October 13, 2014

Malnutrition: the quiet epidemic that’s sweeping the nation

We are constantly confronted with media reports focusing on the current ‘obesity epidemic’, and the dangers of consuming too much sugar, salt and fat are widely broadcast. However, this focus on the need to tackle obesity has overshadowed a hidden crisis that affects millions nationwide: malnutrition.

 Dangers of malnutrition

 Over three million people in the UK are malnourished or at risk of malnutrition, and our elderly population is particularly at risk – over one million of those affected are aged over 65. The danger of this can’t be overstated, because malnutrition has serious implications for the health issues older people often face: it has the power to exacerbate on-going health issues such as frail bones and muscles, wound healing or a weak immune system, and can lead to problems absorbing medication.

 Malnourished people typically visit their GP twice as often as those who are getting a healthy, well-balanced diet. Malnutrition also contributes to a ‘revolving-door’ phenomenon amongst some hospital patients, who are discharged but subsequently become ill again as a poor diet inhibits their recovery at home – and are ultimately re-admitted to hospital.

 Why are our elderly malnourished?

 An elderly person might be under-nourished for various reasons: some older people living alone might not like to cook for just one person, or those who are frail might not feel confident going out of the house to the shops. However, one driving factor is the way we talk about diet and health, both in the media and in the health advice given by public bodies and the government.

 With the current focus on tackling obesity, there is a tendency to apply a very prescriptive, ‘one size fits all’ perspective to our diets, but this risks confusing older people, who often need very different dietary advice from the rest of the adult population: for example, older people may need to eat more fat and sugar to maintain a healthy weight.

 To tackle the problem of malnutrition amongst older people, The Malnutrition Task Force (MTF) was established in 2012. MTF aims to actively influence behaviours across the NHS, residential care and in the community to prevent and reduce malnutrition in older people. apetito, the parent company of Wiltshire Farm Foods, is one of the five founding partners of the MTF and has made a substantial financial contribution to its funding (along with Age UK, WRVS, BAPEN and Nutricia). Paul Freeston, apetito’s chief executive is also a member of MTF’s Steering Group.

 What’s to be done?

 There is a long way to go in fighting malnutrition in the elderly, but there are some tips those working with the elderly can bear in mind:

    • Spotting the signs: There are warning signs that might indicate an older person is malnourished. It can be difficult to gauge someone’s weight without forcing them onto a set of scales, but looking out for clues such as wedding bands that have become loose, or a noticeable decrease in upper arm circumference can give you an idea if the person has lost weight. You may also notice that an elderly person may seem more frail – when someone is malnourished they are likely to have deficiencies in several vitamins, such as zinc or vitamin D, that have knock-on effects for the rest of their health.

    • Debunk the myths: Healthcare professionals should work to combat false perceived norms, which are commonly held by older people: for example, that fat and sugar is bad for you and should be cut out of a diet where possible. It’s also worth emphasising that getting vitamins and minerals can come from a really wide range of sources, to suit all budgets: for example, frozen vegetables are just as full of nutrients as fresh (and sometimes more so), but many older people may think that only ‘fresh’ food is nutritious and therefore overlook alternatives. 

  • Offer flexible advice: A personalised approach should be taken when delivering dietary plans or advice, which takes into account varying medical needs of older people. It’s important to consider the person’s ability to swallow and digest food when creating a dining plan for them; texture-modified foods may make eating much easier for someone suffering from a condition like dysphagia.

Tasty, tempting and varied food is also essential to engage older people in eating well. At Wiltshire Farm Foods, we have a number of processes in place to make sure that the dishes we develop meet the tastes and preferences of our customers: perhaps most importantly, we have customer panels, where we invite feedback and ask our customers what they’d like to see. One example is our ‘Extra Tender’ range, which we developed in response to feedback from customers about what they found most comfortable to cut up and eat.

Education, care and nutritious food are the tools we have to tackle malnutrition amongst our elderly population. Reducing and, ultimately, preventing malnutrition is an enormous challenge, but with the work of the Malnutrition Task Force, government support and the enthusiasm of those working in health and care, we believe that we can make a real difference to the quality of life of so many older people.

By Helen Willis BSc RD, apetito and Wiltshire Farm Foods Dietitian; member of the British Dietetic Association and the National Association of Care Catering


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October 09, 2014

NHS Confederation responds to King’s Fund report on NHS finances

The NHS Confederation has said the King’s Fund report published today (9 October), ‘Financial failure in the NHS: What causes it and how best to manage it’, is a great contribution to the debate defined in the 2015 Challenge Manifesto.

