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An introduction from BAPEN’s chair – Dr Tim Bowlin Contents

An introduction from BAPEN’s chair............................................................................3 What is BAPEN?.............................................................................................................4 BAPEN’s mission...........................................................................................................5 BAPEN aims 2012 – 2013...............................................................................................5 BAPEN’s history.............................................................................................................6 BAPEN key achievements.............................................................................................7 BAPEN education and training.....................................................................................8 BAPEN – the structure.................................................................................................10 BAPEN Core Groups....................................................................................................11 How BAPEN works.......................................................................................................12 Membership..................................................................................................................14 A financial overview.....................................................................................................14

It’s a shocking fact that malnutrition in the UK is a major problem. It costs the NHS and social care around £13 billion per year and is one of the highest spends in healthcare. Currently a third of people admitted to UK hospitals are undernourished or at risk of malnutrition, which suggests that nutrition is a problem long before they come into hospital. Malnutrition can often be difficult to recognise and often develops very gradually, which can make it very difficult to spot in the early stages. Malnutrition affects every system in the body and results in increased vulnerability to illness, increased complications and in very extreme cases it can kill. In 2011, a hospital survey of 7,541 men and women conducted by BAPEN showed that women appeared to be at greater risk of malnutrition, with 28% affected by malnutrition vs 22% of men. While risk increased with age, there was substantial malnutrition risk present in all ages. The results confirmed that malnutrition is common on admission to acute and community hospitals, all types of wards and in all age groups and diagnostic categories. Dr Tim Bowlin Given the established association between malnutrition and disease related complications and length of hospital stay, there is great potential to improve the quality of patient care by addressing malnutrition, and this could also lead to substantial savings for the NHS. At BAPEN we are working hard to get the message across to GPs and primary care teams, Clinical Commissioning Groups and local area teams, that nutrition is a key issue that must be addressed, not just in hospitals and care settings but in the wider community. The challenge is to ensure that people are adequately screened; and those who are found to be malnourished or at risk of malnutrition are then managed properly with robust care pathways. While we are beginning to make progress there is still a long way to go.


What is BAPEN?

BAPEN’S mission

BAPEN is a Charitable Association that raises awareness of malnutrition and works to advance the nutritional care of patients and those at risk from malnutrition in the wider community.

Working with its members and key national partners BAPEN works to ensure that all individuals who are malnourished or at risk of malnutrition in any healthcare or social setting are identified early through nutrition screening, using a validated tool such as BAPEN’s ’Malnutrition Universal Screening Tool”’(‘MUST’), and then receive appropriate, individualised treatment.

BAPEN is made up of six Core Groups, representing patients and the various professional disciplines involved in managing malnutrition, with most of the members being practising healthcare professionals. BAPEN brings together the strengths of its Core Groups to raise awareness and understanding of malnutrition in all settings and provides education, advice and resources to optimise care. BAPEN’s Core Groups include: • BAPEN Medical • BPNG (British Pharmaceutical Nutrition Group) • BSPGHAN (The British Society of Paediatric Gastroenterology Hepatology and Nutrition • NNNG (National Nurses Nutrition Group)

In order to achieve this, all health and social care professionals should be adequately trained to understand the importance of good nutritional care and have the skills appropriate to their role to implement this. BAPEN believes good nutrition and hydration care should be recognised as being a fundamental core component of providing safe and effective quality care in all care settings. BAPEN is committed to ensuring that nutrition becomes everyone’s responsibility. Its Malnutrition Action Group is working on a project to develop and test ‘self-screening’ for malnutrition so that individuals and their carers can undertake this initial screening themselves. It is also working to improve the information available for patients and their carers, and to ensure that this information is easily accessible. BAPEN is also committed to ensuring that the best available clinical and scientific evidence is implemented in practice. The Charitable Association therefore produces reports, toolkits and guidance for health and social care professionals and commissioners.

• The PEN Group (Parenteral & Enteral Nutrition Group of the British Dietetic Association) • PINNT (Patients on Intravenous and Nasogastric Nutrition Therapy) BAPEN also has a number of partners with whom it works closely to support the delivery of nutritional care in the UK, which is made up of associate societies such as the British Society of Gastroenterology, various charitable partners and the nutrition industry.

