Government action is urgently required to prevent malnutrition amongst older adults due to COVID-19

March 25, 2020

Hertfordshire Independent Living Service (HILS) joined fellow members of the UK Malnutrition Awareness and Prevention Network (MAPN), to urge the UK Government to take action as COVID-19 fuels malnutrition among older adults.

With more than 100 signatures from a range of professionals working to tackle malnutrition, the compelling letter addressed to the Secretary of State for Health and Social Care and his associates, highlights the significant impact COVID-19 has had on the nutritional health of vulnerable communities across the UK.

Research shows that malnutrition is estimated to affect over 3 million people in the UK, of those affected, 1.3 million are over the age of 65. As the country moves beyond the initial peak of the Coronavirus pandemic, it is anticipated that fluctuations in rates of infection, paired with shielding recommendations and the impending flu season, will negatively impact food accessibility, exacerbating the risk of malnutrition.

This letter, published 30 June 2020, was addressed to Rt Hon Matt Hancock MP, Secretary of State for Health and Social Care. Those who also received a copy included:


Rt Hon George Eustice MP, Secretary of State for Environment, Food and Rural Affairs, Dr Alison Tedstone, National Director with responsibility of diet, nutrition and obesity, Public Health England

Northern Ireland

Mr Robin Swann MLA, Minister of Health Mr Edwin Poots MLA, Minister of Agriculture, Environment and Rural Affairs


Ms Jeane Freeman MSP, Cabinet Secretary for Health and Sport Mr Fergus Ewing MSP, Cabinet Secretary for Rural Economy and Tourism Mr Joe Fitzpatrick, MSP and Minister for Public Health, Sport and Wellbeing Ms Christina McKelvie, Minister for Older People and Equalities


Mr Vaughan Gething MS, Minister for Health and Social Services Ms Lesley Griffiths MS, Minister for Environment, Energy and Rural Affairs

Dear Secretary of State for Health and Social Care,

It has been estimated that malnutrition affected over 3 million people in the UK, pre-COVID. Of this group about 1.3 million are over the age of 65, representing one in ten of that population. Since the beginning of the pandemic, it has been reported that nearly five million adults are experiencing food insecurity. COVID-19 has significantly impacted nutritional health and increased the risk of malnutrition among vulnerable communities in the UK, including many older adults and those from Black, Asian and Minority Ethnic backgrounds. We are calling on your departments, which have overall responsibility for health, care and food policy, to work with all arms of government to take urgent action to address these issues.

Whilst we have moved beyond the initial peak of the pandemic, subsequent rises in rates of infection alongside ongoing social distancing measures and shielding recommendations will continue to affect normal means of accessing food and significantly increase risk of malnutrition. These risks will be exacerbated as we move towards the ‘flu season this winter and are likely to increase at-risk groups’ vulnerability to both malnutrition and COVID-19, particularly as social isolation and loneliness can often be significant underlying social causes of malnutrition. The impact of the pandemic is creating a perfect storm for an increase in malnutrition in the UK.

Most people who are malnourished live at home, in their community, and raising awareness of the risk of malnutrition among these households and the people who care for them is vitally important now and in the coming months. Malnutrition and undernutrition impact on the immune systems of people affected and will increase their vulnerability to the effects of COVID-19 and other infectious diseases. Malnutrition impacts on frailty through muscle wasting and cognitive impairment, leading to an increased risk of falls and an inability to go about typical daily tasks such as buying or preparing food. A parallel risk of anxiety and depression is also a concern.

Organisations supporting older and more vulnerable people and helping with the emergency food response report that too many ‘new’ individuals have become vulnerable to malnutrition during the pandemic and urgently require ongoing assistance. Food banks, sadly, continue to play a significant and increasing role in filling the gap left by the failings of our welfare system, despite the government’s increases in the value of Universal Credit. Many people will be unable to cook healthy meals even if they can access food, due to a lack of equipment, facilities, capacity or fuel.

Individuals recovering from COVID-19 will have additional nutritional needs as a result of being ventilated or inactive for long periods.

