malnutrition prevention programme chris bryant programme director - nhs elect
TRANSCRIPT
Malnutrition Prevention Programme
Chris Bryant
Programme Director - NHS Elect
Malnutrition – A serious health issue
It is common:•Over a million older people (1:10 )It has serious consequences•Decreased resistance to infection•Delayed recovery•FallsIt is costly to NHS
…yet much overlooked
Some interesting Facts!Support the campaign by downloading, posting and tweeting these infographics:
Malnutrition Prevention Programme• The Programme is part of the Government’s response to the Francis Report
into the failings at the Mid Staffordshire Foundation Trust (see ‘Recommendation 241‘ on the Department of Health website). The report revealed that patients, many of them older, had been unable to eat or drink properly and that nutrition was not treated as a priority (Mid Staffordshire NHS Foundation Trust Public Inquiry, Volume 3‘ p. 1600).
• This programme is guided and supported by the Malnutrition Task Force, the Malnutrition Prevention Programme is a Department of Health funded scheme to help the 1 million plus older people in England who are suffering from or at risk of malnutrition. NHS Elect are proud to support this programme by providing change management and facilitation skills in order to support the five Pilot Sites across the UK.
The Founders
• Founders– Age UK– apetito– Bapen– Nutricia– Royal Voluntary Service (WRVS)
• Set up in June 2012• Under the Dignity in Care Partnership
The Malnutrition Task Force
Independent group of experts across health, social care and local government united to address the problem
of preventable malnutrition in older people
Programme Steering Group
Dianne Jeffrey Chairman – Age UK
Caroline Abrahams Age UK
Marie Batey NHS England
Karl Demian Royal Voluntary Service
Andrew Forster Wrightington, Wigan and Leigh NHS FT
Paul Freeston apetito
Kate Hall Nutricia
Des Kelly National Care Forum
Ruth Rose Service User Representative
Mike Stroud Bapen
Jude Thorling DH
Task Force Mission
To ensure the prevention and treatment of malnutrition is embedded in all care and community support services and awareness is raised amongst
older people and their families
Task Force developed‘The Five Principles’
• Raising awareness of Malnutrition among staff and older people
• Working Together within and across organisations• Identifying malnutrition and malnutrition risk early• Providing Personalised Care, support and treatment• Monitoring and evaluating the impact of the
interventions and the individual outcomes
Guidance
Guides for•Food and beverage providers•Hospitals•Care homes•Local communities•CommissionersAvailable to download fromwww.malnutritiontaskforce.org.uk
Task Force Recommendation for Dissemination
• May 2013: MTF final recommendation:• Test out a model for whole communities working together• Summer 2013: proposal to DH
– to pilot process in five areas– Develop a social marketing campaign
• Government response to Francis Report• Funding secured for 2013/14• Age UK is the grant holder on behalf of MTF• Late 2013 - NHS Elect/AqUA appointed as ‘Change
Facilitators’ for the Programme, reporting & accountable to MTF through Age UK
The Malnutrition Prevention Programme
Jan 2014 – March 2015
The Programme:
A. The Pilot Programme in 5 areas
B. Dissemination of learning from A.
C. The Social Marketing Campaign
D. Evaluation of A-C
* Evaluation - by Chester University
The Social Marketing Campaign
• Focus groups with public and professionals • Posters and leaflets for older people and for
carers• Posters for hospital and for care home staff• Local campaign led by community
organisations • Knowledge, Attitude and Practice (KAP)
surveys: before, in the middle and after the intervention
Local Launch Events
Helping Pilot Sites to:- •Identify a local Team•Understand their ‘current’ state and identify a ‘future’ state by:-
– understanding the current problems and issues– Agreeing a shared purpose and vision
•Making it happen!– Prioritise issues, develop and implement action
plans– Measure, monitor and embed change
The Five Pilot Sites
• Lambeth and Southwark• Salford
• Kent• Gateshead• Purbeck/Dorset• Each of the Pilot Sites face
many challenges!
Gateshead• The latest estimated resident population of
Gateshead is 200,153, with approximately 36,500 aged 65 or over, accounting for 18% of the population. Gateshead’s population is also growing older; between 2011 and 2012 the number of people aged 65 to 74 increased by 800, whilst the number of those 75+ increased by 250. Levels of social disadvantage in Gateshead are markedly higher than England overall; over one third of the population of Gateshead live in areas that are among the 20% most disadvantaged across England.
Salford
• Based on the demographics from the ‘Integrated Care for Older People in Salford‘ document, Salford has a population of 35,000 over 65 years of age. The BAPEN commissioning toolkit suggests 14% of this age group may be at risk of malnutrition – this is almost 5,000 people in Salford.