BAPEN aims 2012 – 2015

More information about BAPEN’s Core Groups and the structure of the organisation can be found on page xx of this publication. Under the Chairmanship of Dr Tim Bowling, the aims of BAPEN for this three year period are to: • Increase BAPEN membership: by increasing membership BAPEN can ensure that more health and social care professionals have access to the best resources to improve nutritional care and are able to access our discussion forums to advance practice • Build on BAPEN’s current position as the leading UK multidisciplinary Charitable Association tackling malnutrition to influence national nutrition agendas and policies, through effective collaborations with the Department of Health, Public Health and Social Care, and lobbying • Carry on developing and providing leading edge resources to support excellence in practice, training and education in nutritional care • Continue to support the collection and dissemination of evidence relating to undernutrition in the UK and the delivery of nutritional care to assist in the planning of nutrition services across the UK • Build on the constructive collaboration with our Industry partners in line with the Government’s aim of developing new ways of working and innovative solutions to improve nutritional care and deliver efficiency savings.



BAPEN’s history

BAPEN key achievements

Since its inception in 1992, BAPEN has had six pioneering Chairmen who have worked hard, alongside fellow committee members, to ensure the Charitable Association meets the growing changes in an ever-changing healthcare environment.

Over the years, BAPEN has implemented a number of significant initiatives designed to raise awareness of and take steps to improve nutritional care in the UK. Here are just some of the highlights.

Now, coming up to its 21st birthday in 2013, there are many key achievements that have been delivered under the leadership of each past-Chairman, and which can be looked back at with pride by our members, including: Professor John Lennard-Jones 1992 – 1995 • Founding Chairman • Malnutrition is put on the map with the seminal Kings Fund report Professor David Silk 1995 - 2000 • BAPEN received recognition as a specialist body by the Royal Colleges • BAPEN produced standards of good practice in the field of nutritional support Professor Chris Pennington 2000 – 2002 • Organisation of the ESPEN conference in Glasgow • Support for non-medical professions in having their expertise equally acknowledged in the field of clinical nutrition • Taking BAPEN’s messages into the wider arena Professor Alastair Forbes 2002 – 2005 • Launch of Malnutrition Universal Screening Tool ‘MUST’ • BAPEN engagement with other organisations, including the Better Hospital Food programme, the Royal College of Physicians and NICE • Launch of the multidisciplinary Handbook of Nutritional Support Professor Marinos Elia 2005 – 2008 • Engagement with numerous partners and with ministers to further the nutritional agenda, producing many reports, guidelines and training tools • Health Economic Report, helping to focus policy makers on the importance of nutritional care • Nutritional Screening Week • Main Nutrition Industry group of ESPEN awarded BAPEN its first ever prize of €30,000 for its work on fighting malnutrition Dr Mike Stroud 2008 – 2011 • Commissioning toolkit published • Nutrition and Hydration included in the Department of Health Safe Care National Work Stream • Nutrition included as one of the Chief Nurses’ ‘High Impact Actions’ and as one of the most cost effective investments identified by NICE • Care Quality Commission introduced enforceable nutritional care standards • Nutrition included in two of the five domains of the DH outcomes framework

BANS – The British Artificial Nutrition Survey (BANS) has been collecting data on patients on artificial nutrition in hospital and in the community since 1996 and is the largest such ongoing dataset in the world. These data are then analysed and reported, both by region and nationally. A report is published annually to ensure the findings are widely disseminated. Data collection and processing has recently been substantially improved through electronic data collection. This has enhanced the quality of data and can aid reporters to capture local data and benchmark against other geographical areas, map national or regional trends and benchmark their own services and outcomes with others. Nutritional Screening Weeks – BAPEN’s 1st Nutrition Screening Week (NSW) was established in 2007 to collect data on malnutrition risk in adults on admission to hospitals, mental health trusts and care homes across the UK in order to establish the prevalence of malnutrition in adults on admission to care across the UK. Since 2007 four screening weeks have taken place in each of the seasons. BAPEN Reports have been produced for each NSW and BAPEN is currently working to combine the data from all of the surveys to present a more comprehensive picture of malnutrition in the UK and the Republic of Ireland This unique data has provided on-going evidence to illustrate the size of the problem of malnutirition, the need for action and the need for resources. As such it has been used at the highest levels for lobbying for services and drawing attention of government, commissioners and managers. However, we still need members to engage in such projects to continue and improve our campaigning. MUST – Since its launch by BAPEN in 2003 ‘MUST’ (‘Malnutrition Universal Screening Tool’) has become the most commonly used nutritional screening tool in all care settings across the UK and is also being used more and more in other countries throughout Europe and the rest of the world. 2012 saw ‘MUST’ translated into 5 languages to reflect its international popularity. ‘MUST’ is a simple 5 step screening tool designed to identify adults who are underweight and at risk of malnutrition, as well as those who are obese. Prior to launch the tool underwent rigorous evaluation in hospital and community settings and was found to be quick and easy to use and reliable. ‘MUST’ is reviewed annually and a range of new charts to calculate body mass index and recent weight loss. Health economics analysis and consequential costs of malnutrition – BAPEN’s Health Economic Report in 2005 was a wake-up call for all involved in nutritional care – the estimated cost of malnutrition of £7.3 billion being far greater than the costs associated with obesity. These data are frequently cited and act as a persuasive aid for investment and action. The Health Economic Report was followed in 2008 by BAPEN’s “Combating Malnutrition” Report, which estimated that public expenditure on disease-related malnutrition in the UK in 2007 was more than £13 billion a year. Working with national governments to get nutrition on the health agenda – For example, nutrition is now included in two of the five domains of the Department of Health (England) outcomes framework and BAPEN, working with the Department of Health, has been instrumental in developing and delivering a national quality improvement programme to ensure safe nutritional care is delivered for patients in England.