Difficulties in detecting community cases of malnutrition are also now exacerbated by the move to health services operating remotely rather than through face to face appointments and visits. Community dietetic services, despite best efforts, are not running ‘business as usual’ because of redeployment to assist acute services, social distancing measures and inadequate access to technology and other resources. This means that individuals who urgently require dietetic support at home are considerably less likely to be referred or to fully access these services.

In the longer term, it is vitally important to prioritise upstream prevention and community capacity building to support eating for health, and to tackle food insecurity. Please take steps to eradicate food insecurity. We, the undersigned, are calling for your government to:

  • Ensure that local authorities have ringfenced additional funding to continue with high quality food provision for people who may need to shield or self-isolate in future, with suitable advice from dietitians.
  • Ensure that local authorities have funding to establish long-term sustainable solutions to malnutrition amongst over 65s, including meals on wheels services.
  • Ensure that funding and support is made available for vital NHS dietetic services and third sector nutrition and food services, both during the COVID-19 pandemic and beyond it.
  • Fund a campaign to raise awareness of the importance of good nutrition for at risk groups and their carers. Invest in proactive case-finding in order to locate and help individuals at risk and an upstream, prevention-based approach to prevent people becoming food insecure in the first place.
  • Prioritise nutrition as part of NHS rehab pathways and support community malnutrition services to return as quickly as possible, albeit exploiting new technological solutions as much as possible.
  • Urgently introduce a legally enshrined “Right to Food”, as laid out within the International Covenant on Economic, Social and Cultural Rights in the UK, to ensure that governments at both a national and local level take appropriate action.

This government has repeatedly stated it wishes to prioritise the prevention of ill health and to create a more resilient and dynamic UK economy. Taking action to ensure that all population groups receive the support they need to eat well should be priority actions so that the government delivers on these aims. We would welcome a response to our call for action.

Signed by the following:

The UK Malnutrition Awareness and Prevention Network partner organisations:

  • Hertfordshire Independent Living Services (HILS): Sarah Wren, MBE, Chief Executive
  • University of Hertfordshire: Professor Wendy Wills, Professor of Food and Public Health; Director, Centre for Research in Public Health and Community Care (CRIPACC) and NIHR ARC East of England Prevention & Early Detection in Health and Social Care theme lead; Dr Angela Dickinson, Senior Research Fellow in Older People’s Health; Jane McClinchy, Principal Lecturer in Nutrition and Dietetics
  • British Dietetic Association: Caroline Bovey RD BEM, Chair; BDA Older People Specialist Group (BDA-OPSG): Alison Smith RD, Chair
  • National Association of Care Caterers (NACC): Sue Cawthray, National Chair
  • Sustain: Morven Oliver-Larkin, Meals on Wheels Campaign Coordinator
  • Food Train/Eat Well Age Well Scotland (EWAW): Michelle Carruthers, MBE, Chief Executive, The Food Train, Laura Cairns, Project Manager, Tilly Robinson-Miles, Impact and Policy Officer, Danielle Redmond Grey, Digital Communications Officer, Eat Well Age Well
  • Age UK Salford: Emma Rose, Programme Director; Dave Hayes, Chief Executive Officer
  • Bournemouth University (BU): Jane Murphy, Professor of Nutrition
  • Nutrition Diet Resources UK (NDR-UK): Linda McPhillie, Chief Executive; Jenni Henderson, Development Officer (Malnutrition Lead)


