Home Parenteral Nutrition Services in England

20/07/2022

Information for patients and carers - May 2022

About this update: This information for patients and carers has been produced by members of the Home Parenteral Nutrition Clinical Advice and Management Group to provide an update on Home Parenteral Nutrition (HPN) services in England. The Clinical Advice and Management Group is an expert and multidisciplinary panel of doctors, nurses, dietitians and pharmacists who review applications for compounded HPN for adults and children in England.

What is the current position with HPN Services in England? Over the last few years there have been significant challenges faced by all homecare companies providing HPN services in England. These have included a reduction in manufacturing capacity to meet regulatory standards and continued staff shortages, in both clinical and logistics roles. This has been made more challenging by COVID-related absences over the past two years. The number of patients needing nursing support has also increased, with companies finding recruitment a continuing challenge. The demand for compounded parenteral nutrition in England has frequently been higher than companies have been able to meet. Increasing capacity requires significant investment, recruitment of a skilled workforce and regulatory standards to be met. Taken together, this means that an increase in the supply of compounded parenteral nutrition products can only be delivered over a long-term timeframe, and companies currently lack the ability to ramp-up supply to alleviate acute pressures.

What action is being taken? We have taken clinically led decisions and action in response to continued challenges in the manufacture and provision of compounded HPN to ensure that patient care is safeguarded:

Where deemed clinically appropriate, some adult patients have been switched from compounded parenteral support to multi-chamber bags (MCBs), to ensure that patients continue to receive the parenteral nutrition they need in a safe way.
For new patients, clinical teams are being asked to consider two additional regimens – supplemented (vitamins and trace elements added to an MCB) or hybrid (part compounded, part MCB). To be matched to a hybrid regimen your clinical team will consider your weekly requirements and then match them with some compounded bags and some MCBs. The more patients that can be clinically assessed to be safely matched to a hybrid or supplemented regimen the more compounding capacity will be released which can be distributed to patients whose prescriptions cannot be closely matched to these regimens.
Hospital Nursing teams are collaboratively reviewing patients receiving nursing care, with a view to offering patients an opportunity to receive line care training to enable them to self-administer their PN where appropriate. This can provide patients with greater independence and quality of life, e.g., daily activities will not be interrupted by the timing of nurse visits. Where possible new patients will commence line care training in hospital whilst awaiting discharge.

What steps should patients take? Against the backdrop of the current challenges, every bag and every nursing visit counts. We are asking all patients to be extra vigilant with their PN infusion prescriptions and to let their clinical team know if the PN prescription or scheduled nursing visits are adjusted in any way, enabling supplies and staff time to be utilised as efficiently as possible, for the benefit of all patients.

We hope this update provides some reassurances that a range of steps are being taken to minimise the impact of current challenges to what we know are vital services for patients. If you have any specific concerns, please speak directly with your hospital team.

Home Parenteral Nutrition Clinical Advice and Management Group
May 2022

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