A more detailed look at some of BAPEN’s key achievements is included in the next section of this publication on pages xx – xx.



BAPEN education and training

BAPEN produces a wide range of educational and training resources designed to help healthcare professionals in all settings understand the issues relating to malnutrition, screen effectively and put protocols in place to improve current outcomes. A summary of some of the key resources are outlined below. More information can be found on the BAPEN website and the Charitable Association is constantly developing new initiatives and refining its existing tools to meet the evolving needs of patients and healthcare professionals. • ‘MUST’ (‘Malnutrition Universal Screening Tool’) ‘MUST’ is a five-step screening tool to identify adults, who are malnourished, at risk of malnutrition (undernutrition), or obese. It also includes management guidelines which can be used to develop a care plan. It is for use in hospitals, community and other care settings and can be used by all care workers. The tool guide contains: • A flow chart showing the 5 steps to use for screening and management • BMI chart • Weight loss tables • Alternative measurements when BMI cannot be obtained by measuring weight and height. BAPEN launched ‘MUST’ in 2003 and it has been widely adopted and is now the most widely used nutritional screening tool in the UK. It is also commonly used in other countries worldwide and has recently been translated into five different languages. • Commissioning Toolkit The BAPEN Toolkit enables Commissioners and providers in local authorities, primary care organisations and hospital trusts to include best nutritional care when commissioning/ redesigning care services in all health and care settings. It helps service providers to include nutritional care in the development of new business cases and supports them in collecting the data needed to prove they meet nutritional quality standards and recommendations. It also assists commissioners to set appropriate and achievable key performance indicators (KPIs) and to effectively contract and monitor services against an appropriate quality specification.

• The Principles of Good Nutritional Practice Decision Trees BAPEN’s Principles of Good Nutritional Practice Decision Trees were launched in December 2012 and offer a pragmatic and effective tool to assist in the care of those at risk of malnutrition and its consequences. The Decision Trees draw together existing guidelines and evidence base, together with best practice where no research is possible, to help guide all levels of health care professionals through the pathway of care of those with malnutrition • e-Learning Modules Two interactive e-Learning modules about nutritional screening using ‘MUST’ have been developed – one for staff working in hospitals; one for staff working in primary care and care homes and Nutrition Support e-Learning has been developed to provide easily accessible nutrition learning materials to all professionals involved in providing care to patients. • Annual Conference BAPEN holds an annual conference that covers all aspects of nutritional care. Renowned for its vibrant and interactive atmosphere, the conference allows networking and dissemination of best practice in nutritional care facilitated by all members, including those engaged in education and research. Each of BAPEN’s Core Groups contribute to the content of the Annual conference and also hold their own annual conference, maximising the opportunity for education and networking. • Regional Study Days BAPEN also has a number of Regional representatives who provide local contact with BAPEN. Members can use them to gain information or pass comments and/or queries to BAPEN. They also organise regional study days for healthcare professionals both for educational purposes but also to assist those who may want to get involved with local planning and delivery of services.

• Quality Improvement Guide BAPEN’s new Quality Improvement Guide, which was launched in December 2012, provides a step by step guide to implementing basic good nutritional care across an organisation. The new Guide is designed to be used in conjunction with the other reports and information contained in the ‘Meeting Nutritional Standards of Care’ resources pack and focuses on the four main tenants of good nutritional and hydration care. The new Quality Improvement Guide outlines the key steps that should be taken by Trusts to deliver quality nutritional improvements and provides a range of supporting information and resources.



