November is Diabetes Month, and we’ve already been covering catering for diabetic children in schools and catering for people with diabetes in care homes. Naturally, though, the NHS bears the brunt of diabetes care, and catering and nutrition have a natural role to play during diabetes management for patients admitted to hospital. Here we’ll be looking at:
What are the statistics for people with diabetes in hospitals?
According to Diabetes UK’s October 2017 Facts and Stats:
- There are currently around 3.5 million people diagnosed with diabetes in the UK, and there’s likely at least another 1.1 million undiagnosed.
- In total, people living with diagnosed and undiagnosed diabetes in the UK represents at least 6% of the whole UK population.
- This prevalence will rise to 5 million by 2025.
Cost of diabetes to the NHS
Clearly many of these 4 million people with diabetes will be admitted to hospital over the course of their lives, for diabetes but also for other unrelated reasons. In fact, people with diabetes are twice as likely to be admitted to hospital. They’ll most likely be admitted to hospital for primary causes relating to diabetes and its attendant complications. There may be planned admissions to manage diabetes, or unplanned/emergency admissions which could also relate to unforeseen complications, such as stroke, heart conditions or kidney problems.
However, even when people with diabetes are admitted to hospital for unrelated causes, the diabetes is inseparable from their care and will always require specialist management , including from the nutrition/dietetic team and from hospital caterers.
Diabetes UK reports that:
- One in seven hospital beds is occupied by someone who has diabetes. In some hospitals, it is as many as 30% .
- Diabetes contributes 44% of the combined angina, myocardial infarction, heart failure and stroke hospital bed days.
In terms of financial cost:
- An estimated 10% of the NHS budget is spent on diabetes, equating to £286 a second
Inpatient care in 2012 was estimated to cost £9.045 billion for both types of diabetes, which was almost 67% of the total NHS spend on diabetes in the UK.
- Annual inpatient care, to treat short and long term complications of diabetes, is estimated at between £1,800 and £2,500 per patient. This compares with annual outpatient costs, which includes the cost of medications and monitoring supplies, estimated at between £300 and £370 per patient.
What can happen to people with diabetes in hospital?
For simplicity, here we’ll focus on the inpatient medical episodes directly caused by diabetes, rather than any satellite conditions whose prevalence may increase with diabetes (such as heart disease, eye problems, stroke, foot problems and so on). Diabetes UK asserts in its State of The Nation report that in 2016:
- 3,000 people needed treatment for DKA in hospital
- 125,000 people had a hypo in hospital, and 12,500 required rescue treatment
- Nearly two in five inpatients experienced a medication error
In addition, with the NHS being underfunded and overstretched, many inpatients with diabetes do not have access to a diabetes specialist during their stay. It’s also reported that many patients perceive that the food offered to them as inpatients was unsuitable, with 34% of patients reporting the hospital sometimes, rarely or never provided the right choice of food to manage their diabetes.
What do hospital caterers need to know about catering for diabetic people?
Diabetes UK has recommended that hospital nutrition policies are structured to meet the needs of the one in six patients who will have diabetes.
Medical nutrition therapy is complex and should be dealt with primarily by the diabetic dietetic/nutrition expert at your hospital in order to optimise glycaemic control for each patient. Clearly, if a patient is receiving enteral or parenteral nutrition (ie, by tube), then it is likely that any drug therapy, such as insulin, will be calculated by medical staff and administered in a similar fashion.
Hospital caterers only usually come into play once the inpatient is back on the normal hospital food cycle. However, what hospital caterers can , and must , do, is design and provide a healthy, nutritious and appealing menu cycle, and provide nutritional information (especially on carbohydrates) to enable Type 1 patients to continue or restart self-management via carbohydrate counting. For Type 2 patients who are on a dietary plan, the catering teams needs input from the dietetics team to facilitate the development of appropriate recipes for these patients. Caterers will follow the guidance set out in the BDA DIGEST, which is also used in the care sector (the Care Quality Commission reference it in Regulation 14 of the standards).
