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Prioritising nutrition, hydration and dysphagia in an ICS context

New PPP report stresses that nutrition, hydration and dysphagia should become key strategic priorities for integrated care systems as they look to improve system efficiency and health outcomes in the face of a ‘super-aged’ UK society.
Hydration Nutrition Dysphagia

As the UK becomes a ‘super-aged’ society, declining nutritional and hydrational status amongst elderly and frail populations will place increasing strain on health and care services. While there is considerable work and investment being allocated to reduce the incidence of obesity and the increase in diet-related diabetes, malnutrition and hydration are not given the same focus, despite their significant impact on health outcomes and roles in the management of other conditions.

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To meet the multifaceted challenges of catering for a ‘super-aged society’, the report calls for integrated care systems (ICSs)  harness all local and strategic assets at their disposal. These include untapped pools of resource hidden in siloed parts of the sector and, crucially, clinical expertise that spans multiple care settings.

According to the report, recent reforms to the health and care sector (most notably, the introduction of ICSs) present new opportunities to develop comprehensive approaches to nutrition and hydration, in a way that improves holistic patient care and saves valuable resource for the NHS.

The report, Prioritising nutrition, hydration and dysphagia in an integrated care context, is sponsored by Nestlé Health Science UK and is the culmination of two roundtables held by PPP in 2023, which convened stakeholders to discuss how ICSs embed nutritional and hydrational health into integrated care strategies. The discussions focused on specific elements of the debate, including improving the management of dysphagia and care provided for frail populations in different care settings.

Roundtable delegates included NHS England clinical leadership, allied health professionals (AHPs), including speech and language therapists (SLTs), social care providers, primary care representation nurses and other key health and care stakeholders.

To help improve nutritional and hydrational status of frail citizens in social care, the report argues for a national review into food and drink provided across the care sector. This review should follow the structure and ethos of the NHS Hospital Food programme.

The report argues that addressing dysphagia should be central to broader NHS goals of enhancing the quality of life for the elderly population. By prioritising the management and screening of dysphagia, the NHS could prevent avoidable hospital admissions and promote more efficient use of resources across the health and care sector.

As with wider nutritional health issues, effectively addressing dysphagia across UK health and care will rely upon an multidisciplinary approach. The complex and multifaceted nature of the condition, with various medical, neurological, and anatomical elements potentially contributing, necessitates close collaboration between a diverse team of healthcare professionals, each with specialised expertise.

A multidisciplinary approach that includes SLTs, dietitians, and physicians is essential for managing dysphagia and addressing the complex healthcare needs of the elderly. Ultimately, addressing dysphagia holistically can contribute to the goal of providing comprehensive and person-centred care for the elderly and frail, enhancing their overall wellbeing and reducing the burden on health and care systems.

To help enable this MDT approach, the report argues that the model of speech and language therapy sitting in community settings should be scaled nationwide, and adopted across ICSs within integrated care strategies. These strategies should also closely involve the voluntary sector.

An expansion of the speech and language therapy workforce is also recommended, with ring-fenced funding for broader allied health professionals – in line with ambitions set out in the NHS Workforce Plan.

Recommendations

  1. NHS England must prioritise nutrition, hydration and dysphagia as part of its drive to improve system performance and broader health outcomes. Nutrition and hydration management are underdeveloped areas which can help enable success in key national strategies, such as the elective care backlog plan, workforce strategy, the urgent and emergency care plan and the delivery plan for recovering access to primary care.
  2. Integrated care systems should consider dysphagia and wider nutritional and hydrational health as key parts of preventative health policies that can help future proof local health systems.
  3. The Department of Health and Social Care (DHSC) should commission a national review into food and drink provided across the care sector. This review should follow the structure and ethos of the NHS Hospital Food programme. The review should be led by a range of stakeholders from within the NHS and social care, as well as representatives from industry and the private sector.
  4. As the population becomes a ‘super-aged’ society, an integrated strategy is required to manage the health of the elderly and frail population. This should draw upon global and international frameworks provided by the WHO’s ICOPE framework.
  5. ICSs should ensure that maximising the ‘intrinsic capacity’ of citizens is a key priority within integrated care strategies, to prevent deterioration of health and supplement preventative health policies.
  6. ICSs should work to prioritise evidence-based nutritional and hydrational approaches within the social care sector, harnessing tools such as nutritional supplements where necessary, to assist those who have difficulty eating, drinking and swallowing.
  7. The model of speech and language therapy sitting in community settings should be scaled nationwide, and adopted across ICSs within integrated care strategies. These strategies should also closely involve the voluntary sector.
  8. NHS England should undertake a national dysphagia screening drive to identify individuals as early as possible. Social care staff and AHPs should be trained to conduct dysphagia screenings for all elderly and frail patients in their care, and much like falls, dysphagia should be considered among the primary risks in any risk assessment of elderly and frail patients.
  9. The speech and language therapy workforce should be expanded with long-term ring-fenced funding for broader allied health professionals.

Download the report here.

This series is sponsored by Nestlé Health Sciences. PPP retains full editorial control of roundtable agendas, speaker acquisition and editorial output. 

For further information on this programme, please contact David Duffy, Group Editor of PPP at david.duffy@pppinsight.com.

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