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Health: Malnutrition in Hospitals

My Lords, I, too, thank the noble Baroness, Lady Neuberger, for introducing this important debate. She raised some very important points, many of which I shall add to. I declare an interest as a healthcare provider. I expect that all of us in your Lordships’ House have heart-rending could relate experiences of our own or of family and friends. Age Concern’s document Hungry to be Heard comes as no surprise to many noble Lords, as the issue has been aired many times. Sadly, little seems to have changed; here we are again discussing an issue so important to the welfare of our most vulnerable groups. As other noble Lords said, six out of 10 older people are at risk of becoming malnourished or of their situation getting worse after coming into hospital. That adds approximately £7.3 billion to NHS costs, as those patients take longer to recover or develop other complications or illnesses through malnutrition. Nine out of 10 nursing staff say that they do not always have enough time to ensure that patients eat properly. However, it is not only about finding time for nursing staff to ensure that patients eat; there are many additional factors. The elderly may not be able to understand nurses. It is not unusual to find staff for whom English is not a first language. If patients are not English-speaking, it is difficult to express a problem with the full confidence of being understood. It might be that a patient suffers from learning disabilities, dementia or Alzheimer's disease. These patients need specially trained staff to encourage them to eat and, in many cases, support them in doing so. Above all, a well balanced menu must be fed to patients, one that takes into account the patient’s ability to eat the meal. I can give many examples. If noble Lords will indulge me, I will cite an example of an Asian lady who went into hospital and could not explain that she was a vegetarian and did not eat onions or garlic. In the end, her family had to bring food in daily. The noble Baroness, Lady Greengross, referred to the fact that people do not always know that they can bring food in to their family, but this lady’s family brought food in because she was not eating any meals at all. Residential care, nursing homes and social services responsible for meal provision to clients in their own homes all have to follow minimum standards which offer choice and meet users’ differing needs. Surely it is even more important that such requirements are essential and followed in hospitals, as the same, if not better, standards need to be met. The Minister will remind your Lordships’ House of The Essence of Care framework, which provides guidelines for nutritional assessments to be carried out on patients coming into hospital, identifying nutritional needs and devising care plans based on those assessments. Will the Minister say whether all hospitals are working to that framework, what monitoring has been carried out, whether results have been published and whether they are available to the public? Will she also assure the House that all patients coming into hospital are screened to identify those at risk from malnutrition so that appropriate action, needed to give staff enough time to help support individuals, is taken? We all are aware of the campaign led by Lloyd Grossman, which looked at the quality of food served in hospitals. The Better Hospital Food programme made much of menus becoming varied and offering more choices. However, if one is sick, elderly and finding it difficult to chew or swallow, as the noble Baroness, Lady Neuberger, said, it is not fancy menu choices that you want but familiar well balanced and easy, manageable food. A spoon of mashed potatoes served in the middle of a plate does not constitute a meal, neither does a thick, salty bowl of soup that looks like wallpaper paste. We understand the practices of remote food preparation and reheating on hospital sites. Will the Minister assure the House that there will be a more rigorous inspection regime of monitoring the quality of food supplied to hospitals, assessing whether that food is of both nutritional value and cost benefit to hospitals and what distance it travels? In many cases, trays are left out of patients’ reach, even where hospitals use the red-tray policy. That is not always deliberate but the result of a lack of staff understanding or the inability of the patient to access the tray. The patient may not even remember whether he or she needs to reach out for the tray. Will the Minister assure us that, whatever the stresses that nurses and auxiliary staff are under today, time will be made in their day to feed vulnerable patients who cannot access a tray. We know about the stresses that nurse and auxiliary staff are facing, especially with hospitals having to square ever-increasing deficits and make cuts to front-line staff. However, will the Minister assure the House that all hospitals have a full and proper policy in place to ensure that all ward staff are food aware, that appropriate training is given to staff and that they have a protected meal-times policy? Do the Government have a firm date for the publication of the findings from the summit to tackle malnutrition in older people, which Ivan Lewis, the Minister in another place, announced last week? Might greater use of the voluntary sector be considered as part of meal-time assistance? What plans will the Government implement to achieve a fundamental shift in NHS cultures and practices on treatment of the elderly and people who suffer from dementia and Alzheimer’s disease?