Millions could be cut from NHS bill by tackling silent malnutrition epidemic

Professor Marinos Elia (right), University of Southampton

A new report identifies more than £200 million of annual savings for health and social care services through simple steps to tackle the nation’s multi-billion pound malnutrition burden.

The report, published by the National Institute for Health Research Southampton Biomedical Research Centre (NIHR Southampton BRC) and the British Association for Parenteral and Enteral Nutrition (BAPEN), says that the estimated cost of malnutrition in both adults and children in England in 2011-12 was £19.6 billion and is only set to increase with an aging population and the rising cost of health and social care.



However, it estimates savings to health and social care of between £172 and £229 million per annum through full implementation of appropriate high quality pathways of nutritional care, as recommended by the National Institute for Health and Care Excellence (NICE)*, for various groups of malnourished adults.



Marinos Elia, Professor of Clinical Nutrition and Metabolism at the University of Southampton and BAPEN Malnutrition Action Group and lead author of the report, comments: “This is an issue that cannot be ignored. We are spending extremely large amounts of money on this problem – a problem which could be readily helped by doing simple things well.”



Malnutrition is a serious and common condition, affecting adults** and children with all types of diseases and in all care settings. Although it is estimated to affect only about five per cent of the general population, affecting older adults more than in younger adults and children, such individuals access expensive health and social care services considerably more than non-malnourished subjects.



Malnourished adults account for about 30 per cent of hospital admissions and with prolonged length of hospital stay, 35 per cent of care home admissions, 15 per cent of outpatient clinic attendances and 10 per cent of those presenting at their GP. Overall the cost of treating a malnourished patient is two to three times more than treating a non-malnourished patient.



“Malnutrition is a burden to a wide range of care services operating in multiple settings,” Professor Elia, who is also a consultant physician at Southampton General Hospital (recently retired), explains: “It is found on every ward, in every specialty, and in every type of care home. It detrimentally affects the function of all body tissues, predisposing to disease, as well as increasing complications after an injury, and delaying recovery from an illness. It also makes day-to-day activities more difficult to complete, and increases the likelihood of dependency, especially in the elderly. That is why it costs so much. We need to ensure a systematic approach to identifying and treating it so we not only improve the health and wellbeing of those at risk of malnutrition, but make economic savings too.”



By using an evidence-based approach and different models of treatment in the groups of malnourished adults targeted by the Malnutrition Universal Screening Tool (‘MUST’), the report estimates that appropriate pathways of nutritional support for medium and high-risk people could produce a potential annual net saving of up to £229 million. This cost saving would arise from a combination of effects, including reduced hospital admissions and length of hospital stay.



“It’s very simple,” continued Professor Elia, “These treatment pathways are available now and should be used as a matter of routine. At present not all malnourished patients are identified and treated. We are not routinely screening all patients that should be screened, and even if they are identified they are not always given a proper care plan that carries over from the first care setting in which they are seen to other settings they may go to, for example from hospital to GP surgery or care home.



“We recognise that there is some cost attached to more screening, more care plans and more nutritional support, but these interventions will ultimately produce a net saving even after initial costs are considered. It is necessary to invest some resource before the financial benefits can be reaped. Coordinated use of malnutrition guidance within and between health and social care settings will maximise both clinical and economic benefits.”



Commenting on the launch of the new report Jane Cummings, Chief Nursing Officer for England said: “The link between nutrition and a person’s health is a fundamental part of any stage of life, but all the more so for the sick or vulnerable. Malnutrition can be both a cause and a consequence of illness, and have a significant impact on health outcomes and wellbeing.



“Person-focused, quality compassionate care involves looking at what matters to a person as a whole, not only concentrating on their specific medical condition. Therefore I hope that this report will stimulate thinking and discussion about the vital role of nutrition as part of caring for people, and the importance of developing strategies to identify and address malnutrition.



“I would also encourage NHS commissioners to use the information within this report to support the implementation of the recently-published ‘Commissioning Excellent Nutrition and Hydration guidance’***.”



To access full and short copies of the report visit:



Full version - http://www.bapen.org.uk/pdfs/economic-report-full.pdf

Short version - http://bapen.org.uk/pdfs/economic-report-short.pdf