Malnutrition Prevention Programme

GatesheadTracey Dixon

Julia Wood

• The Five Principles• Setting the Scene• Our Approach• Launch Event• Workstream Remits• Challenges and Achievements• Next Steps

Contents

The Five Principles

Raising Awareness

Working Together

Identifying Malnutrition

Personalised care, support

and treatment

Monitoring and

evaluation

Setting the scene

Overview of Gateshead

• Total population is 200,000• Five localities• Gateshead is in the top 20% of those areas with the highest levels

of social and economic deprivation• Population of people aged 65 or older is 36,500• Population of Gateshead is projected to grow by 5% by 2032 with

the greatest changes expected in the number of people aged 65 or older

• More than one third of people aged 65 or older live alone, 12,138 people in total

• Large Orthodox Jewish community • 14% (just over 5100) of people aged 65 and over may be at risk of

malnutrition (using BAPEN prevalence tool)

Gateshead Steering Group Membership

Name Job Title Place of work

Jim Brown (Chair) Public Health Specialty Registrar & GP Gateshead Council

Sharon Stuart Chief Executive Age UK, Gateshead

Sharon Dryden Healthy Lifestyles Coordinator Age UK, Gateshead

Carol Wood Director of Public Health Gateshead Council

Robert Buckley Chair Healthwatch, Gateshead

Madeleine Lee Nutrition Nurse Specialist Queen Elizabeth Hospital

Tracey Dixon Diabetes and Weight Management Team Leader

Queen Elizabeth Hospital

Tracey Cowper Clinical Operational Manager, District Nursing Gateshead and Bladder and Bowel Service

North Tyneside NHS FT

Daphne Patel Team Manager, Social Care and Independent Living

Gateshead Council

Margaret Barrett Lead Manager/Principal Social Worker, Adult Social Care

Gateshead Council

Name Job Title Place of work

Victoria Holliday Commissioning Office, Commissioning and Business Development (focus on care homes)

Gateshead Council

Lesley Bainbridge Project Lead, Integrated Care and Older People’s Services

Gateshead CCG

Julia Wood AQuA Affiliate

Salford Steering Group Membership

Our approach• Methodology

– Short sessions:• PDSAs• Measurement• Behavioural change• Sustainability (date TBC)

• Workstream Remits (identified through a matrix)

• Action Plan

Launch Event - June

Project Launch Event

Aims

To share the work of the MTF and the effects of malnutrition

Identify gaps in current service provision

Shape the priorities for taking the work forward

On the day

Over 80 people in attendance

Event was a mixture of presentations, interactive breakout sessions, and group work

Outcomes

Good evaluation

Learning developed into workstreams

Pledges

Photos

Work Stream Remits

Use of volunteers

Raising awareness with staff

Use of standardised tool

Consistency of sharing knowledge and skills

Raising awareness with the public

GATESHEAD WORKSTREAM REMIT:Use of volunteers at mealtimes

ContextProvide support to patients at mealtimes to ensure they are receiving the nutrition they need

Pur

pos

e

ObjectivesThrough the increased use of volunteers everyone within the identified care settings is offered the option of having support/company at meal times by volunteers by

March 2015

Links to MTF workstreams: raising awareness and personalised care support and treatment

Out

puts

ScopePromoting Independence Centres (PICs)

Deliverables• Understand current number and use of volunteers who proactively offer

support/company within PICs (by end August)• Identify any training gaps (by end August) • Understand current number of people not proactively offered

support/company (by September)• Identify number of additional volunteers required (by end September)• Understand barriers e.g. policies around mealtimes in PICs (by end

July)• Gain senior level buy-in (by end August)• Develop training package (by end October)• Recruit volunteers (ongoing)• Deliver training package to current volunteers (where appropriate) and

new volunteers (ongoing)

Success measures• 100% of current (where appropriate) and new volunteers trained • Increased recruitment of volunteers working in PICs at mealtimes to meet

demand • Satisfaction survey by users• Satisfaction survey of volunteers • ? Less waste and cost of food (? one care setting) to demonstrate impact Risks• Lack of senior level buy in• Lack of demand• Lack of volunteers• Cost of training• Volunteer expenses/overheads for VCS • CRB, clearances, red tape issues• Policy restrictions

Res

ourc

es

Others to involveReport to Steering Group

Team structure and rolesLead: Daphne Patel, Social Care and Independent Living Lead

Progress• Four Promoting Independence Centres (PICs)

– Testing use of volunteers in Southernwood initially – intermediate care and accommodation for people usually over 65

– Plan to share learning across all PICs and beyond

• Has been challenging to recruit volunteers but to date X has been recruited and trained (from Gateshead Voluntary Organisations Council)

• Plan is to incorporate the following questions into the satisfaction survey:– Were you offered the opportunity to have a

volunteer to support you at mealtimes?– If no, would you have liked to have had a

volunteer to support you at mealtimes?– If yes, did you find having a volunteer to help

you at mealtimes helpful?

