Malnutrition: Screening and Medical Treatments

Question

Malnutrition is a clinical condition affecting all ages, across all communities, and in all health and care settings. Most cases of malnutrition will be secondary to another health condition, which may impact on nutritional needs or a person’s ability to eat and drink. All National Health Services are recommended to adhere to the National Institute for Health and Care Excellence’s (NICE) clinical guideline, Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition, which is available at the following link:

https://www.nice.org.uk/guidance/cg32

This sets out the recommendations, based on best available evidence, of the organisation, screening, and delivery of nutritional support in hospitals and communities. This includes screening for malnutrition and the risk of malnutrition. The NICE guidelines recommend that all hospital inpatients should be screened for malnutrition on admission, as well as all outpatients at their first clinic appointment. Screening should be repeated weekly for inpatients, and when there is clinical concern for outpatients. People in care homes should be screened on admission, and when there is clinical concern.

All people who are identified as being malnourished or at risk of malnutrition should be assessed by an appropriately qualified health professional, such as a dietitian, to receive an individualised care plan in line with their individual circumstances, dietary preferences, and medical needs.

NHS England’s Nursing Directorate is leading on a review and refresh of the National Nutrition and Hydration guidance, which builds on NHS England’s previous Commissioning Excellent Nutrition and Hydration guidance 2015-2018. This previous guidance is available at the following link:

https://www.england.nhs.uk/wp-content/uploads/2015/10/nut-hyd-guid.pdf

A National Hydration and Nutrition Advisory Board was established in June 2023, providing strategic advice, direction, and oversight across the review, codesign, and development of the policy.

There is no current estimate on the savings that could be made as a result of increasing the screening and treatment of malnutrition. However, efforts to prevent malnutrition and to treat it early could potentially reduce both the clinical and economic burden to the healthcare system. Malnourished patients spend on average 30% longer in hospital than patients who are not malnourished.

Integrated care systems, made up of local partners including the NHS, councils, the voluntary sector, and others, are responsible for planning and commissioning health services for their local population. Integrated care systems and providers will be responsible for implementation and delivery of the refreshed National Nutrition and Hydration policy.