Ireland Niamh Rice IrSPEN Warsaw 20 th May 2016

Optimal nutritional care for all Education Public health Implementation Undergrad Postgrad Nutrition Day Hospital ICU Oncology Care home Public awareness National nutrition plan Hospital Care home Community Trained Staff Stakeholder groups Multi-stakeholder PEN Ger Medicine Gastroenterologists Patients Dietitians Nurses Pharmacists General practice Hospital Health insurance Industry Health Service* Doh Media Policy and standards Screening policy Standards/ quality indicators Audit Discharge management Hospital Care home Community Guidelines Screening Hospital Care home Community Intervention Dietitians Medics Nurses Pharmacists Economic data Cost DRM Value of intervention Presence Engagement Prevalence DRM Hospital Care home Community Reimbursement Hospital Care home Community Malnutrition Services ONS Tube PN Ireland 16/05/16 Discharge management Screening Care plan Medical nutrition Discharge management 30% VAR 4% In development

Set the agenda with key stakeholders Gain commitment and resources to address gaps and set policy Develop guidelines, standards and implementation models Get malnutrition recognised as a major public health priority Current priorities and actions towards ONCA 2012………2013……..……2014…………………………2015……………………2016…… National advisory committees established on Nutrition & Hydration Gain approval for national clinical guidelines. Conduct review of nutritional care standards in hospitals (as base) Engagement with Politicians, HSE National Directors and Key stakeholders. Partnership initiatives with HSE Director for Quality Improvement announced IrSPEN 2015 Build evidence base into business case for action. Create awareness of cost of malnutrition and value of nutritional intervention. Publish data and maintain high news profile / refreshing story/ engaging patients. Develop guidelines Establish and test implementation models Audit improvements and establish /communicate patient and cost benefits. Continue to advocate for resources to underpin.

New phase in establishing good nutritional care for all at IrSPEN 2015 conference: From ‘call to action’ in 2013 to partnership with health authorities for implementation pathway commencing 2015 (but much still to be done) Policy seminar involving both health services executive (HSE) and health information and quality authority (HIQA) Partnership programmes announced. Patients spoke to audience Over 180 invitees and delegates attended. National media coverage significant

National Advisory Committee on Nutrition & Hydration, HSE Quality Improvement – set up June 2015, work moving to cross divisional group April National Steering Committee, Hospital Nutrition Inspections, Health Information and Quality Authority (HIQA) - review of all hospitals conducted and criteria for good nutritional care issued to all hospitals (publication May / June 2016) National Clinical Guidelines on Undernutrition & Nutrition support, National Committee for Clinical Excellence, Dept of Health. – Submission by IrSPEN/hse approved for development October 2015 – work starting shortly. Policy implementation workstreams

2016 communications focus Business case for National IF centre Submission June 2016 plus media advocacy / stakeholder engagement 13 Home Enteral Nutrition Standards and Guidelines To be launched October Advocacy will focus on deficits / gaps / inequity of support services for home patients. Workshops with patients held May 2016, filming patients sharing their experiences. 2 Nutritional Care in Cancer in Ireland (Expert Report) IrSPEN report in development to highlight critical role of nutritional care in cancer patients and the need to screen patients to prevent weight loss / improve outcomes. Advocating for more resources, and treating cancer patients as a high risk group requiring earlier / better access to nutrition services and support.