---

Health: Malnutrition in Hospitals

My Lords, I congratulate the noble Baroness, Lady Neuberger, on securing this very important short debate. I welcome, as she did, the Age Concern Hungry to be Heard campaign and the Government’s announcement of their own campaign last week. We always have to remember that, as life becomes very narrow with old age, if someone is not well, is frail and has to go into hospital or into a care home, time for food is more and more important, choice of food is more and more important, and eating is perhaps the only remaining social activity of importance for many people. It is therefore appalling that so many people in hospital are malnourished. It is equally terrible that people going into hospital are malnourished. It means that this is a problem not just for the hospitals but for the whole community, and that it is seriously under-recognised. I hope that the Minister will acknowledge that when she responds. The noble Baroness, Lady Neuberger, quoted many of the very important and distressing figures. I shall add only that four out of 10 over-80s are admitted to hospital when they are already malnourished. Malnutrition costs us more than £7.3 billion a year, with more than half of that spent on the over-65s. The risk of malnutrition increases with age. Another aspect of it which is usually forgotten is dehydration, which is a huge problem. Water is not always available and to hand. It is a very simple to correct, but it is not done. In both hospitals and care homes, huge numbers of people suffer from dehydration. We know that we will live longer as we get older, so all these problems will be exacerbated unless we change things now. Sadly, as with obesity, the attention always seems to be focused on the diet of the very young. We do not want to take away that focus; we just want to extend it so that all age groups are considered as we try to improve this situation, because the old people whom we are talking about are very vulnerable and require our attention. Malnutrition is also a key marker of inequality in health, social care and housing within regions and localities. It is one of the key reasons behind the shorter life expectancy in the north and Scotland which the noble Baroness, Lady Neuberger, mentioned. Life expectancy there is about 10 years less than it is in the south-east of this country. That is quite appalling. As we know, the causes of malnutrition are complex and go far wider than just poor food. Among them are social isolation—when you really cannot be bothered with food—underlying disease, lack of mobility and a lack of diverse, accessible local food shops. Therefore, finding solutions in the community is even more complex than doing so in the clinical settings that we have described. They require input from a range of sources: the NHS— particularly primary care services—local government, the voluntary sector and families. One of the reasons why elderly people who are malnourished somehow slip between the cracks in the plaster is that nobody is quite certain who should take responsibility, so everybody pushes it on to someone else and the problem is easily and frequently overlooked. Some months ago, I was privileged to launch the National Association of Care Catering’s menu planner for care homes here in Parliament. I commend it on the great attention to detail that went into devising menus that were not only nutritious, but often tailored to specific conditions such as osteoporosis, anaemia and others; for example, when a person has difficulties chewing or swallowing. The menus would retain a person’s interest in eating. The menu planner is about 160 pages long, so it is not light reading, but it provides a very good model and is worth studying by many professionals in this field. I call on the Government to develop professional accreditation, filling gaps in training for people among the different professions who care for frail, old people. I have referred previously in the House to enhanced training for care professionals, and this seems to be a very good element to include in it. We also have to ensure that screening for malnutrition is embedded in practice at all levels of older people’s health services. The International Longevity Centre has been involved in a European study of malnutrition which shows that the problem is not limited to this country, but that it is worse here than in many other countries because we do not have a culture of taking food into our relatives in hospitals and care homes. The food is provided there, but it is often very poor. I hope that the Government agree that we needto strengthen local government and community involvement, maximising the use of agencies such as sheltered housing groups, GPs’ surgeries, meeting clubs, leisure centres and voluntary organisations, as well to get across the message of how important nutrition is. We need in particular to ensure that families, which often do such a great job in caring, are aware of the signs. I hope that we will be reassured by the Minister that these issues will be taken forward by the Government.