BAPEN – the structure

BAPEN Core Groups

BAPEN is a coherent network of highly motivated healthcare professionals working with patients and their carers across a range of inter-connected disciplines to deliver improvements in nutritional care in the UK.

BAPEN is an association of patients and professionals involved in nutritional care. Many BAPEN members are drawn from its Core Groups, each representing a different patient/professional group.

Other Organisations

BAPEN Council

BAPEN Faculty

Standing Committees

The British Pharmaceutical Nutrition Group (BPNG) is a specialist group primarily for pharmacists and scientists, but open to all with an interest in clinical nutrition. The group was founded in 1988 following growing concerns about the stability of parenteral nutrition feeds. BPNG has published position statements on ‘multichamber bags’, in-line filtration of PN and calcium phosphate stability. Education is now a focus for the group which runs multidisciplinary ‘fundamental parenteral nutrition’ and ‘advanced’ nutrition courses. Publications include the ‘Handbook for drug administration via enteral feeding tubes’ and a competency framework for pharmacists working within clinical nutrition. The British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) provides professional leadership and promotes standards of care for children with nutritional, gastrointestinal and hepatological disorders. Its membership includes consultants and specialist trainees in paediatric gastroenterology, hepatology and nutrition as well as specialist dietitians, nurses and nutrition pharmacists. The society supports research, training and education for members and the development of standards of care for children with nutritional disorders; it also gives advice and support to implement child-centred strategies to deliver nutrition assessment and nutrition support through the Nutrition & Intestinal Failure Working Group.

Executive Officers

Special Interest Groups

BAPEN Medical is primarily aimed at doctors but is open to all those with an interest in clinical nutrition. Its aims are: Education and training of clinicians at all levels; to encourage research and development and to foster collaborations between members’ research groups; to foster inter-disciplinary links and collaboration between medical specialties; to foster multi-professional links and collaboration between health professionals.

Core Groups

BAPEN membership

Associate Organisations

The National Nurses Nutrition Group (NNNG) The NNNG was established in 1986. It is a registered Charitable Association which aims to promote education and the nursing role in nutrition and related subjects for the nursing profession, for the benefit of patients in hospital and community environments. Over recent years the focus of the group has widened to reflect the increasing profile of nutrition: from screening strategies and mealtimes to the complex nature of artificial feeding. The Parenteral and Enteral Nutrition (PEN) Group is a specialist group of the British Dietetic Association. The PEN Group strives to train, educate, support and represent dietitians working in oral, enteral and parenteral nutrition support in all care settings. The group acts as the professional voice on matters pertaining to nutritional support and is a founder group of BAPEN. Members are registered dietitians who aim to ensure that nutritional support for patients is safe and clinically effective both in hospital and at home. PINNT is the UK support group for patients on home enteral or parenteral nutrition. Established 25 years ago, PINNT has grown into a community that provides genuine understanding to help individuals and carers deal with the many challenges faced on artificial feeding at home. They also work closely with healthcare professionals, suppliers and manufacturers in order to enhance the patient journey. The PINNT network provides a unique and united voice to campaign for a better, flexible and safer service.



How BAPEN works

BAPEN Council BAPEN policy and business are directed by its Governing Council. Members of BAPEN Council are all full members of BAPEN and include elected representatives of the Core Groups and Associate Societies of BAPEN, the Chairs of the Standing Committees and the elected members of the Executive Team. Members of Council are usually appointed annually and serve a maximum term of three years. BAPEN Council is responsible for the governance and strategic leadership of the Association. It is responsible for BAPEN membership and has the power to award members of the Association with marks of special acclaim, including honorary life membership of the association, the award of a Roll of Honour and the invitation to become a Member of the BAPEN Faculty. It appoints the members of the BAPEN Executive and any Standing Committees of the Association, setting their terms of reference, duration and composition. The Council meets a minimum of twice a year. BAPEN Executive Team The BAPEN Executive Team is made up of elected group of up to eight key healthcare professionals who fulfil the roles of Chair, Honorary Secretary, Honorary Treasurer, and Honorary Officers responsible for Membership, Communications, Data & Measurement and Clinical Guidance and Education. The Executive Team is responsible for the governance and day-to-day affairs of the Charitable Association such as: • Preparation and development of BAPEN strategy in association with Council • Development and progress of Council items

