Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, October 26, 2021

Official Report 1097KB pdf

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UK Malnutrition Awareness Week 2021 (Older People)

The final item of business is a members’ business debate on motion S6M-00917, in the name of Clare Adamson, on United Kingdom malnutrition awareness week 2021: malnutrition in older people. The debate will be concluded without any question being put.

Motion debated,

That the Parliament acknowledges UK Malnutrition Awareness Week 2021; notes that the annual initiative, which was launched by BAPEN and Malnutrition Taskforce, will take place between 11 and 17 October; believes that malnutrition, which is also known as undernutrition, is a substantial public health issue, with one in 10 older people in Scotland being at risk of, or living with, the condition; recognises that research from projects such as Eat Well Age Well (Food Train) indicates that this figure might be an underestimate, with an estimated 30% of older people at risk; believes that measures such as screening and early intervention, training for health and social care professionals, investment in community initiatives that address social isolation and policies that take account of the differences between food poverty and food insecurity, are integral to addressing malnutrition in older people; understands the continuing challenges faced by older people across Scotland who are at risk of malnutrition with isolation, which has been exacerbated by the COVID-19 pandemic, being a contributory factor; further understands the unprecedented and sustained demand on health and social care services and third sector organisations since the onset of the pandemic; notes the view that addressing malnutrition in older people is a matter of national importance both as a moral imperative and an issue that puts avoidable strain on the country’s health and social care services; further notes calls for the Scottish Government do everything in its power to ensure that everyone has reliable access to nutritious, culturally-appropriate and affordable food, as recommended by the Social Renewal Advisory Board in its January 2021 report, If not now, when?; commends the work of food policy organisations, such as the charity, Food Train, and dedicated volunteers, in advancing this issue, and wishes everyone involved with UK Malnutrition Awareness Week every success.

18:35  

It is a privilege to bring the debate to the chamber, and I thank all those colleagues who supported the motion and those who will speak this evening.

I thank Food Train for its Eat Well Age Well initiative, and for its tireless advocacy of rights-based policy making and better outcomes for older people in Scotland. Food Train was set up to help older people with access to food, and for 25 years the organisation has been developing its services to help people to eat well and age well.

Food, company and feeling safe and cared for have been the top priorities of the people who have used Food Train services. Through Food Train, service users have been given timely and invaluable insight into the issues that we are discussing this evening. Further insight into the issue of malnutrition has never been more necessary. The impact of the issue on older people in our society is frequently underrecognised, and there are real concerns that the pandemic is compounding the problem, in particular with regard to isolation, which I will cover later.

One in 10 older people in Scotland are at risk of, or are living with, food security issues. Approximately 103,000 people in Scotland who are over the age of 65 are at risk of suffering from malnutrition. Research from projects such as Eat Well Age Well indicates that even those sobering figures may be underestimates; as many as 30 per cent of older people could be at risk. That should give us pause for thought and determination for action. However, tackling the problem requires an understanding of it and its many facets.

Food Train has been championing the “Let’s Build the Picture” message, urging everyone who works in a community setting to uncover the true prevalence of malnutrition and the challenges that older people face in eating well. Malnutrition is largely preventable and treatable through screening and early intervention. Eat Well Age Well has produced a toolkit that includes clear tips and simple tools to help to identify individuals who could be at risk from malnutrition.

Most malnutrition occurs among people who are living at home, and yet the rates of malnutrition in the community for those living at home, and for older people in particular, are less well known in comparison with reported rates during, for instance, hospital admissions or in care homes and residential care settings. Building the picture, understanding the extent of the problem and recognising that its causes are multifaceted are essential in ensuring that steps to overcome malnutrition are taken.

Last year, I was fortunate to attend the launch of a joint report from Eat Well Age Well and the University of Glasgow: “Exploring Household Food Security and Malnutrition Risk with Psychosocial Indicators of Healthy Ageing in Place”. The report highlights the financial barriers that are typically the focal point of research and policy on food insecurity, but notes that, for vulnerable older people in Scotland, food poverty and food insecurity are not the same thing. In Scotland and across the United Kingdom, there are stark inequalities regarding the ways in which people age and their experience of ageing. Those inequalities manifest in deprivation and poverty, but policy makers must recognise that that is only part of the picture of malnutrition in older people.

