Concern over loss of community meal provision for older people
HACA View point
On 12 Jan 18 the DHSC will discontinue all financial support for the home meal delivery service to frail and vulnerable older people on the Isle of Man. Their alternative, which they maintain will provide an equivalent service with a wider range of meal options, is simply to recommend two commercial suppliers of frozen meals who can provide a delivery service.( Only one is Island based).
There is no contract with these suppliers and, therefore, there are no defined standards of service to be met and no guarantee of future service which will be subject to commercial and market fluctuations.
There will be no assessment of nutritional requirements or suitability, no consideration given to the availability of adequate food storage facilities in the home, and no monitoring or supervision. Support may be given to those who request it although it is probably unrealistic to expect the current community health workforce to cope with daily, or even weekly, visits to current meals on wheels clients. Any support given by Community Health Workers generally involves payment of a fee by the recipient.
In our view, the DHSC is failing to recognise or address the needs of some of the most vulnerable members of our society, and this ,in turn, will have a major impact on readmission rates along with increased pressure on front line services costing more in the long run than any short term saving.
There is clear evidence that the benefits of treating malnutrition far outweigh the costs. There is clear evidence that shows we can prevent malnutrition through screening and early intervention. Malnutrition is a key issue affecting the health of older people yet it remains under-detected, under-treated, and under-resourced, and often overlooked by those working with and for older people.
Malnutrition often leads to health problems including increased infections, delay in recovery from illness, increased attendance at GPs, increased hospital admissions and length of stay and poor wound healing. This has a major impact on health care resources and costs.
Evidence suggests that 93% of malnutrition and malnutrition risk is in the community, meaning the focus on prevention and effective intervention should be with older people living in their own homes.
There is no ‘one size fits all’ solution and therefore any programme of prevention of malnutrition must tackle social exclusion, isolation, and poverty as well as regular access to food, meals and nutritional information.
Community meals have a key role in supporting people to stay in their own homes. There is economic evidence of the cost effectiveness of community meals. In addition, the benefits of ensuring people living at home are eating regularly, have personal contact and are monitored to ensure their care needs are met and their nutrition risk does not increase are well documented. Currently the meals on wheels service fulfils these requirements.
There are many questions that the DHSC appears to have chosen to ignore:
1: Can the DSHC confirm that they have no contract with any commercial supplier of meals and, consequently, no conditions of service and no guarantee of supply?
2: What is the evidence that the meals on wheels service represents poor value for money? On the contrary, evidence available suggests the benefits far outweigh the costs.
3: Has the DHSC implemented any NICE recommendations for screening and early intervention of malnutrition among older people.
4: Has the DHSC assessed the impact of discontinuing a monitored community meals service on front line services?
5: Has the DHSC fully explored other alternatives to the current meals on wheels service, perhaps involving charities, the voluntary sector along with commercial suppliers?
6: Has the DHSC considered that some older people (through failing vision or hearing,loss of hand co-ordination, or loss of mental agility) may be unable to order meals independently?
7: How are older people at risk of malnutrition to be identified in the future,given the fact that 50% of meals on wheels recipients have no direct contact with Social Services?
8: Is there any planned follow up of current recipients of meals on wheels in order to assess whether the new recommendations are appropriate?
9: Is any data to be collected on the nutritional value of meals delivered by commercial suppliers to older people at risk of malnutrition?
For more information visit the Malnutrition Task Force website: www.malnutritiontaskforce.org.uk