Oral Nutritional Supplements (ONS)
Oral nutritional supplements are prescribed to treat malnutrition.
They are cheap in hospital (1p per carton) but expensive in the community setting (£1.71 – £1.85 per carton) and increasing. Inappropriate prescribing (57-75% of prescriptions) has led to £28-37 million of wasted spend in London PCTs over the last 4 years and the annual national spend is £89 million.
If NICE guidelines were met then there is a chance of saving between £51-67 million annually. One of the reasons for inappropriate prescribing is a lack of dietetic capacity to provide effective care.
Source/Reference: www.evidence.nhs.uk/qualityandproductivity
Dietitians reduce inappropriate prescribing of oral nutritional supplements. Improving nutritional care can reduce admissions, readmissions and shorten hospital stay. It can also improve quality of life and promote independent living. Dietitians can reduce long term dependence on artificial nutrition. Dietitians maximise food intake facilitating long term recovery and nutritional health.
Source/Reference: A Toolkit for Commissioners and Providers in England British Association of Parenteral and Enteral Nutrition (BAPEN) 2010. Link to National Demographics: Links to national work on Adult Rehabilitation.
Dietitians can provide cost effective quality care by ensuring patients receive the most appropriate treatment, thereby reducing inappropriate prescribing of oral nutritional supplements (ONS). Source/Reference: London Procurement Programme. Clinical Oral Nutritional Support Project, 2010.
Using behavioural change skills, dietitians can empower patients to return to a balanced food intake, reducing the need for inappropriate ONS. Source/Reference: Allied Health Professional Oral Nutritional Supplements commissioning toolkit NHS London March 2012.
Patient reported outcome measures (PROMS).
Local data showed patient education and treatment, in the form of dietary counselling and food fortification, was perceived as beneficial by the majority of patients who completed treatment (80%). Overall intervention resulted in improved nutritional health outcomes and experience of the community dietetic services received.
Clinical outcome measures.
Clinical outcome data show intervention had a positive impact on anthropometric measurements such as weight and body mass index.
General London data.
From 2005/06 to 2009/10 expenditure on ONS in London increased by 8% per year. The forecast expenditure for 2011/12 based on ePACT data, is for a £900,000 (6%) reduction in expenditure. Incorporating cost avoidance this equates to a £2 million saving.
Inner North West London financial outcome data.
Central London Community Healthcare achieved a significant reduction in ONS expenditure in Kensington and Chelsea NHS Trust, demonstrating cost avoidance and cash releasing savings. Expenditure changed from an annual 22% increase in 2007/8 to a 32% reduction in spend in 2010/11.
This resulted in an estimated saving of approximately £300,000 in terms of cost avoidance and cash releasing savings over three years. Forecast data from 2011/12 indicate a further 12% reduction in expenditure.
Source/Reference: Allied Health Professional Oral Nutritional Supplements commissioning toolkit NHS London March 2012.