Older adults who are at risk of malnutrition have an increased risk of lower wellbeing and social isolation, and they may have a perception of lack of control over their lives. The report’s findings reveal correlations between food insecurity and early indicators of malnutrition risk, with poorer wellbeing and social connectedness, and the researchers were clear that supported access to food is crucial in breaking that link. Those who are in receipt of Food Train services were more likely to say that services help them to feel in control of their lives. It is clear that malnutrition is about much more than poverty.

Eating, preparing and sharing food is inextricably linked to the physical and mental wellbeing of us all. Food is intrinsic to a person being in control of their lives, and it plays a key role in the feeling of social connectedness that is crucial for older people across Scotland. Building a sense of empowerment across our national policy and integrating that into community settings is, therefore, key to addressing those complex, multifaceted issues.

As Dr Kate Reid outlined in the report, the inequalities that older people experience can be attributed not simply to financial barriers but, further, to a diminished sense of social and cultural capital. That point is key, because the issue is more nuanced than a lack of finance, and it can make problems harder to detect. That is why we must embed such concepts in our policy making on malnutrition, and why raising awareness and investing in training, screening and support around malnutrition is essential if we are to address the problem.

I emphasise that the problems are not to do with Covid-19. The challenges have been underlined and exacerbated by the pandemic, but we cannot view malnutrition in older people through a narrow lens. As our society recovers from Covid, we must galvanise systemic and sustainable change. We know that Scotland is ageing: the over-75s are the fastest-growing age group, and the proportion of those aged 75 plus is expected to rise by 79 per cent over the 25 years from 2016 to 2041. That is an impending demographic challenge, but also delivers a unifying objective for policymakers and legislators.

We must build a fairer Scotland for older people, and we must ensure that the challenges that older people face, such as food insecurity, loneliness and access to health and social care, are met with compassionate and rights-based governance. The Scottish Government has consistently shown its commitment to advancing the human rights agenda. It set up a national task force on human rights, and it remains committed to incorporating the United Nations Convention on the Rights of the Child in domestic law.

In order to meet the challenges of an ageing population, the Scottish Government’s strategy “A Fairer Scotland for Older People: A Framework for Action” outlines priority actions to tackle the barriers to a positive older age that were identified by the older people’s strategic action forum. Malnutrition was specifically identified as a key issue that is affecting older people, and the strategy makes a national commitment to tackle malnutrition.

However, too many older people in Scotland are at risk, and there remains a dearth of public awareness around the problem. Malnutrition regularly goes undetected, untreated and unrecorded, and it can be overshadowed by public health messages that focus on other diet-related issues. We must better understand the problem and continue to gather essential primary data through research.

We have to recognise at policy level the nuanced difference between food insecurity and food poverty. We must invest in training on malnutrition for health and social care professionals in order to improve confidence and knowledge in screening and providing support. Finally, we must support community initiatives that address social isolation, given that that is a key factor in malnutrition. By investing in long-term systemic change, we can empower older people to feel in control of their lives and support them to eat well and live well, and we can build a fairer Scotland for older people that is founded on the principles of dignity, respect and compassion.

18:45  

I welcome the opportunity to speak in this members’ business debate and to highlight the excellent work of food policy organisations such as Food Train and all the volunteers in organising a very successful UK malnutrition awareness week. I thank Clare Adamson for lodging the motion.

Malnutrition impacts most on the poorest and most vulnerable citizens. Good-quality meals do not have to be expensive, but people need to have access to such food and the ability to put things together to make a nutritious meal. Access, ability and education are absolutely key.

No one in Scotland should have to worry about access to affordable food but, sadly, that is not the case. Often, those in our most deprived communities have less access to fresh produce and, in turn, to healthy meals. Their options are restricted by the shops that are available in their local areas.

Driving to a large supermarket a few miles away is simply not an option for many elderly people who have had to give up driving for various reasons. Getting to a large supermarket in which the offering is greater and, in many instances, significantly cheaper is sometimes a non-starter for a person who no longer has the ability to drive, as supermarkets are not always on a convenient bus route. For example, getting to my nearest large supermarket by bus would entail my having to take two long bus journeys, which would take well over an hour all in. By car, the journey takes me less than five minutes.