GATESHEAD WORKSTREAM REMIT:Raising awareness across staff groups

ContextEnsure all staff have an awareness of the effects of malnutrition and what to look out for

Pur

pos

e Objectives• To raise awareness about malnutrition and its negative impacts on health amongst health and social care professionals working in

the community• Link to workstream 3 and 5: increase knowledge and skills amongst these groups to be able to comprehensively assess nutritional

status and recognise malnutrition, signpost or refer to other professionals and wider services, and if appropriate initiate appropriate management of malnutrition.

Links to MTF workstreams: raising awareness, working together

Out

puts

ScopeHealth, social care and community settings in Gateshead

Deliverables• Support start-up event to raise awareness among health

and social care professionals from across Gateshead [by end June 2014]

• Identify key groups/teams and distribute information leaflets and posters. [by end July 2014]

• Agree key messages and care pathways for groups/team [by end of November 2014]

• Engage with key groups/teams to raise their awareness [by December 2014]

Success measures

• By 30th June 2014 have supported the start up event• By end of July 2014 have distributed posters and

information leaflets to key groups/teams• By end of December 2014 to have arranged awareness

raising session with key groups/teams• By end of March 2015 to have undertaken awareness

raising sessions with key groups/teams

Res

ourc

es

Others to involveReport to Steering Group

Input from workstreams 3 and 5

Team structure and rolesLesley Bainbridge (CCG; co-Chair)

Margaret Barratt (Adult Social Care; co-Chair)Dr Jim Brown (Public Health)

Lynne Shaw (Nurse Specialist for Older People STFT)

• Chairs acted as facilitators at ‘start up’ event

• Established links with nurse specialists for older people aligned with all Gateshead nursing homes

• Posters and information distributed to all community health teams

• Time taken to understand and determine interface with training work stream

• On target to have key group meeting December 2014 so as to have undertaken all awareness raising sessions by end of March 2015

Progress

GATESHEAD WORKSTREAM REMIT:Use of a standardised tool

ContextStaff, regardless of which organisation, use the same validated assessment tool

Pur

pos

e

ObjectivesPromote the use of a validated assessment tool across all care settings in Gateshead by March 2015 and develop Train the Trainer

Programme for deliveryLinks to MTF workstreams: raising awareness, working together, identifying malnutrition, personalised care, support and

treatment, monitoring and evaluation

Out

puts

ScopeHospital (21 wards), pilot care homes (5) and promoting independence centres (4)

Deliverables• Agree on a preferred validated tool (by end July)• Understand through audit the number of care setting

where validated assessments tools are being used, and which tools are currently being used, to understand baseline (by end August)

• Identify number of care settings where training of proposed validated assessment tool could take place (by end August)

• Gain organisational/senior level buy-in (from now until March 15)

• Develop questionnaire to understand potential problems (by Nov 14)

• Develop training package and train the trainer package (by end dec)

• Deliver training package within those organisations who agree to use the suggested tool (January through to March 15)

Success measuresMeasures:• 45% of care settings in Gateshead who agree to use the

preferred validated tool have received training in train the trainer (by March 2015)

• Stakeholder analysis (before and after)

Risks: • Care homes have corporate policies which may restrict

implementation (but potentially have commissioning frameworks which could influence this but this could take time due to commissioning cycle)

• Level of transition costs (printing, training)• Lack senior-level buy in

Res

ourc

es Others to involveReport to Steering Group

Team structure and rolesTracey Dixon (Diabetes and Weight Management Team Leader, QEH) to Lead Madeleine Lee(Nutrition Nurse Specialist, QEH)Victoria Holliday (Commissioning Officer ,Commissioning and Business Development Gateshead council)Julia Wood (AQuA Affiliate)Aileen Spain (acute team leader dietitian , QEH)

GATESHEAD WORKSTREAM REMIT:Consistency of sharing knowledge and skills

ContextTo ensure all staff have the same knowledge and skills regardless of where they work

Pur

pos

e

ObjectivesEnable consistency of sharing knowledge and skills around approaches to nutrition and hydration across professional groups and

settingsby March 2015

Links to MTF workstreams: raising awareness, working together, identifying malnutrition, personalised care, support and treatment,

monitoring and evaluation

Out

puts

ScopeHospital (21 wards), pilot care homes (5) and promoting independence centres (4)

Deliverables• Identify what is currently shared, where and how through a mapping

exercise to develop baseline (by nov 14)• Identify best practice in each sector (by dec 14)• Define knowledge and skills to be shared

(?against published criteria) (by Dec 14) • Design consistent training skills package (by Nov 14)• Develop strategy to support consistency (by Dec 14)• Within each setting identify training gaps

(by Dec 14) • Deliver strategy to those organisations wishing to be involved (by

March 2015)• Develop rolling programme to use post March (by March 2015)

Success measures• 45% of care settings in Gateshead have

received training in train the trainer (by March 2015).

