The questions we posed and the response from the Department of Health.
Q: What does the department think of our figures on Meals on Wheels? How do they fit in with the policy of trying to help people to remain at home and live independently for longer? How can the department justify the regional differences? Is the department concerned about the malnutrition figures in particular?
A: The current community care policy comes from the department’s People First document published in 1990. This stresses the importance of maintaining people in their own home for as long as possible. This reflects the preference of many older people to stay in their own homes and within their own communities. Within Northern Ireland, Community Meals (also referred to as ‘meals on wheels’ or a ‘meals at home’ service) are provided or arranged by trusts for vulnerable people where an individual needs assessment shows that a person is unable to obtain a nutritious cooked meal and would be at risk of malnutrition if such a meal services was not provided. The inability to prepare a meal may be assessed as a temporary or a long-term inability and the meal can be provided directly by the trust or by the independent sector, either within the person’s own home, in the form of a cooked, frozen or chilled meal, in a day care setting.
It is correct to note the drop in statutory community meal provision but there are a number of factors behind this statement including the success of the reablement approach (please note that reablement is an overall approach to supporting and encouraging independence over a range of personal domains, not just meal preparation); the development of luncheon clubs and other similar facilities in the community; provision of shop bought ‘ready-meals’ for individuals by their carers/families; people choosing to exercise personal choice in purchasing their own hot meals from local private sector outlets (shops, garages etc) some of which will deliver on request; and people choosing to purchase their meals directly from independent sector community meal providers without any need for trust involvement.
In every case, the responsible trust will provide services based upon an individual assessment of need. This assessment will take into account nutritional needs, in conjunction with input from professionals such as GP, speech and language therapy, occupational therapy and nursing services where appropriate.
Q: What is happening with the Malnutrition Task Force in Northern Ireland?
A: ‘Promoting Good Nutrition: A Strategy for Good Nutritional Care for Adults in all Care Settings in N. Ireland’ was launched in 2011. The vision of the strategy was to improve the quality of nutritional care of adults in Northern Ireland in health and social care, whether delivered or commissioned, through the prevention, identification and management of malnutrition in all health and social care settings. The strategy relates to adults in all care settings including their own home. The nutrition strategy has been rolled out in adult acute inpatient settings, including private nursing homes over the past five years and has been extended for a further two years to allow for full rollout and implementation in primary and community care settings.
The policy is in electronic format and hosted on the departmental website along with the guidance and resources produced by NIPEC to support the use of the MUST nutritional screening tool. You can find it here https://www.health-ni.gov.uk/publications/promoting-good-nutrition-strategy-and-guidance
Q: Professor Peter Passmore said that the regional differences “smack of postcode provision” and asked “How can there be justification of this varied approach for older people?” He also said the increase in formal diagnoses of malnutrition among older people is worrying. What is the department’s response to this?
A: Trusts are required to ensure that a range of services and approaches are available to meet the needs of their resident population. Variations in activity levels across and between trusts can often be accounted for by the responses made by trusts to their local circumstances i.e. their understanding of what best meets their local population needs. In every case, the responsible trust will provide services based upon an individual assessment of need.
This assessment will take into account nutritional needs, in conjunction with input from professionals such as GP, speech and language therapy, occupational therapy and nursing services where appropriate. Key to this process is outlining actions to support good care based on prevention, identification and management of malnutrition. This is achieved through nutritional screening on admission to hospital. Any person identified to be at risk of malnutrition will then have a nutritional care plan developed appropriate to their needs.
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