Dh improving hospital food

Improving Hospital Food Event 11March 2013

NHS | Presentation to [XXXX Company] | [Type Date] 2

Issues for our vulnerable patients

Caroline Lecko Patient Safety Lead NHS Commissioning Board

Fundamental Principles – implications to our vulnerable patients

• Nutritious and appetising hospital food and drink is an essential part of the personal package of care and hospitals should take all reasonable steps to ensure that patient have a healthy food experience

• All patients should be able to choose from a reasonably varied menu which compliments their clinical care requirements whilst meeting their social and religious needs

• All patients should have access at all times to fresh drinking water, unless this is contraindicated by their clinical condition

• Access to food and drink outside planned mealtimes should be available where appropriate

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Who are our vulnerable patients? • Chronic disease – COPD, cancer,

inflammatory bowel disease, GI, renal or liver disease

• Chronic progressive disease – dementia, neurological conditions e.g. Parkinson’s disease, MND

• Acute illness – food unlikely to be consumed for 5 days

• Debility – frailty, immobility, old age

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High Profile Reports

CQC Dignity and Nutrition Inspections

The Malnutrition Task Force

• Independent group of experts from health, social care and local government united to address preventable malnutrition in all settings

• Aim to reduce malnutrition in older people to optimise their health, reduce unnecessary costs improve quality of later life

• Developed best practice principles and guidance including one for hospitals – the principles are • Raise awareness of the issue, costs and benefits • Working together –clinicians and caters • Identify malnutrition • Personalised care, support and treatment • Monitor and evaluate impact and progress

• Visit www.malnutritiontaskforce.org.uk

Malnutrition Task Force

Francis Report At Stafford some patients were left food and drink and offered inadequate or no assistance in consuming it. Even water or the means to drink it could be hard to come by. The experiences at Stafford to which witnesses testified are by no means unique in the NHS in England, as has been shown by the Care Quality Commission dignity and nutrition reports since. Recommendation

241 Provision of food and drink

The arrangements and best practice for providing food and drink to elderly patients require constant review, monitoring and implementation.

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For those not familiar with Francis……..

“Swallowing was a problem for Irene and I had to give her Fortisips with a syringe. I was just trying to make sure Irene was eating. However at 5pm you had to go. This was meal time. I could not see whether Irene was eating or not. One time I visited I saw a trolley with a dinner on it at the foot of her bed, out of Irene’s reach. I asked the lady next to her whose dinner it was. She told me it was [my wife’s]. It had been left uncovered and was stone cold. I found a nurse and asked her whose dinner it was; she told me it was Irene’s I said “you’re joking, Irene can’t eat a dinner”. The nursing staff should have known about [her] eating requirements.”

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“the glasses on the ward, they were flimsy, they were the plastic glasses. And mum’s eyesight was really, really bad, and anybody with bad eyesight can’t pick the jug up and see where they’re pouring into they—by the time you’ve picked that glass up you’ve crushed it, you know, its collapsed in your hand.”

“… some of the people in there can’t even get out of bed; they can’t fill in their own menu. You would find the food tray was 3 foot away from the bed; they couldn’t get a drink. There was just nobody there. I remember a conversation with one of the senior nurses who told me that she was on her own and had 50 meals to serve. I’d have put an apron on myself and gone and helped, that is what you felt you wanted to do.”

Going back to the principles - 1 • Nutritious and appetising hospital food and drink

is an essential part of the personal package of care and hospitals should take all reasonable steps to ensure that patient have a healthy food experience

“Visits to hospitals indicated that there is a

heightened awareness of the need to get systems in place to ensure proper nutrition and hydration for all patients and a variety of local, frequently nurse-

inspired, initiatives were seen.”

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Going back to the principles - 2 • All patients should be able to choose from a

reasonably varied menu which compliments their clinical care requirements whilst meeting their social and religious needs

• Do we really think about reasonably varied

menu’s for all?

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Going back to the principles - 3 • All patients should have access at all times to

fresh drinking water, unless this is contraindicated by their clinical condition

• Do we really think about what access means?

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Going back to the principles - 4

• Access to food and drink outside planned mealtimes should be available where appropriate

• Is accessible food really suitable for all?

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Some other challenges to consider • Meal times – who do they suit? • Fit for purpose packaging!!!

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Thank you

[email protected]

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