The situation was made worse when travel was discouraged and lift sharing was not permitted during the Covid-19 pandemic. Constituents have told me that they were reliant on their small local shops as opposed to having access to the bigger supermarkets, in which access to fruit and vegetables is significantly cheaper and easier.

In my Aberdeen Donside constituency, food bank use has increased significantly over the past five years, and many elderly people, families and individuals have become dependent on emergency food parcels. I pay tribute to the brilliant efforts of a local charity in my constituency. In order to help the most vulnerable to access food in a more dignified way, Community Food Initiatives North East, in partnership with Fersands and Fountain Community Project and FareShare UK, and funded by the Scottish Government, has established the Woodside pantry in the Woodside community centre in Aberdeen. The pantry scheme provides food for its members at a token price and allows those who are on a low income to pick the produce themselves in a shop-like environment. The items in the pantry are weighted by value, and it is ensured that all members equally receive meat or fish, fruit and vegetables, and ambient food every week.

Malnutrition harms the most vulnerable in our communities, whether they be the elderly who simply cannot travel to access affordable food or young families who cannot afford nutritious food to feed the whole family. Obesity and starvation are two sides of the same malnourished coin. We must strike for better education, better access to food and better lives for those vulnerable individuals and families in the areas that we represent.

18:48  

I am delighted to be able to participate in the debate on Clare Adamson’s motion, and I pay tribute to her for the work that she has done.

It is right that we acknowledge UK malnutrition awareness week. The condition, which is also known as undernutrition, has been noted as a substantial public health issue, with one in 10 older people in Scotland being at risk of it or living with it. National Records of Scotland’s latest mid-year population figures suggest that almost half a million people in Scotland are over the age of 75 and can be affected by the issue.

As my party’s shadow spokesperson on equalities and older people, and having experience of working in the sector, I have a good understanding of the disadvantages, effects and causes of the condition. It is important that we understand some of the reasons behind the condition because it affects the person, their family and the carers. There is also no doubt that the Covid-19 pandemic has had a terrible, adverse effect on the older population, among whom loneliness and isolation have grown massively during the pandemic. With that in mind, we must focus on not only malnutrition but food insecurity, which is a subject that has been highlighted in the Parliament many times.

We cannot lay the blame for the situation completely at the pandemic’s door because many organisations and individuals in the care sector and the third sector have been highlighting the issue. I spoke on the topic back in January 2019 in the Parliament when we tackled some of the issues of social isolation and loneliness for the older generation. I was supportive of the strategy that the Government published at that stage, and I was also at pains to emphasise that the public health concern needed to be addressed with financial support and that we needed to acknowledge that it was a problem in many sectors and for many people in our communities.

It is a matter of urgency that we tackle the issue as we go forward. I pay tribute to the British Association for Parenteral and Enteral Nutrition—BAPEN—for highlighting the point that everyone should look out to try to find people who are at risk. Its ask, look, listen campaign is vital. We have already heard about Food Train, which is phenomenal at trying to support individuals. It works in areas of Clackmannanshire and Stirling in my region, and it has been a lifesaver for many individuals.

Back in 2017, the then Minister for Public Health and Sport, Aileen Campbell, talked about the new diet and obesity strategy. We must consider diet and obesity in the wider context of access to food. That strategy also encompasses malnutrition, especially within our older population. BAPEN has identified the issue. We have talked about Food Train and its Eat Well Age Well project. That organisation delivers meals to hundreds of people in communities throughout Scotland.

Access to nutrition is a major concern, especially in our older and vulnerable population, even when such people are hospitalised or living in a care home. It also causes major concerns when they are discharged back home. Access to affordable food also requires further attention. The social renewal advisory board has talked about that.

We all have a duty of care to look after our constituents and to provide support to them. By doing that, we will inform them and provide opportunities for good food and nutritional choices. All that will help us to assist and to stop putting undue strain on the community health and social care services in our constituencies and regions.

18:53  

I thank Clare Adamson for bringing this important debate to the chamber. Malnutrition must be addressed, especially among our older people, who must have access to the support and resources that they need to eat well and not be socially isolated. Covid-19 exposed and exacerbated health inequalities and isolation in Scotland and we must work to alleviate those issues.

