Health and Care Bill

Written evidence on the Health and Care Bill submitted by the British Specialist Nutrition Association BSNA

(HCB12)

This response is submitted by the British Specialist Nutrition Association (BSNA), the trade association representing UK manufacturers of high-quality foods designed to meet the needs of people with very special nutritional requirements. Our members include manufacturers of medical foods (tube feeds and oral nutritional supplements), parenteral (intravenous) nutrition and other aseptic preparations (e.g. chemotherapy) as well as infant nutrition products. BSNA is responding on behalf of our medical foods manufacturers which includes Abbott Nutrition, Aymes, Fresenius Kabi, Galen, Mead Johnson, Nestle, Nualtra, Nutricia and Vitaflo.

Executive Summary

· BSNA welcomes the introduction of the Health and Care Bill as a valuable opportunity to embed optimum nutrition into our health and care system as never before.

· The emphasis on Integrated Care Systems (ICSs) enables us to join up primary and community, secondary (hospital) and local government care creating a holistic view of the health and care system but also of the care of the patient.

· With a proper statutory footing, ICSs will have the incentive to optimise the health of the individual citizen as this will minimise the need to use the health system, delivering benefits to the citizen through better health outcomes and to ICSs by reducing the overall cost to the system.

· The Bill allows the opportunity to introduce a new clause to place a duty on each ICS to develop a system wide strategy for effectively supporting patients at risk of malnutrition or are malnourished.

· Such a strategy should include: a requirement to screen patients for risk of malnutrition on entry to hospital; if identified as at risk or malnourished, a duty to develop a care plan and deliver that care plan whilst in hospital and on discharge; a duty to ensure that the nutritional status of the patient is communicated to the relevant GP practice and that care is provided in the home, if necessary.

· As part of this provision, each ICS should have an identified lead for nutritional care at Board level to ensure the delivery and accountability of the strategy.

· Of particular importance to prioritising and improving nutritional care across all care settings is Part 5, Clause 126 which gives the Secretary of State a general power to make regulations to impose requirements in connection with food or drink provided or made available to any person on hospital premises in England that are used in connection with the carrying on of a regulated activity.

· Such requirements include the power to specify nutritional standards, or other nutritional requirements.

· This is a vital step in improving nutritional care for patients, however BSNA believes that in an integrated system, a nutritional care pathway should apply across the system and such standards should therefore be introduced for all care settings within an ICS, on a similar statutory basis.

Background

1. Under nutrition affects three million people in England at a cost of £19.6 billion [1]  . This is 15% of overall health and social care expenditure.1

2. It costs £5,000 more to treat an under nourished patient. [2]

3. Many hospitals report low levels of malnutritinon even though research shows an average of 25% of patients are at risk or are malnourished. [3]

4. Malnourished patients account for 1 in 10 GP consultations, are twice as likely to visit their GP and will require more prescriptions to treat their condition. [4]

5. Disease related malnutrition nutrition includes patients with kidney disease, diabetes, chronic lung disease, head and neck or gastrointestinal cancer, living with other forms of cancer, experienced a stroke, conditions which cause malabsorption, dementia, allergies, certain genetic conditions or injury and COVID-19.

6. The consequences of untreated malnutrition include physical decline (loss of muscle mass, impaired growth in infants and children), impaired psychosocial function, functional decline with reduced muscle strength, fatigue and inactivity, reduced quality of life, poorer clinical outcomes (e.g. increased infections, poor wound healing, mortality), and greater health care use (more hospital (re)admissions, longer hospital stays, more GP and HCP visits, increased prescription costs). [5]  

7. Poorer outcomes leading to greater health care use by malnourished patients when untreated is the main driver of the large costs of this condition.5

8. Patients are spread across all age groups and in all care settings.

9. With the proposals to create an ICS body with stronger responsibilities for commissioning primary medical, dental, ophthalmology and pharmaceutical services, and a wider statutory health and care partnership, responsible for developing a plan that addresses the wider health, public health, and social care needs within each ICS, the link between nutritional care and statutory food standards across the system should be more clearly established.

BSNA calls to action for nutritional care standards

10. In order to improve nutritional care for all patients in hospital, and support improvements across all settings, three key actions must be prioritised within the standards and included within the responsibility of the ICS Board: a duty to screen patients for malnutrition on entry to hospital ; if malnourished, a duty to develop a care plan and deliver that care plan whilst in hospital; on discharge, a duty to ensure that the nutritional status of the patient is communicated to the relevant GP practice and that support is provided in the home, if necessary, to ensure that the nutritional needs of the patient are met.

11. The Hospital Food Review 2020 identified the critical need for leadership to ensure that the calls to action are delivered. As the Health and Care Bill is considered by Parliament, provision needs to be made to ensure that ICS Board level responsibility is assigned for nutritional care. This will ensure that the success factors identified in the Review are delivered but also that the wider issue of malnutrition is tackled both in secondary, community and primary care.

12. There also needs to be appropriate funding to support the investment required – both in terms of workforce and transformation of services, where necessary. This will support the implementation of a standard to ensure that all patients receive nutritional screening and an appropriate care plan regardless of malnutrition risk.

13. Linked to funding is the need to support multidisciplinary working, with dietitians playing a key role at the heart of multidisciplinary teams and sufficient capacity to ensure the proper implementation of standards. Nursing support and wider clinical involvement to support a ‘one team’ approach will also be necessary, as well as the involvement and engagement of catering companies whose staff may be on the ward.

14. BSNA would be delighted to provide oral evidence to the Committee to explore in more detail the proposed amendments to the Bill outlined in this submission.

Thursday 19th August 2021.