Additional academic signatures

University of Hertfordshire
– Jackie Kelly, Dean of the School of Health and Social Work
– Professor David Barling, Professor of Food Policy and Security
– Professor Natalie Pattison, Florence Nightingale Foundation Clinical Professor of Nursing
– Professor Brian Littlechild, Research Lead for Social Work
– Professor Hilary Thomas, Emeritus Professor
– Professor Jeremy Lewis, Professor of Musculoskeletal Research
– Professor Karen Beeton, Head of Department of Allied Health Professions, Midwifery and Social Work
– Professor Kathryn Almack, Professor of Health, Young People and Family Lives
– Professor Elizabeth Pike, Head of Sport, Health and Exercise
University of Bristol
– Professor Eric Herring, Professor of World Politics
City University, London
– Professor Tim Lang, Professor of Food Policy
University of East Anglia
– Professor Ailsa Welch, Professor of Nutritional Epidemiology
– Professor Fiona Poland, Professor of Social Research Methodology
University of Edinburgh
– Professor Liz Grant, Director Global Health Academy
– Professor Mary Brennan, Chair of Food Marketing and Society
– Francesca Bray, Emerita Professor of Social Anthropology
– Steve Platt, Emeritus Professor of Health Research Policy
Glasgow Caledonian University
Professor John H McKendrick, Co-Director, Scottish Poverty and Inequality Research Unit
Lancaster University
– Jennie Popay, Distinguished Professor of Sociology and Public Health
University of Leeds – Professor Marion Hetherington, Thomas Ward Endowed Chair in Psychology
– Professor John E Blundell, Faculty of Medicine and Health
– Professor Andrew J Hill, Professor of Medical Psychology
University of Manchester
– Professor John McLaughlin, Professor of Gastroenterology and Nutrition
Manchester Metropolitan University
– Carolyn Kagan, Professor Emerita Community Social Psychology
Newcastle University
– Professor Thomas Scharf, Professor of Social Gerontology, President, British Society of Gerontology
Northumbria University
– Professor Greta Defeyter, Professor in Developmental Psychology
University of Plymouth
– Professor Mary Hickson, Professor of Dietetics
University of Reading
– Professor Lisa Methven, Professor of Food and Sensory Science
University of Strathclyde
– Professor Daniela Sime, Chair in Youth, Migration and Social Justice, Associate Dean (Public Engagement and Impact)
Teesside University
– Professor Amelia Lake, Professor of Public Health Nutrition, Associate Director of Fuse, The Centre for Translational Research in Public Health
University of Warwick
– Professor Emeritus, Elizabeth Dowler, Retired Public Health Nutritionist
NHS trust signatories
– Cambridgeshire Community Services NHS Trust – Vittoria Romano, Team Lead Dietitian, Nutrition and Dietetic Services
– Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) – Joanne McDonald, Dietetics Clinical Manager
– James Paget University Hospitals NHS Foundation Trust – Sue Allen, Lead Renal Dietitian
– East Suffolk and North Essex NHS Foundation Trust – Theresa Cole, Professional Lead for Nutrition and Dietetics, Member of BDA
– Essex Partnership University NHS Foundation Trust – Bridie Holland, Team Lead Dietitian
– Salford Royal NHS Foundation Trust – Kirstine Farrer, Consultant Dietitian (Intestinal Failure)
– Torbay and South Devon NHS Foundation Trust – Julie Kemmner Community Clinical Dietitian and Team Lead, Liz Wardle, Head of Nutrition and Dietetics
– West Suffolk Hospital NHS Foundation Trust – Lisa Penfold, Nutrition and Dietetics Professional Lead, Nina O’Brien, Community Lead
Other stakeholder signatories
– Aber Food Surplus – Laura Cooper, Community Hub Officer
– Anglian Community Enterprise (ACE) Community Interest Company (CiC) – Frank Sims, Chief Executive, Kirsteen Bryson, Clinical Lead (Adult Dietetics), Francesca Howe, Community Dietitian, Karine W Hurst, Specialist Dietitian for Children with Learning Disabilities
– Hertfordshire County Council – Tanya Moore, Principal Social Worker Institute of Health Promotion and Education – Syliva Cheater, MBE, President