We have made progress with our young people. I was the minister who took legislation through the Parliament to pilot free, nutritious school meals for primary 1 to 3 pupils, which will be extended to P4 and P5 pupils in January, in addition to the free school holiday meals that are being rolled out. However, more work must be done for the older and more vulnerable members of our society.

I recently met Food Train West Lothian, which does excellent work not only to ensure that our older people are fed and fed well but to tackle loneliness and isolation. Throughout the pandemic, it has responded to unprecedented demand and supported 300 people across West Lothian by providing up to 125 deliveries per week.

The work that Food Train West Lothian does tackles both malnutrition and isolation. The eat well buddy service is one of its innovative and highly successful services. Food Train West Lothian identified that many members needed additional support to complete their shopping order, and it created a buddy system to provide older people with a volunteer who talks through nutrition, suggests different snacks and meals and provides company and connection to the community. The outcomes of that service include a decrease in social isolation, increased consumption of fresh produce, increased fluid intake and an increased number of meals eaten each day by people who use the service.

Food Train West Lothian is in the early stages of an innovative partnership with the Larder, which is a food enterprise organisation that is based in Livingston. That partnership will have an impact on malnutrition and social isolation by providing two key services. A supper club will take members to the Larder’s catalyst kitchen once a week for a home-cooked meal and social interaction, with the additional aim of increasing intergenerational relations. The partnership will also provide ready meals and work with a focus group of older people to discuss the menu, meal size and cost. It is envisaged that the meals will be cooked by the Larder and offered to customers instead of ready meals from supermarkets. They will have a higher nutritional value and will be cooked locally.

The two services that I highlighted are just a snapshot of what Food Train West Lothian does to work with our older people. The third sector is leading the way in ensuring that our older people are fed well and are not alone. Like Food Train, other third sector organisations are coming up with innovative ways to tackle malnutrition and social isolation.

We must ensure that our third sector is properly funded and resourced in a sustainable and long-term way, and we must work to ensure that everyone in society has access to the support and resources that are needed to allow them to have a nutritious diet and remain connected to the people and community around them. The call for action in the “If not now, when?” report to ensure that everyone can access nutritious, culturally appropriate and affordable food must be viewed as a priority, and we must work together to achieve that.

18:57  

I thank Clare Adamson for marking the significance of malnutrition awareness week by bringing the debate to the chamber. Our elderly, who are the most vulnerable in our society, are at the greatest risk of malnutrition that is caused by undernourishment. It should concern all of us that one in 10 people who live in the UK is malnourished or at risk of being malnourished. Others have mentioned that figure, which Eat Well Age Well Scotland has suggested could be an underestimate.

That devastating and potentially underestimated figure will be a shock to many who think that a rich country such as Scotland could not experience such problems. I worked in the national health service for years—I have mentioned in the chamber before that I was a dietician—and I cannot stress enough that the problem is real. However, of all the social and economic challenges that we face in Scotland, we hear little about the challenge of malnutrition. It is described as a hidden problem, and Eat Well Age Well has argued that, although malnourishment is preventable and treatable, it often goes undetected, untreated and unrecorded.

As others have said, we must do more not only to highlight the existence of malnutrition in Scotland but to look at the causes and what we can do to reduce the number of people who live in such circumstances. A lack of public awareness and a lack of Government attention will only lead to an increase in the numbers of those who are malnourished. In turn, that will increase pressure on national health services, which are already under significant strain.

Given that we know that those who are malnourished are more likely to use health services and the health service’s resources for lengthy periods, I ask the minister to take malnutrition very seriously, and I urge the Scottish Government and colleagues to act with purpose to address an issue that we know exists but which is rarely spoken about. I ask the minister to act to protect those who are malnourished and need support and to protect our NHS, which already faces serious challenges.

Scottish Labour has offered solutions to many of the causes of malnutrition in our country. In response to social isolation, we have set out a comprehensive plan for universal basic services, which would strengthen communities and support those who have experienced loneliness by offering services and resources that are backed up by serious funding for local government.

