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<p>NHS Digital has provided a count of finished discharge episodes<sup>1</sup> for
in-hospital deaths<sup>2</sup> where the cause of death<sup>3</sup> was malnutrition<sup>4</sup>,
split by independent and National Health Service providers for the years 2008-09 to
2017-18<sup>5</sup>. This information is provided in the following table.</p><p> </p><table><tbody><tr><td
colspan="3"><p>Activity in English NHS hospitals and English NHS commissioned activity
in the independent sector</p></td></tr><tr><td><p>Provider type</p></td><td><p>NHS</p></td><td><p>Independent</p></td></tr><tr><td><p>2008-09</p></td><td><p>50</p></td><td><p>-</p></td></tr><tr><td><p>2009-10</p></td><td><p>50</p></td><td><p>-</p></td></tr><tr><td><p>2010-11</p></td><td><p>40</p></td><td><p>-</p></td></tr><tr><td><p>2011-12</p></td><td><p>50</p></td><td><p>-</p></td></tr><tr><td><p>2012-13</p></td><td><p>50</p></td><td><p>-</p></td></tr><tr><td><p>2013-14</p></td><td><p>45</p></td><td><p>*</p></td></tr><tr><td><p>2014-15</p></td><td><p>50</p></td><td><p>*</p></td></tr><tr><td><p>2015-16</p></td><td><p>50</p></td><td><p>*</p></td></tr><tr><td><p>2016-17</p></td><td><p>55</p></td><td><p>-</p></td></tr><tr><td><p>2017-18</p></td><td><p>65</p></td><td><p>-</p></td></tr></tbody></table><p>Source:
Hospital Episode Statistics (HES) data linked to Office for National Statistics (ONS)
death registrations data</p><p>Notes:</p><p><sup>1</sup>A finished discharge episode
is the last episode during a hospital stay (a spell), where the patient is discharged
from the hospital or transferred to another hospital. Discharges do not represent
the number of patients, as a person may have more than one discharge from hospital
within the period.</p><p><sup> </sup></p><p><sup>2</sup>HES records the circumstances
under which a patient left hospital. For the majority of patients this is when they
are discharged by the consultant and it is only recorded for the last episode in a
spell.</p><p><sup> </sup></p><p><sup>3</sup>Cause of death has been obtained through
linkage to ONS data. These data do not provide enough information to link the deaths
to poor care. It is not possible to determine from these figures how or where the
condition originated. There are many explanations as to why someone becomes malnourished:
for example they may have cancer of the digestive tract, which means they can not
eat properly or can not absorb nutrients; they may have suffered from a stroke or
have advanced dementia which can cause difficulties chewing and swallowing; or they
may abuse alcohol and so not eat properly. The deceased may have been malnourished
before they went into hospital (for any of the reasons mentioned previously), and
perhaps only have been in hospital a very short time and the malnutrition may have
nothing to do with not being fed properly in hospital. Also, in the majority of deaths
in hospitals from falls, it is likely the fall occurred elsewhere, not in the hospital.
It is possible that poor care may have been a factor in some of the deaths, but ONS
data does not provide enough evidence to draw this conclusion.</p><p><sup> </sup></p><p><sup>4</sup>ICD-10
Codes used to define malnutrition are:</p><p>E40 Kwashiorkor</p><p>E41 Nutritional
marasmus</p><p>E42 Marasmic kwashiorkor</p><p>E43 Unspecified severe protein-energy
malnutrition</p><p>E44 Protein-energy malnutrition of moderate and mild degree</p><p>E45
Retarded development following protein-energy malnutrition</p><p>E46 Unspecified protein-energy
malnutrition</p><p><sup> </sup></p><p><sup>5</sup>HES figures are available from 1989-90
onwards. Changes to the figures over time need to be interpreted in the context of
improvements in data quality and coverage (particularly in earlier years), improvements
in coverage of independent sector activity (particularly from 2006-07) and changes
in NHS practice. For example, apparent reductions in activity may be due to a number
of procedures which may now be undertaken in outpatient settings and so no longer
include in admitted patient HES data. Conversely, apparent increases in activity may
be due to improved recording of diagnosis or procedure information.</p><p> </p><p>It
should be noted that HES include activity ending in the year in question and run from
April to March, e.g. 2012-13 includes activity ending between 1 April 2012 and 31
March 2013.</p><p> </p><p>Disclosure Control</p><p> </p><p>In order to protect patient
confidentiality '*' appears in the table above for all sub-national breakdowns, where
it is possible to calculate a value between 1 and 7 from the data presented. All other
sub-national data has been rounded to the nearest 5.</p><p> </p><p>If the national
total is between 1 and 7 (inclusive), no sub-national breakdown will be displayed.</p><p>
</p><p>If the national total is greater than or equal to 8;</p><p>a. Sub-national
counts between 1 and 7 (inclusive) will be displayed as ’*’.</p><p>b. Zeroes will
be unchanged.</p><p>c. All other counts will be rounded to the nearest 5.</p>
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