'Postcode lottery' of nutrition care

Many hospitals do not have specialist artificial nutrition teams

Patients experience huge variations in waiting for potentially life-saving nutritional treatment, a charity has warned.

People can need to be fed through a tube if they have had cancer, a stroke, or digestive problems.

The British Association of Parenteral and Enteral Nutrition (Bapen) says patients can die while waiting for the artificial nutrition care they need.

It warns many miss out on expert care because their local hospital does not have a specialist team.

Bapen estimates 60% of UK hospitals do not have specialist teams.

Patients who cannot feed or absorb nutrition properly urgently require total parenteral nutrition [artificial nutrition] and will die without it

Dr Barry Jones, Bapen

It says this means patients can be forced to travel hundreds of miles for treatment.

Enteral feeding can be needed temporarily if a patient's gut is unable to cope with digesting food, perhaps after an operation.

However, some older patients may need artificial feeding for the rest of their life.

Some patients with conditions of the gut, such as Crohn's Disease, may need parenteral feeding, where the patient is fed via an intravenous tube.

Quality of life

Up to 25,000 adults and children need artificial nutrition support at any one time, and numbers are increasing by about 20% each year.

The two UK specialist centres, at Hope Hospital in Salford and St Mark's, Harrow are seeing waiting lists for the specialist care they provide grow as patients are forced to come to them for routine treatment they cannot receive nearer home.

In 2000 to 2001, 14% of patients on the waiting list at Hope died. At St Mark's, the figure was 6%.

Bapen's annual survey concentrated on the Trent region.

It found 151 patients per million in Scunthorpe were receiving clinical nutritional care at home compared with 430 per million in Nottingham.

Bapen said the study provided a snapshot of what was happening across the country.

And it said it was unlikely the contrast could be explained by different levels of diseases, such as cancer and intestinal failure which can mean patients require clinical nutrition.

Previous reports have also shown wide variations of care between regions.

Dr Barry Jones, who co-authored the report and who is a gastroenterologist in Dudley, said regional variations were even more significant for patients who needed total parenteral nutrition (TPN).

"Patients who cannot feed or absorb nutrition properly urgently require TPN and will die without it.

"Additionally, the quality of life of those who could be receiving enteral feeding, cancer patients for example, will be curtailed and may affect life expectancy."

'Overlooked'

Professor Marinos Elia, chairman of the British Artificial Nutrition Survey committee, said: "It is vital that there is increased awareness of the potential value of these life-saving and life-enhancing nutritional therapies so that an appropriate infrastructure is developed and funded to ensure high quality care is available to all who need it."

A report by the Royal College of Physicians, published in July this year, called for hospitals to set up special groups to keep a check on nutrition quality.

At the time, Professor Peter Kopelman, chair of the Royal College of Physicians working party which compiled the report, said: "Too often nutritional status and nutritional management are overlooked in clinical practice to the detriment of patient care."