Enteral feeding disruption and supply issues

To all our members working in enteral nutrition, we know that you have been experiencing significant pressures within your services to manage and mitigate against the risk of patient harm because of the recent escalating issues relating to the supply of enteral feeds and associated equipment.  

We want to update you on the actions that the BDA and our specialist groups (PENG, Critical Care, Paediatric and Optimising Nutrition Prescribing) have undertaken to date, to support the management of this issue and be the voice to advocate and highlight the impact on dietitians and patients at a national level.  

Issues with enteral feeding supplies are not new. We highlighted our supply issue concerns to NHS England (NHSE) in 2022, when there were several issues with out-of-stock feeds and equipment affecting many providers.  

In June 2022, a survey completed by PENG and BAPEN found 98% of respondents had experienced issues with enteral feed supplies, of which 50% in adults and 25% in paediatrics were reported as moderate to severe. While issues somewhat improved, they never fully resolved. We have come to expect and work with a level of uncertainty, along with the extra workload and burden for our services and patients, that comes with shortages in enteral supplies.  

Unfortunately, in recent months, these issues have escalated as increased demand has temporarily outstripped existing production capacity and there are currently shortages impacting teams and patients in acute and community settings. However, we do know that supply issues of feed are not isolated to Nutricia and that other providers including Abbott and Fresenius Kabi frequently report temporary shortages of enteral feeds.    

We felt that this needed a strategic voice, utilising the BDA and BAPEN, to engage with government agencies and industry to highlight the impact that these supply issues are having on day-to-day service delivery.  

We, (PENG, Critical Care, Paediatric and Optimising Nutrition Prescribing Specialist Groups) have been working together to advocate for and support our members. In a recent meeting with Department of Health and Social Care (DHSC) and NHSE we highlighted several concerns including:   

• The increased financial costs  

• Compromised nutritional care  

• Impact on dietetic service capacity  

• Incidents of patients in community being left without feed 

• Lack of reliability/ confidence in the out-of-stock feed reports received daily to weekly from suppliers 

• Difficulties teams have had with sourcing alternative feeds   

• That changing to bolus feeding or decanting feeds, as suggested by manufactures, may not be appropriate and/or we will need to change/go outside of our guidance around hang times  

• Adapting feeding regimens can increase equipment use / increase feed waste - counteracting sustainability targets  

• There is a shortage of adaptors to allow feeding with non-contract feeds 

• The impact that this is having on patients' quality of life, dietitian morale and fracturing the relationship and trust between dietitians and their patients.  

We welcome the recent action from NHSE to collect data through a MS online form to report issues and to gather data, which they can then review weekly to try and support with the resolution and management of the most significant issues reported. A root cause analysis from each enteral feed provider has been requested, in order to fully understand the cause of disruption and the business continuity plans that have been identified to mitigate shortages in the future.

We recognise that this is an England-only reporting form and we have asked and/highlighted that there should also be something similar to collect data in Scotland, Wales and Northern Ireland, where we know teams are likely to be disproportionally worse affected. This week the BDA will be meeting with board members in Northern Ireland, Scotland and Wales to understand the actions being taken there and how we can support.   

Our recommendations for members:  

1. For hospital settings – if your required Nutricia products is out of stock and where there is an appropriate alternative, try to observe the Nutricia instructions in their stock report (below) for ordering Fresenius Kabi alternative products from Tamworth. This partnership working helps preserve stock for community colleagues.  We know that the stock report dates quickly and acknowledge the additional time the liaison is taking.  
2. Continue to report incidents and risk of harm through your trust systems i.e. radar/datix  
3. In England, use the Online form from NHSE to report issues. For those in acute settings, it is recommended to complete this on behalf of the hospital weekly, quoting the number of patients impacted  
4. In England, you can assign a member of your team (i.e. team lead, operational lead, procurement) to attend weekly meetings with NHSE. The aim of these meetings is to support system colleagues, to understand disruption progress and to inform dialogue with the supplier. These meetings are optional drop-in sessions and will be held until there is agreement that the situation is resolved. The meetings commenced from 4 June 2025, 10am – 10.30am.  If colleagues would like to attend, details for a nominated lead/s to represent your trust/ ICB at these meetings should be sent to [email protected]  
5. In the circumstance where there has been no available suitable alternative feed, despite going through all channels outlined on the National Supply Disruption Response (NSDR) website, report these incidents by email to the NSDR:  [email protected] 

Nutricia's recommendations for members:  

Please refer to supplier guidance on how to best manage hospital and community patient product availability. Nutricia are currently experiencing disruption on some of their Nutrison range, up to date information and guidance on how to best manage hospital and community patient product availability is published in their weekly Stock Update [see Nutricia communications update tab].

Feedback

Please do contact the BDA supply disruption working group via the BDA’s continuously monitored inbox [email protected] to let us know of anything we could raise on your behalf – noting that you will need to escalate local issues as advised above and that we cannot look into individual local disruption issues.  

On behalf of  

The BDA’s Parenteral & Enteral Nutrition Specialist Group, Critical Care Specialist Group, Optimising Nutrition Prescribing Specialist Group and the Paediatric Specialist Group.

[Last updated 18 June 2025]