Index (BMI).[18]
2.07 Malnourished elderly patients are
more likely to be readmitted to hospital than normally nourished
elderly patients. 14
2.08 Currently there is no effective
nutritional screening programme in place that is linked to care
pathways. 16
2.09 The National Service Framework
for Older People recommends that routine nutritional screening
should be undertaken and nutrition care plans implemented.[19]
2.10 Essence of Care[20]
is a benchmarking tool for nurses and Food and Nutrition is one
of the standards of care. Nutritional screening and ongoing assessment
of nutritional status is recommended.
2.11 Resolution ResAP (2003)3 on food
and nutritional care in hospitals[21]
also calls for nutritional risk screening to identify and prevent
the causes of undernutrition, and recommends that the definition
of disease-related undernutrition should be accepted and used
as a clinical diagnosis. 21
2.12 Malnutrition also affects children
and if left untreated may result in impaired cognitive development,
delayed puberty as well as other potential long-term health consequences.
16 Currently there is no standardised nutritional screening process
for children.
RECOMMENDATIONS
3. We would like to recommend that nutritional
screening of adults and children becomes standard practice in
order to facilitate the early identification and treatment of
undernutrition in the UK.
4. Abbott Laboratories would like to thank
you for the opportunity to comment on the Public Health White
Paper. We hope that you will agree that there needs to be a coordinated
multidisciplinary approach to ensure undernutrition, as well as
overnutrition, is appropriately identified and treated. We strongly
feel that undernutrition should be considered as part of the Government's
strategy on improving nutritional health.
January 2005
14 Stratton R J, Thompson R L, Margetts BM et al.
Health care utilisation according to malnutrition risk in the
elderly: an analysis from the National Diet and Nutrition Survey.
Proceedings of the Nutrition Society 2002; 61: 20A. Back
15
Chima C S, Barco K, Dewitt M L A et al. Relationship of
nutritional status to length of stay, hospital costs and discharge
status of patients hospitalised in the medicine service. Journal
of the American Dietetic Association 1997; 97: 975-978. Back
16
Malnutrition Advisory Group. The "MUST" Report. Nutritional
screening of adults: a multidisciplinary responsibility. BAPEN,
2003. ISBN 1 899467070 X. Back
17
Margetts B M, Thompson R L, Elia M and Jackson A A. Prevalence
and risk of undernutrition is associated with poor health status
in older people in the UK. European Journal of Clinical Nutrition
2003; 57: 69-74. Back
18
Martyn C N, Winter P D, Coles S J, Edington J. The effect of
nutritional status on the use of health care resources by patients
with chronic diseases living in the community. Clinical Nutrition
1998; 17: 119-123. Back
19
Department of Health. National Service Framework for Older People,
2001. Back
20
Department of Health. Essence of Care. Patient focussed benchmarking
for health care practitioners, 2001. Back
21
Council of Europe. Resolution ResAP (2003)3. Back
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