Moreover, to support those who are forced because of the decisions of Governments here and at Westminster to choose between heating and eating, we pushed for the introduction of a right to food bill—led by my colleague Rhoda Grant—to enshrine in law a right to sufficient and nutritious food. Unfortunately, the SNP and Greens kicked that into the long grass at committee stage a matter of weeks ago. It is absolutely right that we talk in the Parliament about malnutrition awareness week, but we do little to support those who are malnourished and little to support health services and the vulnerable if we do not back up our words with action.

The Scottish Parliament has the power to deliver radical action, to enact the change that we all want and to raise awareness, which we all know is needed. Covid will undoubtedly have exacerbated many of the issues that we have discussed, such as food poverty, food insecurity and social isolation. Malnutrition awareness week is an opportunity for us to propose impactful change to stop a trend that has for too long discriminated against the elderly and vulnerable.

I thank you, Presiding Officer, and other members for allowing us to discuss this important issue. I again congratulate Clare Adamson on lodging the motion and so enabling us to participate in malnutrition awareness week 2021.

19:01  

I, too, thank Clare Adamson for bringing the debate to the chamber. It is sobering to take part in a debate on malnutrition. As we head into the second winter of the pandemic, malnutrition awareness week is especially important and poignant. The pandemic has highlighted the fragility of our food systems and has placed previously food secure adults at increased risk of malnutrition. Social isolation and loneliness have peaked, which has increased the risk of more Scots, particularly the elderly, becoming undernourished. That increased risk is not theoretical, given that demand for services from Food Train, for example, has increased by 51 per cent since the onset of the pandemic.

Although most Scots are familiar with the risks of obesity, large numbers of undernourished older Scots remain invisible to most of us. Malnutrition can no longer be a taboo topic; we need a wider discussion on that public health issue to help to tackle the root causes of malnutrition head on.

As food insecurity among older people is a multifaceted issue, we must have a holistic civic response that connects all the elements. Factors such as reduced mobility, social isolation and general frailty have been exacerbated by the pandemic, and many of the levers to respond to poverty still rest with the UK Government. However, the challenges cannot be used as a cover to do nothing. We need to move forward with a programme of preventative actions that start making a positive difference now. A recent report by the University of Glasgow in partnership with Food Train made recommendations that included community screening for early signs of malnutrition, embedding malnutrition issues into basic health and social care training and investing more in community initiatives that address social isolation, such as befriending, which a few members have spoken about.

The key overarching basis on which we need to respond to malnutrition among older people is to ensure that we all recognise the critical way in which food connects people—for example, an older person might struggle to eat alone after losing their partner. Befriending groups and other community responses can offer critical support. Some older people have become less physically mobile during the pandemic. A reluctance to go out as a result of Covid cases remaining high can lead to poor eating habits, and the risks of malnutrition accelerate as mental health and general wellbeing deteriorate.

If we are all educated in the importance of strengthening connections for older people, we reduce the risks of older people becoming undernourished. Food Train’s pilot work seeks to raise awareness of older people who are at risk from malnutrition and to help them back to health, and that could become an exemplar across Scotland. Only by taking a truly collaborative partnership approach that involves the NHS, local government, the third sector and housing organisations can we create the necessary environment to prevent malnutrition.

Beyond the moral imperative of ensuring that everyone has access to wholesome and nutritious food, there is also an economic imperative. People who are suffering from malnutrition are twice as likely to access general practitioner services and three times as likely to be admitted to hospital, which places further strain on our NHS. Identifying malnourishment early and taking positive action reduces unnecessary strain on our NHS and council care services by, for example, reducing falls as well as mental health issues that are caused by isolation.

In closing, I will widen the discussion to food insecurity. I commend the Scottish Government on its plan to make food banks the last port of call. That uplifting plan is yet another example of Scotland taking a different and more dignified approach to supporting people at a time of crisis, compared with the approach that Westminster is pursuing. There is no doubt that the Scottish Government’s wider focus on food insecurity will ensure that malnutrition among older people is no longer a heartbreaking, invisible blight on our society. Our older people deserve so much more. The right to food is a human right that must not and will not be denied.