Of course, providing food that is safe for patients with diabetes is one thing, but the perception is that hospital food is notoriously unappealing. It helps to give patients a choice when ordering food to minimise this wastage and guard against risks of malnutrition. Nutritional information can be provided to enable carb-counting for those patients that self-manage, but this is often for a whole portion. Assessing actual nutritional intake can be problematic because patients may leave part of a meal, and so it’s difficult to know which micronutrients they’ve actually consumed from each meal.
Discharge from hospital
People with Type 1 diabetes are likely to have a longer experience of managing their diet to deal with their blood glucose levels, because they are usually diagnosed at a younger age. They’re therefore less likely to require a new meal plan from the dietetics team when they’re discharged.
However, people with Type 2 diabetes may require more dietary advice to manage their condition on discharge. The specialist diabetes team, in conjunction with dietetics, will usually handle this, but there may be some input required from the catering team in relation to what food has worked well (or not) for each patient.
How can Saffron software help hospital caterers care for patients with diabetes?
Software is vital for efficiency and accuracy when it comes to the patient volumes, data complexity and costs associated with the NHS. Catering can’t afford to go wrong when it’s financed by the public purse.
We asked Andy Jones, former Chair of the Hospital Caterers Association, about his experiences of using Saffron in healthcare. He said, ‘Diabetes is only going to increase and the burden on hospitals, and the food they provide, is consequently coming under increasing pressure to cater safely and sensitively for patients with diabetes. I’ve used Saffron software in several different companies, and it’s proved to be a very efficient patient dining solution. Dining is part of a patient’s treatment, the NHS is under financial strain and so the use of Saffron plays an important part in the management of both. Food is the best form of medicine: ensuring that food plays an integral role in the patient’s care plan is key.’
Here we’ll explore which Saffron products and modules can help hospital caterers meet each challenge:
|Challenge||How Saffron software can help|
|Food Choice||Saffron Patient Ordering can help patients decide which meal they’d like. It increases order accuracy (reducing the risk of wrong orders), streamlines kitchen production, reduces time manually taking orders and reduces wastage.|
|Identifying dietary suitability and restrictions||Information about the patient’s diabetes and any other health conditions (such as a renal diet, for example) can be entered directly into Saffron Patient Ordering, in conjunction with the Recipe and Menu module. The software can then cross reference these dietary restrictions against each available dish, and remove unsuitable dishes so the patient can’t order unsuitable food.|
|Designing an appealing yet healthy menu||Chefs can use the Recipe and Menu module in conjunction with the Nutritional Analysis module to design recipes and whole menu cycles. Nutritional information is populated at ingredient level from suppliers, databases, so is automatically nutritionally analysed as the recipe is built. Nutritional guidelines can be imported or set by the user, against which any dishes can be benchmark. Any food that doesn’t meet the set guidelines can then be adapted at ingredient level in order to comply.|
|Providing nutritional information to patients who self-manage||Many patients with Type 1 diabetes will self-manage, monitoring their own blood glucose and calculating their own insulin dosage. For this they will often require accurate nutritional information about the carbohydrate content of each dish. Patients with Type 2 diabetes may also be on a dietary plan, requiring nutritional information to make an informed healthy choice. Saffron Patient Ordering, in conjunction with the Nutritional Analysis module, can provide patients with real-time accurate nutrition information to aid their choices.|
Read about these Saffron functionalities in detail here:
- Business Challenge: Recipe and Menu Planning
- Business Challenge: Nutritional Analysis
- Business Challenge: Nutritional Labelling and Providing Allergen Information
We’re already providing Saffron Patient Ordering and Saffron software in multiple NHS trusts and the majority of their leading contract service partners – running into the hundreds. To find out how your hospital or contract service provider can use Saffron software provide better catering for patients with diabetes, contact us for a demo.
Call us on 0114 281 6060, email us at firstname.lastname@example.org, or fill out our contact form to find out more.