Health and Social Care Bill

I shall speak to Amendments Nos. 54 and 55, which are in this group. My noble friend Lady Knight ably and persuasively drew our attention to an issue which is of immense significance for the health of the nation. I should like to supplement what she said with a few rather sobering statistics. According to the National Institute for Health and Clinical Excellence, at least 2 million people in the UK are undernourished. That figure is higher in absolute terms than that for Morocco, Libya or Algeria. The cost to our society is undoubtedly immense. The number of people admitted to hospital with a diagnosis of undernutrition has increased from 70,000, 10 years ago, to 130,000 in 2006-07—a rise of 85 per cent. The overall cost to the NHS is estimated at £7.3 billion a year. Only about half this cost arises in hospitals; the remainder arises in community settings—for example, from the care required for the undernourished living in residential care facilities. The guidance issued by NICE has been implemented, as so often, in a very patchy way. It recommends that all patients are screened for nutritional risk on admission to hospital, as well as on first registration at a GP practice. However, NICE itself has estimated that only about 30 per cent of patients are screened on admission to hospital, while a survey by BAPEN, the British Association for Parenteral and Enteral Nutrition, published in April 2008, found that more than one in 10 hospitals does not have a nutrition screening policy in place. I have heard it said that compliance with NICE guidance in community settings is likely to be far lower than in secondary care, but that is only surmise. Hard information on this is not readily available. Undernutrition can occur at any age, of course, but as my noble friend has indicated, it is particularly associated with the elderly. Like my noble friend, I pay tribute to Age Concern and its campaign called ““Hungry to be Heard””, which highlights among other things the greatly increased prevalence of malnutrition among patients aged over 80 who are admitted to hospital compared with those aged under 50, and how important it is to obtain the views and experiences of elderly patients if compliance with the standards is to be properly assessed. The effects of malnutrition are well documented: prolonged hospital stays, delayed recovery, an increased risk of contracting healthcare-associated infections and poor respiratory function. In some studies, the mortality rate among undernourished patients is up to eight times higher than that among well-nourished patients. But it is a condition that is relatively easy to identify. The Malnutrition Universal Screening Tool is available for healthcare professionals to use, and once identified as being at risk, patients in hospital or vulnerable people in the community can be supported in their nutritional needs by a wide variety of measures. These range from simple steps such as red tray schemes and protected mealtimes; enteral nutrition, which means specially formulated foods that are taken by mouth or tube directly into the digestive system; to the most intensive parenteral nutrition involving tube feeding directly into the blood. To their credit, the Government have done quite a lot to tackle undernutrition in recent years. A nutrition action plan was published last October and some useful work has been conducted by the National Patient Safety Agency. Nutritional care is also prioritised in the core standards monitored by the Healthcare Commission. Core Standard C15 B ensures that an individual’s, "““nutritional, personal and clinical dietary requirements””," are being met. However, there is some evidence to suggest that this requirement is insufficient. In 2006-07, none of the 34 NHS trusts which discharged the highest number of patients in an undernourished state failed the Healthcare Commission’s Core Standard C15 B. Conceivably this may be because the way that adherence to the standard is measured is by providers assessing themselves. The Government have undertaken work to improve the nutritional care offered to patients, but the evidence we have suggests that the problem is getting worse, not better. The Bill presents a valuable opportunity to oblige health and social care providers in primary as well as secondary care to put a higher priority on nutritional standards. The intention behind my amendments is that nutrition should be placed on the same statutory footing as tackling hospital-acquired infections. I am well aware that Ministers have said that they intend to use the powers in the Bill to tackle undernutrition, but there is a good case for being explicit about this. A consultation is currently running on the possible registration requirements, which includes a specific registration requirement on nutritional care. The problem is that the consultation does not commit the Government to taking action. It is entirely possible, given the difficulty encountered by the Healthcare Commission in monitoring adherence by providers to the current core standard, that the registration requirement on nutrition may be abandoned following consultation. We just do not know. For all those reasons, the amendments deserve the support of the Committee. I beg to move.