19:05  

I thank Clare Adamson for raising this important issue as part of malnutrition awareness week, which was earlier this month. The role that food plays in our society is often underestimated. Food connects us all, nourishing mind and body. It brings us together. Malnutrition and dehydration are often hidden issues in our communities, which makes it even more important that we raise awareness of them. Malnutrition awareness week is a valuable opportunity to raise awareness and understanding and to consider further action, and I had the privilege of speaking at an event that the Eat Well Age Well project organised as part of this year’s programme.

Let me be clear that malnutrition is wholly unacceptable. Without doubt, more needs to be done to better support older people to be able to access healthy and nutritious food in ways that suit their needs. Really good work is under way through our funding of Food Train’s Eat Well Age Well project and Meal Makers. We continue to support vital work to lead on the prevention, detection and treatment of malnutrition in Scotland and to tackle social isolation among older people through meal sharing. The work of Food Train and others to support older people to shop, eat well and socially connect is invaluable, as many members said. I recognise Food Train’s efforts, which benefit so many older people and have provided a vital lifeline during the pandemic.

Older people are at particular risk of malnutrition. In 2019, we published “A Fairer Scotland for Older People: A Framework for Action”, which committed to working with health and social care partnerships and others on actions to ensure that malnutrition is identified and managed quickly and effectively.

Of course, over the past 18 months, older people have been significantly impacted by the health, economic and social harms of Covid-19. Although the pandemic has delayed the progress of the work, it is more important than ever that, as we rebuild and remobilise our health and social care services in Scotland, we ensure that older people are placed at the centre of the recovery and we focus on a preventative, joined-up approach to healthy ageing in older people.

We will remobilise our efforts, and I announce today that we will convene a short-life working group to develop a framework for the prevention of malnutrition and dehydration.

Back in March, the Cabinet Secretary for Health and Sport and the Cabinet Secretary for Social Security and Older People published a statement of intent, which set out our commitment to develop a new strategy for older people’s health and social care in Scotland. That builds on the great foundation created by “A Fairer Scotland for Older People”. We are now engaging with older people and the organisations that represent them to co-produce a draft strategy, which we plan to publish for consultation in early 2022.

Following the recommendations of this year’s review of adult social care, we committed to introduce in the next 12 months legislation for a national care service. The consultation is under way and it gives us an opportunity to consider how a new national care service can best support older people to eat and drink well. We also accepted the review’s recommendation to remove charging for non-residential social care as soon as possible.

Our proposals on the reform of integration joint boards, which are contained in the national care service consultation, seek to strengthen the integration arrangements that were legislated for in 2014. Reformed integration joint boards will be better placed to provide high standards of care for older people who use services and better support and training for the workforce in this sector.

That brings me to our health and social care workforce. We know that recruitment and retention of staff has been challenging, and even more so during the pandemic. Further work is under way to develop longer-term improvements to the social care workforce, including better terms and conditions and improved training and development opportunities. We hope that that will improve the experience of the workforce and, in turn, improve outcomes for older people who are served through social care.

I want to touch on food insecurity, which many members mentioned. We have made the eradication of poverty a national mission, and that includes tackling food insecurity and ending the need for food banks. However, food insecurity for older people is linked not just to poverty but to broader issues of access, as members said. Loneliness and social isolation are strongly associated with malnutrition. That is why projects such as Food Train’s Meal Makers are so important. We continue to support food responses that maximise dignity, while being aware of just how vital food is for our sense of belonging and wellbeing.

Earlier this month, we introduced our Good Food Nation (Scotland) Bill in the Parliament. The bill will place duties on the Scottish ministers and certain public authorities to produce plans of their policies on food and to set out what they will do to make those plans real. As part of that, we are exploring options to expand the Food for Life Scotland programme, which we currently support in the school setting, so that more of the food that local authorities provide for our children and older people not only supports people to eat well but is locally produced and sourced. At the heart of our approach is our commitment to make Scotland a good food nation. We want everyone in Scotland to have reliable access to nutritious, locally sourced, locally produced, good-quality food.

I recognise that there is without doubt still much more work to do. I welcome the opportunity that this debate has given me to set out some of the actions that the Government is taking to ensure that all older people in Scotland have the resources and support that they need to eat and drink well. I again thank Clare Adamson for lodging her motion, which the Government supports.

Meeting closed at 19:11.