• Stakeholder analysis (before and after)

Risks• Unable to access appropriate level of funding• Lack of buy-in by organisations to release staff

Res

ourc

es Others to involveReport to Steering Group

Team structure and rolesTracey Dixon (Diabetes and Weight Management Team Leader, QEH to LeadJulia Wood (AQuA Affiliate)Lynne ShawVictoria Holliday (Commissioning Officer ,Commissioning and Business Development Gateshead council)Nursing Home Representative (TBC)

Progress• Considering what level of involvement is required by different staff groups:

– Identifier – who will actively screen and take appropriate action– Reporter – they will report their concerns to someone more senior to

take action• Event planned for January/Feb 2015 to showcase the new screening tool

of choice – MUST (currently use NRS Tool – Nutritional Risk Screening) and increase consistency of knowledge and skill

• At this event there will be training on:– How to use the tool– What actions to take after someone has been identified as being

malnourished (or at risk of)– Practical tips on how to fortify normal foods to prevent malnutrition

developing or progressing• Overarching plan is to develop a rolling training programme which

includes an easy to use board game on malnutrition for all involved

Progress• Training Needs Analysis developed and

circulated to support in the understanding of what people are currently doing, what training they have had in the past, and what training they will need in the future around malnutrition and MUST

• Although this is still underway, current findings show that 65% are– happy with the proposed change – don’t see any problems with the changeover

of tool for those involved– eager to have the levels and personnel clearly

defined with their areas (identifiers/reporters)

GATESHEAD WORKSTREAM REMIT:Raising awareness for the public

ContextTo raise awareness across the Gateshead community so signs of malnutrition can be identified early

Pur

pos

e ObjectivesTo raise awareness about malnutrition in older people living in the community and its negative impacts on health amongst older people

and their carers

Links to MTF workstreams: raising awareness, working together

Out

puts

ScopeGateshead community settings

Deliverables• Organise a start-up event to provide an opportunity for local

organisations that are participating in the Pilot to meet and agree a shared vision and objectives

• Run information sessions at appropriate venues aimed at older people and their carers

• Engage five local VCS organisations in raising awareness about malnutrition and their beneficiaries including carers organisations

• Deliver six eat well events in the community aimed at older people and their carers

• Work with Tesco community champions to deliver a number of shopping events at the new Tesco superstore in Trinity Centre Gateshead

• Engage with local GP practices to raise awareness about the project

• Raise awareness at CEO level within VCS

Success measures• By 30th June 2014 have delivered the start up

event• By end of December 2014 delivered 15

information events and/or opportunities• By end of December 2014 engaged with five

VCS organisations who will be more informed about nutrition and older people

• By end of December 2014 delivered three supermarket based shopping events

• By end of December 2014 developed closer links with a number of GP practices

Res

ourc

es Others to involveReport to Steering Group

Team structure and rolesLead by AgeUK Gateshead I Sharon Stuart and Sharon Dryden

Progress

• TV appearance– Sharon Stuart from Age UK did a TV

appearance in August• Local news

– Article in Council News

Progress

• KAP Survey– Number of older people/carers who said they have no

information reduced from 29% to 14%– Number of older people/carers who said they have enough

information increased from 26% to 32%– Recognition for symptoms such as ‘a lack of food in the

cupboard or fridge’ increased from 59% to 71% amongst healthcare professionals

• Use of Twitter, website pages, and leaflet dropsStatistics have been reported through Twitter and also on a dedicated page on the Age UK website. The ‘Eat Well Live Well Lunches’ have been highlighted on both and leaflets to homes, community centres and VCS organisations have been distrobuted.

• CEORaising awareness at the Older Peoples Partnership Board, Gateshead CCG, Gateshead Health NHS Foundation Trust and target VCS groups

Progress• Information sessions

– Held at numerous venues aimed at older people in the community. Venues include the Queens Elizabeth Hospital, Gateshead Civic Centre, community and other Gateshead VCS groups such as Alzheimer’s Society, Crossroads, Gateshead Older Peoples Assembly, Groundworks and Gateshead Carers

– Stands with representative from AgeUK Gateshead

– Stands with information, statistics and leaflets

– Queen Elizabeth Hospital – afternoon tea with patients and families

Progress

• Eat Well Live Well Lunches– Held in Low Fell (day centre),

Gateshead – • 6 to date (23 people in total)

– Uptake initially slow but an improvement in numbers over recent months

– Voluntary qualified chef prepares appetising dishes that have been copied and produced by way of leaflets

Progress• Shopping trips

– Difficulty building relationships with Tesco and Sainsbury’s– Just going ahead with them now:

• Four delivered to date – approximately 30 people• Provide transport (Age UK Gateshead bus)• Meet in the cafe • Discuss the project and its aims• Volunteers on hand to assist with wheelchairs and the less mobile

• GP engagement– Slower than anticipated– Age UK recruited a new Primary Care Navigator role (encourage

involvement with Age UK Gateshead including malnutrition work)– Working with three GP practices in Gateshead from January

Challenges and Achievements

Our Challenges and Achievements

Challenges• Developing a cohesive group • Working across boundaries • Governance/accountability • Conflicting priorities • Change in leadership

Achievements• Relationships have now formed

which ensures the sharing of knowledge and skills

• Great launch

Next Steps

Next Steps

• Sustainability • Scoping document• Local event - ? planning

Any Questions?