Monitoring and evaluation: making your work count Dr Liz Weekes Consultant Dietitian & NIHR Clinical Lecturer Department of Nutrition & Dietetics Guy’s & St Thomas’ NHS Foundation Trust and King’s College, London

Why monitor and evaluate? To demonstrate a measurable impact on service users and their carers To demonstrate a measurable benefit for service providers To provide robust evidence to Clinical Commissioning Groups and Health & Well Being Boards  commission services

MTF fifth principle – Monitoring and evaluation Practical ideas to measure the impact of your interventions and individual outcomes Lambeth and Southwark Action on Malnutrition Project (LAMP) Two year project funded by Guy’s & St Thomas’ Charity Phase 1 – Mapping and scoping (April 13 - March 14) Phase 2 – Model development (April 14 – March 15) Using BAPEN Toolkit and MTF Five Principles as a framework

LAMP (April 2013 – March 2014) 1.Audit compliance with national nutritional care guidelines in –Care homes –Intermediate care –Community mental health 2.Map current service provision and associated costs (acute and community) 3.Establish the extent of malnutrition across community care settings and assess its impact on health and social care costs 4.Identify and test nutritional care pathways

Audit compliance with nutritional care guidelines Audit of documentation relating to nutrition screening, nutrition care plans, monitoring and onward referral if required (+ training and policies) Compare with national guidelines i.e. Essence of Care, NICE (2006) 1.Care home audit 19 care homes audited N = 722 residents Mean age 83 years (range 35 to 105) Mean length of stay 3.37 years (range 1 week to 27 years) Documented nutrition risk assessment in 417 (83 %) but…….. 2.Currently auditing: Mental Health Intermediate Care Page 4

Map current service provision Focus groups 12 completed (including dietitians, OPALs, district nurses, intermediate care, GPs, practice nurses, OTs and physiotherapists) 72 staff and 43 citizens (12 % of population approached) Exploring current practice around screening, assessment and management, referral methods, communications and networking Currently analysing results Page 5

Census data % BMI < 20 kg/m 2a Aged > 65 years 14 % at risk b Living in care homes 40 % at risk c Lambeth (303,100) Southwark (288,300) 16,975 16,145 22,976 22,329 3,191 3,126 1, ,12045,3056,3172, Population at risk across Lambeth & Southwark Page 6 Sources: a Elia & Russell 2009, b Elia & Stratton 2005, c BAPEN 2011

No current data on people receiving care at home, intermediate care or GP practices Plan to undertake a cohort study in 350 subjects to determine the risk of malnutrition in each of these settings To quantify the extent of malnutrition in community settings across LSL To determine the health (and social care) costs associated with malnutrition To determine the impact of malnutrition on quality of life Population at risk across Lambeth & Southwark Page 7

Next steps Analysis of food and drink provision in care homes Mealtime observations in care homes Quality of transfer documentation i.e. audit of compliance with LPP guidelines Training needs assessment for health and social care staff Health economic analysis and economic modelling Page 8

Dr Liz Weekes – Consultant Dietitian and Project Lead Dr Kattya Mayre-Chilton – Research Dietitian Ms Kate Ryan – Research Dietitian Ms Stephanie Thompson –Research Administrator Department of Nutrition & Dietetics Guy’s & St Thomas’ NHS Foundation Trust Westminster Bridge Road London SE1 7EH Tel: (LAMP) LAMP is supported by The Guy’s & St Thomas’ Charity, The Lambeth Strategic Commissioning Management Team & The Southwark Commissioning Team