1. What do you consider to be the highest priority in addressing malnutrition in an ageing population?

To work with the public and commercial sectors to develop programmes to help reduce inequalities with regard to access, availability and pricing policies.

2. What have you recently undertaken or valued to help improve food access or the nutrition of older people?

 

The Strategy for Older People in Wales 2008-2013 recognises the fundamental importance of good nutrition, and of ensuring that vulnerable older people are helped to eat, especially in the hospital setting and care homes. A Food in Hospital Task and Finish Group, chaired by the Chief Nursing Officer for Wales, has explored all aspects of food in hospitals, including issues around feeding. Among the main recommendations of the Food in Hospital Group were that lessons learned from initiatives to improve food quality and practice in hospitals must be shared across Wales and that the work in hospitals be supported by improving the quality of food served in community settings such as nursing homes and through meals on wheels services.

Two subgroups of the Food in Hospital Task and Finish Group were set up to deliver a nutrition campaign and develop nutrition care pathways for hospitals. The Nutrition Care Pathways Sub Group developed a plan to address issues relating to procurement, nutrition screening, catering, and presentation of food, eating environment, oral health requirements and staffing requirements. It developed a "nutrition care pathway" and formalised food and fluid charts to ensure consistency. The nutrition care pathway and the charts have been piloted and will be launched in May.

 

The Nutrition Campaign Sub Group developed and implemented a National Nutrition Campaign for hospital staff that promotes the message that ‘the provision of food and water has the same importance as medication’. The campaign is based on the Council of Europe Resolution "Food and Nutrition Care in Hospitals 10 key characteristics of good nutritional care in hospitals" and is linking with the RCN Nutrition Now campaign. The group recommended that a key element of the campaign should be engagement of the whole multi faceted team engaged in the provision of food in hospitals, from the decision makers in the food procurement process to the ward based multi disciplinary teams. A grant was been awarded to RCN Wales to deliver workshops to hospital staff in each NHS Trust in Wales and establish a Welsh focus site. The workshops are multi disciplinary and cover issues such as nutritional screening, observations of care and the development and implementation of action plans.

 

To support the work in hospitals joint Welsh Assembly Government / Food Standards Agency Wales grants have been awarded to two NHS Trusts to pilot an extension of the Dietetic Capacity Grant scheme to meet the needs of older people. Two community dietitians are being appointed to work in two of the more deprived areas of Wales for a three-year pilot project. The post holders will work with key agencies and health professionals in contact with older people, as well as with care home staff, to provide training on the identification of risk, prevention, and treatment for malnutrition.

The National; Service Framework for Older People  sets national evidence based standards for the health and social care of older people in Wales and sits firmly within the framework of the Strategy for Older People.  The themes of prevention, early intervention, promoting independence and integrated services and Dignity and Nutrition cut across each of the 10 key  standards.

 

As a cross cutting theme, the NSF for Older People recognises the importance of good nutrition and maintaining an appropriate fluid balance for older patients and draws attention to the need to ensure that the best practice outlined in Welsh Assembly Government ‘Fundamentals of Care’ 2003 are implemented. We worked closely with the Wales Food Alliance in developing the NSF in respect of nutrition.

 

The NSF for Older People in Wales has set a target for all NHS Trusts to be using the Malnutrition Universal Scoring Tool (MUST) for adults, by  the revised target date of end March 2009.

 

A 3 year  programme aimed at securing Dignity in Care for older people was announced by the Deputy Minister for  Social Services in October 2007  It is clear we  must have a care system where there is zero tolerance of abuse of and disrespect for older people and this includes issues around food and nutrition.  As a part of the implementation programme for Dignity in Care, a National Reference Group has been established and will shortly produce its initial report on progress and future work. 

 

A joint review of the NSF by CSSIW / HIW is underway that covers the cross cutting themes with a report on phase 1 due at the end of March 2009.  The final report is due October 2009 and this will be one of the key drivers, as well as re-structured health service patterns, which will inform the future of the NSF

 

3. What are your future plans to address issues raised by the Summit?

 

These will be outlined in the forthcoming Quality Food for all in Wales Strategic Action Plan.