Health Call Undernutrition Service

Undernutrition is a common health problem and a serious condition. Untreated it increases the risk of illness, clinical complications and death. Around one in three people admitted to hospital or care homes in the UK are found to be undernourished or at risk of undernourishment. Treating undernutrition can improve clinical outcomes by 70% and reduce mortality by 40%. Despite this it remains poorly recognised, poorly treated and poorly monitored.

This project is looking at the impact of changing the local dietetic service from traditional outpatient appointments (or home visits) to a new digital service – ‘Health Call Undernutrition’. This service uses simple telephone or web-based technology to monitor whether nutritional therapies are working for patients with undernutrition.


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Made you aware of what was going on with your body. I didn't realise how much weight I had lost. It has been really helpful and made me more aware of things.
76 year old lady
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Undernutrition is caused by an inadequate diet or problems absorbing nutrients from food, and affects over 3 million people at any one time. Risk factors include reduced mobility, living alone, long-term health conditions, social isolation and low income, with older people at particular risk. One treatment option is oral nutritional supplements (ONS); these can be effective, but are often prescribed without adequate follow-up.

In order to monitor their patients prescribed ONS, CDDFT have developed an innovative digital health service called “Health Call Undernutrition”. This uses simple telephone or web-based technology to monitor whether nutritional therapies are working for patients with undernutrition. The web-based interface was introduced to make the system more workable for care homes.

Remote monitoring in this way allows clinicians to follow up on their treatments and ensure that ONS are effective in the long-term. It also allows them to pinpoint individuals who are particularly at risk in an efficient and cost effective-manner. Furthermore, it supports patients to self-manage their condition. With a base cost of 33p per patient per day, Health Call doesn’t require any capital investment to buy expensive equipment as it runs via cloud based software. This is a service that could improve dietetics and reduce undernutrition both regionally and nationally.

  • Health Call Undernutrition has now been used by 1,700 patients across three sites.
  • A pilot study in County Durham and Darlington NHS Foundation Trust (CDDFT) enrolled 130 patients (2013-14). This identified potential cost savings of over £150,000 if Health Call Undernutrition was to be rolled out to 1,000 patients. The system has now been rolled out to 960 patients within CDDFT.
  • The system was also trialled in Hartlepool and Stockton CCG area, with dietitian input from North Tees Hospital. This project focused on care home residents, with 229 residents enrolled across 48 care homes (2015-16).
  • Health Call Undernutrition has been implemented in Newry (N Ireland) – the benefits have been replicated and it is now commissioned as the standard dietetics delivery method for care homes in that locality.
  • The system is popular with patients and care home staff.
  • The Health Call Undernutrition Team won the ‘Service Improvement’ category at the Bright Ideas in Health Awards 2014 and the ‘Improving health using technology’ category at the HSJ Value in Health Care Awards 2014. They were also ‘Highly commended’ at the HSJ Patient Safety Awards 2016.
  • Reduced patient waiting time to see a dietitian.
  • Reduced need for patients to attend unnecessary appointments.
  • Reduced need for prescribed ONS.
  • Reduced average intervention time.
  • Increased capacity of local dietetic service.
  • Improved access to fully updated medical data (the system links directly to GP patient records).
  • Cost savings of £150 for each patient registered.
  • To patients: better support, less waiting time for appointments, more contact with dietitians if required, increased safety as problems highlighted sooner, involvement in own care, improved nutrition with fewer health complications.
  • To dietitian staff: support with case load management & patient prioritisation, up to date patient information available, Health Call data linked with electronic patient records, reduced duplication of work, more joined up working with care homes.
  • To Trusts and CCGs: more appropriate ONS prescribing with significant cost savings, significant reductions in dietitian appointments, reduced waiting times, integrated patient records and improved patient data, more coordinated care across the region, highly cost effective service, evidence that excellent nutrition services are being commissioned, reduced complications from undernutrition with further benefits

AHSN NENC awarded £80,000 to the Health Call Undernutrition team to develop the service and support its roll out.

  • Health Call Undernutrition is now available in a range of formats: automated phone calls, web-based portal, app. and text messaging.
  • The system is being developed to enable monitoring of other aspects of health status in care home residents.
  • Health Call Undernutrition is being piloted in Age UK luncheon clubs in Darlington (supported by Health Foundation funding) to tackle the problems of social isolation and undernutrition. New lunch clubs will be set up for people at risk of undernutrition. Older people will attend fortnightly; they will receive a nourishing meal supplied by CDDFT catering and their nutritional health will be monitored using Health Call.
Staff are aware of telehealth and know that if there are any problems a Dietitian will ring.
Care home manager, Darlington