Your Voice in BOB

• A food-based approach to treating identified malnutrition is supported by the National Institute for Health and Care Excellence (NICE). NICE Clinical Guideline 32 (2006) states:
  “Healthcare professionals should ensure that the overall nutrient intake of oral nutrition support offered contains a balanced mixture of protein, energy, fibre, electrolytes, vitamins and minerals.”
• This approach is used in many settings, including hospitals, care homes, and people’s own homes, to help individuals identified as being at risk of malnutrition increase their nutritional intake. A food-based approach involves encouraging nutritious drinks and snacks between meals, as well as “fortifying” foods by adding extra nutrient-dense household ingredients.
• Food fortification enhances meals by increasing their content of calories, protein, vitamins, and minerals. This method helps someone with malnutrition improve their nutrition without needing to eat larger amounts, making it effective even when appetite or food intake is small. Importantly, fortified foods still look and taste good, making them enjoyable to eat.
• Oral nutritional supplements (ONS) are prescribed products that often come in the form of milkshakes. There are no nutrients found in prescribed ONS which cannot be found in ordinary food, they provide calories, protein, vitamins, and minerals—nutrients that can also be obtained from fortified homemade foods/supplements. Homemade supplements can be prepared with similar nutritional value and are often fresher and tastier than commercial products.
• In the Oxfordshire area of BOB Integrated Care Board (ICB), there is already a policy outlining when ONS may be prescribed in care homes, and this policy is currently under review. The aim of the review is to extend guidance to Buckinghamshire and Berkshire West and strengthen local guidance to help care homes clarify when, in addition to a food-based approach, a resident may also need ONS.
• In care home settings, ONS are less often needed because catering staff can prepare homemade fortified foods, offer nutritious snacks and prepare homemade supplements using ordinary household ingredients, providing nutrition similar to prescribed products. Training will be provided to care home staff to explain any updates to local guidance and offer refresher training on treating malnutrition using a food-based approach.
• It is important to note that prescribing ONS does not guarantee an improvement in nutritional intake or weight gain. These outcomes are no more likely to be achieved with ONS than with a well-managed food-based approach.
• When admitting a resident, care homes are expected to comply with the Health and Social Care Act 2008 (Regulated Activities) Regulation 14, which states:
  “A variety of nutritious, appetising food should be available to meet people’s needs… Snacks or other food should be available between meals for those who prefer to eat ‘little and often.’”

 The Berkshire West Health and Care Partnership brings together senior leaders from across our three local authorities, provider trusts (Royal Berkshire NHS Foundation Trust and Berkshire Healthcare NHS Foundation Trust), primary care and the ICB under a shared meeting structure which also engages the voluntary sector and Healthwatch.  

Integrated Care Boards (ICBs) and Healthwatch both play crucial roles in public involvement within the healthcare system, but they have distinct statutory functions and responsibilities. ICBs are part of the NHS structure and are responsible for planning and purchasing (commissioning) health services in their local areas. Their statutory public involvement duties include working in partnership with people and communities to improve services and meet public involvement legal duties.

Healthwatch operates at both national and local levels to represent the views of the public on health and social care services. Their statutory functions include gathering public views about their needs and experiences with local health and social care services. Healthwatch makes reports and recommendations to improve services and promotes public involvement in monitoring, commissioning, and providing health and social care services.

Your Voice is the online platform that NHS Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board uses to carry out surveys and create conversations in a digital space. As the ICB develops its approach to engaging with our communities we are developing this site and have developed a hub for each or our three places. Your Voice as means of communication to complement any activity that they are carrying out.

Following recent feedback from discussions with PPGs, some of the functionality of Your Voice would be beneficial for PPGs to use as they have variety of approaches and resources to support them, our intention is to work with Healthwatch to ensure that any resources that are available for PPGs are placed on Your Voice so that PPGs are able to access these. This also gives a space for countywide PPG conversations for learning and sharing.

Your Voice also allows for PPGs to raise in a structured way common queries to the ICB, if there are multiples of the same queries it allows us as an ICB to gather this feedback, in a themed way and respond in a structured way using internal topic experts to help answer the queries being raised.

Your Voice isn’t a replacement to Healthwatch, it is just an online platform to help improve engagement and increase the numbers of people we can reach.