Caroline Lecko - The National Association of Care Catering

Nutrition and Hydration – it’s a
‘wicked’ problem
National Association of Care Catering
South East Region
Caroline Lecko
29 November 2013
We know what we know….
But we keep telling ourselves
(and everyone else)
the same things………….
Just a reminder
• Three million people in the UK suffering from or at risk of
• 93% of these people are in the community
• Over a million of these people are over 65
• 33% of older people are already malnourished or at risk
on admission to hospital
• 37% of older people who have recently moved into care
homes are at risk
• The scale of dehydration in the UK is unknown
We know people in our care and their
families live with the consequences of
poor nutrition and hydration ......
and the resulting harms ………..
Setting the scene – last 10 years or so
• Patient Environment Action Team Assessments (annually) Now PLACE
• Essence of Care x 2
• Better Hospital Food
• Protected Mealtimes
New for 2013
• Council of Europe resolution
• Age UK Hungry to be Heard
• National Institute for Health and Clinical Excellence
• RCN Nutrition Now Campaign
• NPSA/RCN Hydration Best Practice Toolkit
• DH Nutrition Action Plan
• NPSA10 Key Characteristics of Good Nutritional Care Toolkit
• High Impact Actions for Nurses
• CQC Essential Standards for quality and safety
• NICE Quality Standards
• Nutrition and Hydration Action Alliance
• Malnutrition Task Force
Better Hospital
Food Campaign
DH Hospital Food
Ensuring adequate nutrition and hydration across the health service, and
related care service system, is a significant and longstanding challenge. It
remains a serious and high profile patient safety concern. Previous
initiatives and efforts, by many different people and organisations, have
succeeded in raising awareness for a short time. None have achieved
sustainable change.
It’s a ‘wicked problem’
What is a ‘wicked problem’?
Rittel and Webber's 1973
Dilemma’s in a general theory for planning
"The search for scientific bases for confronting problems of social policy is
bound to fail because of the nature of these problems...Policy problems cannot
be definitively described. Moreover, in a pluralistic society there is nothing like
the indisputable public good; there is no objective definition of equity; policies
that respond to social problems cannot be meaningfully correct or false; and it
makes no sense to talk about 'optimal solutions' to these problems...Even
worse, there are no solutions in the sense of definitive answers."
Rittel, H.W.J, "The Reasoning of Designers," Working PaperA-88-4, Institut
fur Grundlagen der Planung, Stuttgart (1988).
“A recurring theme in research and industry literature is
the connection between wicked problems and design”
Conklin, Jeff; Wicked Problems & Social Complexity, Chapter 1 of
Dialogue Mapping: Building Shared Understanding of Wicked
Problems, Wiley, November 2005.
“Design problems are typically wicked because they are
often ill defined (no prescribed way forward), involve
stakeholders with different perspectives, and have no
"right" or "optimal" solution”
Conklin, Jeff, Min Basadur, and GK VanPatter; Rethinking Wicked Problems:
Unpacking Paradigms, Bridging Universes (Part 1 of 2), NextDesign
Leadership Institute Journal, 2007.
“wicked problems cannot be solved by the application of
standard (or known) methods; they demand creative solutions”
Our ‘wicked problem’
"What are the key issues, barriers and challenges
we face in reducing malnutrition and dehydration
across our health economy?”
A total of 183 answers to the trigger question were
• The participants were asked to work in predefined table groups, to discuss and decide which
3 (per table) of the 183 they thought were most
important, i.e. the biggest issues, barriers or
• They were also asked to place them along with
closely associated answers into related clusters,
and to re-write the key points for clarity if required.
Influence map
Nutrition and Hydration within
NHS England
Nursing Directorate
Domain 4
Domain 5
Patient Experience
Creating conditions for safety
Marie Batey
Head of Acute and Older
National Quality
Improvement and Care
Martine Tune
Head of Patient Experience
(Acute Care)
Caroline Lecko
Patient Safety Lead
(Nutrition/Hydration &
Pressure Ulcers)
The dominating obesity agenda
Nutrition and Hydration Week 2014
• Nutrition and Hydration Week 2014 is a
collaboration between the Hospital
Caterers Association (HCA), National
Association of Care Catering (NACC)
and Patient Safety First.
• During Nutrition and Hydration Week
2014 we are asking everyone – and we
really mean everyone – to pledge their
support to raising awareness of the
importance of nutrition and hydration as
an essential element of care.
•18 @NHWeek #NHW2014
Many thanks
[email protected]