• The ‘Integrated Care…’ document further states that in excess of £100 million per annum of health and social care expenditure in Salford relates to older people, which will increase substantially as the population becomes older. The number of older people is forecast to rise by 28% by 2030, from 35,000 to 43,300.
Kent• Kent is a large county with a population of
approximately 1.5 million. Its population has been steadily increasing in recent years, suggesting that the proportion of those in need of nutritional support will increase also.
• Kent has a number of large towns, but the majority of the county is rural which in turn brings its own challenges when addressing malnutrition and social isolation
Lambeth and Southwark• Lambeth and Southwark are two densely populated
boroughs in south London with a combined population of nearly 600,000. Lambeth has nearly 303,000 residents and Southwark around 294,000.
• Both boroughs have relatively high levels of deprivation. The 2010 Index of Multiple Deprivation (IMD) places Southwark as the 41st most deprived local authority in England (out of 326) and the 12th most deprived borough in London (out of 33). Lambeth meanwhile was placed 29th in England and is the 9th Highest in London.
Purbeck• In 2009, the total population of Purbeck was estimated at
45,300, with more than 24% of these people coming from the 65+ age group, significantly higher than the national average of 19.5%.
• Life expectancy – around 81 years for males and 86 years for females – is around two years longer than the national average.
• Along with an older population, Purbeck is predominantly rural and suffers from limited access to services. Purbeck is one of the 20% most deprived in England for access to services. Currently, 68% of villages have no general store, and since 2005, three rural post offices and one urban one together with two rural petrol stations have closed.
NHS Elect - Who we are and what we do!• An NHS members’ network
– founded in 2002 and working directly with 58 + sites as members
• Provide support to members in the following areas:– Service improvement– Business of healthcare– Marketing, branding and patient experience
• Led major national improvement programmes
Our relevant experience • NHS Elect:
– Leads the national Ambulatory Emergency Care (AEC) programme• Working with 60 + systems on spread of AEC
– Supported the national delivery of 18 week waiting times• Including, early adopter communities and MSK coaching
– Diabetes Programme of Improve – London– Malnutrition Programme– Frailty
• AQuA:– Advancing Quality initiative
• Delivering measurable improvements across sites
Both teams use only senior, experienced leaders to support colleagues in local improvement programmes
Better Care Better Value Indicators
• Provider Indicators – Acute Trusts– Managing variation in length of stay– Day case rate for procedures– Reduction in wasted bed days as a result of admission prior to operation– Reducing DNA rates– Reducing New to Follow Up rates– Reducing Emergency Re-admissions at 14 days
• Commissioner Indicators - PCTs– Admission rates for selected procedures where surgery is recognised as unnecessary– Reduction of avoidable emergency admissions against 19 recognised diagnoses– Managing variation in Outpatient Attendances
• GP Practice Indicators– Admission rates for selected procedures where surgery is recognised as unnecessary– Reduction of avoidable emergency admissions against 19 recognised diagnoses– Managing variation in Outpatient Attendances
NHS Elect/AQuA partnership
• Common aims, staff and model of engagement with members
• Currently work together on areas of common interest to support our members to excel
• Split national programmes on geography– AQuA supports the North and NHS Elect supports
the South– NHS Elect taking role of Project Director
We use a collaborative approach • Typically - Short-term (6 to 15 month) learning system that
brings together a number of teams from health communities to seek improvement in a focused topic area
• Teams attend Learning Sessions (face-to-face or virtual meetings over the course of the collaborative) and work on improvements locally, often supported by expert facilitators
• Teams in collaborative’s have achieved dramatic results
• It is a well-established model for improving services in the NHS and fits well with the structure of the Malnutrition Prevention Programme
Using the IHI Model for Improvement
PDSA Cycles – Small Steps can create big changes!
SOMETHING
BIG!
How can we achieve this?
Continuous Im
provement
Small Steps
© NHS Institute for Innovation and Improvement 2010. All rights reserved.
Support for Pilot Sites
• Named coach for each locality• Coaches provide support and facilitation for
anything from a 1:1 coaching session to supporting the set up of Launch Events etc.
• Support Pilot Sites with the development of Case Studies
• Provide access to visual media resources to share learning with other Pilot Sites
• Publish regular Newsletters for stakeholders
• Much of the source material found in this presentation is taken from the Malnutrition Task Force Website, please click on the link below to access the site, which contains lots of information!
http://www.malnutritiontaskforce.org.uk/