Individual signatories
– Dr Jennifer M Speirs
– Dr Clare England
– Dr Keri McCrickerd
– Dr Richard W Gray
– Isabella Mighetto
– Julia Hewitt
– Kathryn Edwards
– Kathryn Machray
– Lourdes Santos Merx
– Fiona Bennett
– Tamar Wildwing
– Valerie Aspin
– Jarg Bergold
– María Jesús Vega
– Samir Sweida-Metwally
– Sarah Fakray, Bernardine Farrell
– Farihah Choudhury
– Chloe Patel
Additional academic signatories
University of Hertfordshire
– Dr Angela Madden, Principal Lecturer in Nutrition and Dietetics
– Dr Claire Thompson, Senior Research Fellow, NIHR EoE ARC
– Dr Julie Vuolo, Head of Department Nursing, Health and Wellbeing
– Dr Neil Howlett, Senior Research Fellow
– Dr Rosalind Fallaize, Research Fellow
– Dr Samantha Rogers, Senior Research Fellow in Food and Public Health
– Karina Vafeiadou, Nutrition Programme Leader
– Laurence Blanchard, Lecturer in Nutrition and Dietetics
– Simone Roberts, Community Dietitian
– Xenofon Tzounis, Lecturer in Nutrition and Dietetics/Specialist Bariatric Dietitian
Aberdeen University
– Dr John McKenzie, Research Fellow, Rowett Institute of Health and Nutrition
University of Brighton
– Dr Helen Johnson, Principal Lecturer in Psychology
University of Bristol
– Dr Catherine Dodds, Senior Lecturer in Public Policy
– Dr Elizabeth Haines, Vice-Chancellor’s Fellow in History
– Dr Keir Williams, Senior Lecturer in Design Thinking
– Dr Lauren Blake, Research Associate (agri-food systems)
– Saima Shah, Subject Lead, Psychology
– Bridget Anderson, Professor of Migration, Mobilities and Citizenship
– Gene Feder, Professor of Primary Health Care
– Lucy Haslam, Research Administrator
– Maitri Patel, Student Administrator
Cardiff University
– Angelina Sanderson Bellamy, Research Fellow, Sustainable Places Research Institute
Edge Hill University
– Dr Paul Simpson, Senior Lecturer, Applied Health and Social Care
University of Edinburgh
– Dr Aaron Kappeler, Lecturer and Director of the MSc Programme in International Development
– Dr Niamh Moore, Senior Lecturer, Sociology
– Dr Kirsteen Shields, Global Academy of Agriculture and Food Security
– Sonia Bhaskaran, Specialist Community Dietitian
– Kaveri Qureshi, Lecturer, Global Health Policy Unit
– Valeria Skafida, Senior Lecturer in Social Policy
University of Glasgow
– Dr Esther K Papies, Senior Lecturer
– Matthew Waites, Reader in Sociology
– Dr Kate Reid, Health Psychologist and Senior Lecturer
– Dr Catherine Lido, Social Psychologist and Senior Lecturer
University of Grenada
– Dr David Garcia-Burgos, Marie Sklodowska-Curie Cofund Athenea3i Research Fellow
Leeds Beckett University
– Dr Maxine Woolhouse, Senior Lecturer in Psychology
Loughborough University
– Dr Clare Holley, Lecturer in Psychology, Oonagh Markey, Vice-Chancellor’s Research Fellow
University of Liverpool
– Dr Charlotte Hardman, Senior Lecturer, Department of Psychology
University of Manchester
– Dr Elizabeth Dalgarno, Research Associate
– De Montfort University
– Dr Victoria Aldridge, Senior Lecturer in Psychology, Dr Andy Northcott, Senior Lecturer
Northumbria University
– Dr Crystal Haskell-Ramsay, Associate Professor
SOAS GTA University of London
– Nora Faltmann
University of Plymouth
– Dr Clare Pettinger, Lecturer Public Health Dietician and Food Plymouth (equality project)
Robert Gordon University
– Dr Flora Douglas, Reader in the School of Nursing and Midwifery
University of Roehamton
– Dr Sue Reeves, Principal Lecturer
University of Salford
– Dr Dave Beck, Lecturer of Social Policy
University of South Wales
– Dr Elizabeth Cookingham Bailey, Lecturer in Public Services
University of St Andrews
– Dr Jo Mhairi Hale, Lecturer in Population Health
University of Sussex
– Dr Catherine Will, Reader in the School of Law, Politics and Sociology
Tilburg University (Barcelona, Spain)
– Frans Folkvord, Tilburg School of Humanities and Digital Sciences
University of Westminster
– Dr Alizon Draper, Reader in Public Health Nutrition
University of Warwick
– Thijs van Rens, Associate Professor, Stephen Jackson
University of Wolverhampton
– Dr Gurpinder Lalli, Senior Lecturer in Education Studies