Standing Committees The current BAPEN Standing Committees are: • British Artificial Nutrition Survey (BANS) • Clinical Guidance & Education • Malnutrition Action Group (MAG) • Programmes • Quality Group The role of these committees is to design, manage and deliver a range of important resources and materials under the BAPEN banner which are for use by healthcare professionals working across the UK to improve the standards of nutritional care through: • Government lobbying • Meetings and conferences • Audits and surveys • Education and training resources and materials • Implementation of research BAPEN is also setting up specialist interest groups (SIG) to cater for specific clinical situations. At present there is one SIG - the British Intestinal Failure Alliance - which brings together those managing the highly complex group of patients requiring nutritional support in the community. Other SIG’s will be set up in the near future.

• Dealing with any interim issues or press enquiries • Issues management • Fulfilling requirements of the Charity Commission • Liaison with BAPEN Faculty • Undertaking responsibility for financial issues (including management, consideration and preparation of financial plans and finances, for discussion and approval by Council) BAPEN Faculty BAPEN Faculty comprises up to six members of the Charitable Association who, over the years have served BAPEN in various capacities and who have made a significant contribution to the field of clinical nutrition in the UK. The role of the Faculty is to advise Council and the BAPEN Executive Committee and bring to their attention any concerns regarding future strategy. The Faculty also reviews nominations for the John Lennard-Jones medal – BAPEN’s highest award - given to members of the Association for their outstanding contribution to BAPEN over a long period of time.




The Bapen Office

BAPEN is the only UK Charitable Association that brings together dietitians, doctors, nurses, patients and pharmacists into an integrated and effective organisation dedicated to raising awareness of malnutrition and working to advance the nutritional care of patients and those at risk from malnutrition in the wider community.

The BAPEN Office is based in Redditch and is open five days a week Monday-Thursday: 09.00-17.30 and Friday: 09.0017.00 to deal with all aspect of membership, publications and e-learning. The office also co-ordinates the Annual Conference and the team are available to answer any queries and ‘point’ you in the right direction regarding any nutritional matters.

Over the years, through the work of its membership, BAPEN has made great strides to improve standards of nutritional care in the UK. Currently the majority of BAPEN members are also usually members of one of the BAPEN Core Groups (see page xx), however other professionals who are not members of any of these other organisations are also encouraged to join BAPEN. As is evident from the extensive array of publications, resources and successful lobbying, BAPEN is collectively a powerful resource effecting change. However it actively encourages new members to bring in new ideas and viewpoints. Becoming a member is very easy and membership rates are extremely competitive with annual membership costing from as little as £10.00. A full list of BAPEN’S rates, downloadable application forms and other information is available on the website 2013 will see BAPEN putting even greater emphasis on its membership to increase numbers. But like any Charitable Association BAPEN is only as strong as its membership, which is why the greater the membership the stronger the voice.

BAPEN Office Secure Hold Business Centre, Studley Road, Redditch, Worcs B98 7LG Tel: 01527 457 850 Fax: 01527 458 718 Email:

A financial overview from BAPEN’s Honary Treasurer Simon Gabe BAPEN is a healthy Charitable Association that is gaining in strength year on year. In 2011 its total income was £461K, with a surplus profit of £71K (in 2009 and 2010 the surplus were £20K and £14k respectively). BAPEN has a reserve of £200k which is placed in a high interest deposit account. A copy of the 2011 Annual Report is available from the BAPEN office on request: 01527 457 850 or from the Charity Commission website. Looking ahead to 2013 BAPEN has a promising future ahead. However, these are challenging times financially and all charities are going to continue to feel the pinch. We will continue to develop ways of increasing our revenue, such as from the ‘MUST’ screening tool, not for the sake of profit, but to be able to reinvest in our various activities, to maintain BAPEN’s position at the forefront of nutrition and its management in the UK.

Simon Gabe Honorary Treasurer


BAPEN Press Office Issues relating to malnutrition in hospitals and the wider community are high on everyone’s agenda. BAPEN understands that when preparing a story, journalists need access to qualified spokespeople, as well as important facts and the latest data which is why it runs a 254 hour, 365 day a week press office. The Press Office team works closely with national, regional, local and online media so whatever the story the team are there to help. Please check out the BAPEN media centre for a wide range of resources or call a member of the BAPEN press office team who are available during office hours on the landline number or out of office via mobile. 01892 525 141 – Office number (Monday – Friday office hours) 07928 700 277 – Charlotte Messer 07879 818 247 – Helen Lawn



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