INDI 2013 PRE-BUDGET SUBMISSION
LOW PRIORITY GIVEN TO NUTRITION WITHIN HEALTH SYSTEM COMPROMISING HEALTH OF CHILDREN AND ELDERLY
Nutrition screening and earlier access to ‘first line’ nutrition services are among the key actions sought by national body for Dietitians and Clinical Nutritionists to address the dual burden to the health service of malnutrition and obesity.
The Irish Nutrition and Dietetic Institute (INDI) called for greater commitment from the Department of Health and HSE to the nutritional care of children with nutritional problems, elderly patients and those with chronic illnesses throughout the healthcare system.
In a week in which the needs of children were at the top of the news agenda, the President of the INDI, Richelle Flanagan, echoed calls by the IMO for greater investment in tackling childhood obesity, adding that “early detection and correction of other nutritional problems in children, such as nutritional deficiencies, disease related weight loss or malnutrition, are just as important.”
“Most GP practices and PCTs around the country have nowhere to refer parents of obese children or those with serious feeding or nutritional problems to obtain a ‘first line’ assessment or treatment, since paediatric dietetic services are almost exclusively confined to children’s hospitals. There is also very limited access to community based group prevention programmes, despite the success of initiatives like Up4It and ACE.’’
Ms Flanagan said that the biggest gaps in services are found in socially deprived areas of Dublin and its surrounds – the very areas of greatest need, “Over 160 PCTS that serve a population of over 1.6 million, have no access to dietetic services for any group, which really shows how little attention and resource is being dedicated to addressing what are acknowledged to be a major threat to the health of patients and to the health system.”
Paediatric Consultant at AMNCH and Our Lady’s Hospital Crumlin, Dr David Coghlan stated ‘our Dietitians play a very important role in our clinics in addressing nutritional complications in babies and children, so much so that we get referrals from the community just to access the Dietitian in our clinics due to the lack of a Dietetic service in the community. This seems a very poor use of resources as waiting times for Dietetic services can be upwards of 12 months, which for a child, is simply a case of too little, too late. Services need to be integrated between hospital and community to help address nutritional problems early so as to avoid children appearing for admission through A&E departments. I think regular access for health professionals to education on nutritional issues in infants and children would also go a long way in helping catch children with special dietary needs early when we can have the most impact.’
In their pre-budget submission, the INDI also highlighted the inadequate attention to nutritional care needs of children with disabilities, adding: “The prevalence of both obesity and nutritional deficiencies and disease related weight loss or malnutrition are far higher amongst children with disabilities than in able children, most of which could be avoided by ensuring adequate access to specialist services alongside better nutrition education of healthcare staff, parents and carers. We are calling for the expansion of community based programmes and adequate services for all high risk children, since poor nutrition in early childhood has lasting effects on growth, mental development and disease risk.”
The pre- budget submission also calls for Government commitment to eliminating avoidable malnutrition in elderly and chronically ill patients in hospital and community settings, which they say will deliver significant cost savings. Malnutrition affects an estimated 140 000 patients, over half of whom are elderly. Treating malnourished patients costs the HSE an estimated €1.4billion per annum, over 10% of the total healthcare budget.
The National Institute for Clinical Excellence (NICE) in the UK, found that malnourished patients stayed an average of 1.4 days longer in hospital undermining the health care targets to reduce in- patient length of stay.
Adding support to calls for better nutritional care systems, leading Cancer Surgeon and Chairman of the Irish Society for Clinical Nutrition and Metabolism, Professor John Reynolds, said: “Malnutrition in our hospitals and amongst community patients is not receiving anything like the attention it deserves. This is despite overwhelming evidence that patients who are poorly nourished become sicker, respond less well to treatment, stay longer in hospital and have poorer outcomes than well-nourished patients. It simply doesn’t make clinical or financial sense to pay lip service to a patient’s nutritional care while aggressively treating their medical condition.”
Although the Department of Health acknowledges that much of the chronic disease burden is diet- related, the nutritional care of key patient groups is not being adequately supported with the health systems, screening programmes and early treatment needed to address these problems reliably.
Leading Dietitian and INDI Vice President, Philomena Flood, said that actions to improve nutritional care of patients must follow words: “Minister Reilly has consistently championed investment in prevention or interventions delivered at the earliest and least costly opportunity – at primary care level. We are now asking for his commitment to ensure that systems and services are available to ensure that those least able to withstand the effects of poor nutritional intake, even for relatively short periods, do not slip through the net..”
The INDI supports Government aims to address health inequalities and improve access to primary care services, reducing pressure on acute services. However, gaps in the nutritional care of patients, particularly in the community, must be addressed if the goals for an effective healthcare system that optimises patient safety and outcomes are to be achieved.
If the INDI achieves its goals, every individual involved in the care of Irish patients will understand their role in delivering excellent nutritional care, driving up standards and helping to achieve better patient outcomes.
Professor Reynolds concluded: “Inadequate investment in good nutritional care is a false economy – earlier detection and more effective targeting of nutritional support can achieve major savings for the HSE”
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