Rob Webster, chief executive of the NHS Confederation, said:

“Unfortunately, evidence of hospitals in financial deficit is a sign of our times with the NHS facing unprecedented financial pressures. These financial challenges require a sustained approach in the medium term. The King’s Fund report is a great contribution to the debate around the future of health and care as defined in the 2015 Challenge Manifesto.

“On the specifics, we have called for more to be done to support organisations in distress, so failure is only seen as a last resort. We believe that short-term solutions to long-term financial problems are not sustainable and we maintain that the only way to turn around a failing organisation is to look at the challenges being faced across the whole system, rather than trying to solve them in isolation within one trust.

“The rules of engagement around crisis-driven change needed to be clearer and we were pleased to have secured reforms in the Care Act to strengthen the involvement of patients and staff in the Trust Special Administration (TSA) process. As we continue to work on a cross-party committee advising on the new guidance to TSAs, we will be adamant that the rules for TSAs need to be as clear, realistic and meaningful as possible.”

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October 07, 2014

Suffering in silence: New statistics prove that gout is no laughing matter

Quarter of gout patients say doctors do not consider gout to be an important health problem

 Today, Arthritis Care launched a new report which showed that the health service is failing to address the seriousness of gout. Gout Nation 2014 reveals that 83% of people with gout struggle with daily activities when their disease is at its worst, like walking and even putting on their shoes. The report also highlights that the pain associated with the condition can be so excruciating that 9% have reported often taking time off work and 4% under the age of 65 give up work altogether. One-third of people also reported feeling depressed during an attack of gout. Despite the effect that gout is having on people across the UK, Gout Nation 2014 shows that almost a quarter of sufferers believe that their healthcare professional does not consider gout to be an important health problem and half of sufferers who have discussed their gout with their family or friends have had unhelpful reactions from them, including that they find their gout condition humorous.

 With one in 40 people now suffering from gout, the report urges the public to change their perceptions of gout, and for those suffering in silence, to seek the help they need. At present, 10% of gout sufferers are diagnosing their condition online and 21% feel that they do not receive enough information from their GP about the long-term drug therapy treatments available to them.

“It is important to understand that gout can affect anyone, regardless of their age, sex or risk factors  and, if left untreated, can lead to serious health problems such as permanent joint damage, kidney disease and cardiovascular disease.”, said Michael Doherty, Professor of Rheumatology at University of Nottingham. “Gout is attributed to an interaction between a number of factors including genetics, the environment and personal circumstances, and it is important that people are aware of the factors which increase the risk of developing the condition. These include having a close family member with gout, certain medications, a diet rich in protein or purines, drinking excessive beer and spirits and being overweight.”

“The number of people living with gout and being diagnosed every year is continuing to increase, yet we as a nation are still not taking this condition seriously.” Said Judi Rhys, Chief Executive ofArthritis Care. We need new quality standards on the treatment of gout and we are calling on The National Institute for Clinical Excellence to take this forward.”

Gout Nation 2014 included results from a survey amongst 1,259 people with gout conducted by YouGov.  Access the full report via: www.arthritiscare.org.uk/LivingwithArthritis/gout-nation-2014/

7th October 2014

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October 07, 2014

care.data ‘pathfinder’ CCGs announcement

The first four areas to trial NHS England’s care.data programme should be announced this afternoon.

care.data is the NHS England scheme that was forced to “pause” in February amongst public and political criticism about the sale and use of NHS patients’ medical data. The basis of the programme is unchanged – identifiable medical information will be extracted from the GP record of every man, woman and child in England; this data will be centralised, linked with information taken from other parts of the NHS and made available in various forms to an open-ended array of organisations and companies for ill-defined purposes.

At this point there are still a number of fundamental issues to be resolved [1].

Phil Booth, coordinator of medConfidential [2], said:

“It’s crucial that patients are given the full picture if care.data is to be attempted. Fundamental issues about the consent process and who will be able to use patients’ data, and for what, are still not properly nailed down.

“It’s all very well to make promises, but patients must be able to trust those promises are true. NHS England cannot fudge what it says to doctors and patients, or it risks another crisis of confidence.”

“We look forward to reading what NHS England are actually proposing.”


a) Significant questions still outstanding:

1.    What exactly will GPs and patients in ‘pathfinder’ practices be told, and will every patient be written to directly with a consent form? What will patients who opted out in January or February, or since, be told? Will NHS England require any patients to visit their GP practice to opt out?

