​Nutrition and Hydration 


Malnutrition is common in the UK, affecting more than three million people (AHP, 2012) at any one time. Around 1 in 3 of your patients admitted to acute care will be malnourished or at risk of becoming so (NICE, 2011), and 35 percent of individuals admitted to your care homes will be affected; for those living in the community 93 percent of those will be suffering from malnutrition. (Wise, 2015) The under nutrition of children and young people is usually associated with poverty and poor food choices. Dehydration is also common, although the overall numbers affected are less clear.

The excess annual health costs associated with malnutrition alone are estimated to exceed £19 billion. (BAPEN, 2015) Therefore it is essential that malnutrition and dehydration problems are better recognised and treated. An additional benefit is the reduction of pharmaceutical waste, resulting in better use of scarce resources.

In Greenwich, we have been proactive in addressing malnutrition and have been identified as an example of excellent commissioning of Nutrition and Hydration Services by NHS England. In 2014 we commissioned our new integrated Malnutrition Service to address malnutrition in adults in the community. The service comprises of three teams of dieticians and nutrition nurses who deliver clinics in surgeries, care homes and patients own homes.
The three teams cover:

Home Enteral Nutrition. The HEN team cover all tube fed patients in the community; in particular Head and Neck Cancer, Stroke and Motor Neuron Disease patients.

Food First. The Food First Team provide a dietetic service which includes assessment and on-going reviews of community and care home residents at risk of malnutrition together with training to up-skill the catering teams and nursing home staff on a Food First approach.

Primary Care. The Primary Care Team provide a local dietetic service to patients identified with malnutrition and clinical diseases requiring specialist dietetic intervention in primary care practices in Greenwich. It was designed to replace the need for general outpatient dietetic clinics in the hospital.

By promoting integrated working the Food First Team has been developing opportunities to work with domiciliary care workers in the community. Through early intervention to identify malnutrition there is an opening to prevent many of the complications associated with malnutrition in the community.  Ideally, in Greenwich we would like to address malnutrition from the earliest possibility by ensuring that someone who is not eating has full fat milk in the fridge to the more complex nutrition support patients being discharged from hospital. We have been also linking in with the Malnutrition Task Force and looking at opportunities to work with the voluntary sector.

In evaluating this work we have linked in with Kings College London to carry out projects with final year students for their dissertation. We have managed to gather useful data which will help us to shape this service in the future and continue to develop and improve our nutrition and hydration services. 

Influencing National Guidance on Nutrition and Hydration

As Greenwich CCG offers established nutrition and hydration services​, and thanks to our work with Kings College London and NHS England, Greenwich CCG are helping to evaluate and influence NHS England's Commissioning Guidance for Nutrition and Hydration - click here for the Commissioning Guidance​. 

The NHS England Commissioning G​uidance outlines:

  • Why commissioners should make nutrition and hydration a priority
  • How to tackle the problem
  • How to assess the impact of commissioned services
  • How commissioners have begun to tackle the problem via commissioning

It details a number of steps that commissioners should undertake

  1. Ensure commissioning intentions include a focus on prevention of malnutrition and dehydration.
  2. Undertake steps to understand the needs of your local population through effective engagement with the public and local providers.
  3. Assess the baseline of your local providers provision against NICE guidelines and best practice.
  4. Develop nutrition and hydration care pathways to meet your population’s needs.
  5. Ensure nutrition and hydration outcomes are in the contracting, quality assurance and performance and monitoring of commissioned services.
  6. Monitor and evaluate the outcomes of commissioning intentions for nutrition and hydration.
  7. Deliver continuous improvements of nutrition and hydration needs of the local population through setting an improvement trajectory
  8. Ensure the commissioning process is taking an integrated approach that provides the delivery of an all-encompassing approach that takes into account all aspects of nutritional care including, psychological, physical and social aspects.​

Learn more about our work

Picture1.jpg