2.    Given the widespread confusion between care.data – which is for ‘secondary use’ only, i.e. purposes other than the direct care of the patient – and the Summary Care Record (SCR), will people who were confused between SCR, which may be used in direct care, and care.data, which will not, be made very clear about their existing consent settings?

3.    Patients who opt out should have this respected by the Health and Social Care Information Centre (i.e. no data will be extracted from their GP record) but when will the opt out – currently the gift of the Secretary of State – be put on a statutory basis?

4.    The Government claims to have added legal protections but when will the Care Act Regulations detailing crucial definitions such as use “for the promotion of health” and sanctions for misuse be laid before Parliament?

5.    Who have the Department of Health consulted on the Care Act Regulations, to be implemented by HSCIC and the Health Research Authority, which are the basis for NHS England’s assurances to patients?

6.    Claims to rule out “solely commercial” use look like a loophole; will companies which get data from the HSCIC still be able to sell it on for ‘re-use’ by third parties? Will “the promotion of health” still permit uses such as marketing?

7.    When will the new contracts and agreements be in place? Drafts on the HSCIC website still appear to permit commercial re-use and make no mention of ‘one strike and you’re out’ sanctions or access via safe settings.

8.    The planned secure data facility (‘safe setting’) at HSCIC to hold linked GP and hospital data is not yet built. When will it be ready, and what will patients be told about the use of their data?

9.    Where will NHS patients’ individual-level data go in the longer term? Will their data ever be permitted to leave the secure data facility in any form other than publishable aggregated statistics?

10.  What will patients and GPs be told about future changes to the care.data programme?

11.  As NHS England doesn’t know what will be effective, what principles will be followed to correct deficiencies in communications for any particular trial? medConfidential supports managed testing of processes, but we have seen no commitments to address trials that go less well.

b)  medConfidential campaigns for confidentiality and consent in health and social care, seeking to ensure that every flow of data into, across and out of the NHS and care system is consensual, safe and transparent. Founded in January 2013, medConfidential is an independent, non-partisan organisation working with patients and medics, service users and care professionals.


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October 02, 2014

Is your brain Male or Female? Horizon, BBC 2, 29th September, 2014.

Joy of joys, a programme on a fascinating topic presented by my two favourite science programme presenters, Michael Moseley and Alice Roberts.

The question at issue was whether male and female brains are different apart from the well documented fact that male brains are, on average, larger. It also transpired that the hypothalamus is better developed in males and the hippocampus better in females.

The main focus of the programme was on brain function rather than structure.

Alice made it clear from the start that she believes any differences in brain function as manifested by behaviour are the result of social conditioning, whereas Michael believes that the differences are innate – partly genetic and perhaps partly the result of the intra-uterine hormonal environment.

The well known propensity of infant boys to play with cars and infant girls with dolls was demonstrated but is this just a reflection of parental expectations influencing the type of toys provided? To test this hypothesis is not possible in humans but the fact that with macaque monkeys the males show a preponderant interest in toy cars whereas the females show more interest in dolls seems to suggest that this difference in preferences is innate. There is a view that the male preference for toy cars is in fact a preference for things that move.

It has long been thought that males are better at visuo-spatial challenges whereas females are better at reading social signals. This was tested using standard tests and a mixed sex group of volunteers and the results were as expected, but only by a small margin. The differences between the genders are significant but not large.

Autism, it seems is just an extreme form of the male mindset – good at visuo-spatial tests but poor at social skills. High intra-uterine testosterone levels may be a key factor here.

Another interesting finding was that the dominant brain functional connections in children are the same in both genders but change after adolescence with male connections being predominantly longitudinal – from visual cortex to frontal cortex and female connections being predominantly transverse – from right lobe to left lobe.

In the end Michael and Alice agreed that the currently available evidence suggests that the differences between males and females are in part innate and in part socially/environmentally conditioned. So Michael accepted that he is not from Mars and Alice was adamant that she is not from Venus!

All in all an informative and well presented programme which gained from the sparky interaction between its two stars.

When I was a boy it was a rare to see a woman driving a car. When I achieved my 17th birthday my father gave me driving lessons but he did not do the same for my three sisters. Last week in the course of having an extension built on our house the mechanical digger used for excavating the trenches for the foundations was driven by a woman. So the impact of social conditioning towards the traditional female role is clearly in decline. The innate differences between the brains of males and females are likely to persist for the foreseeable future but, being small, in the end will have little impact on who does what.

Paul Walker, October 2014.

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