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Health and Social Care Bill

We enjoyed a long and detailed debate on this issue in Committee. As I said then, I have a great deal of sympathy with the motives behind the amendments, but there are good reasons why they are unnecessary. As most hon. Members have recognised, we are making significant progress. We have been working closely with the Food Standards Agency to improve the nutritional quality of hospital meals. We have launched the better hospital food programme, which is having an impact. The patient environment action team assessments show that there has been an increase from 17 per cent. of food being described as good in 2002 to 44 per cent. being rated excellent in 2006-07. We also recognise that older people in hospital are particularly vulnerable to malnutrition. To identify and deal with that risk, we have introduced protected meal times. We are putting particular emphasis on the screening that has been advocated by a number of hon. Members in this afternoon's debate. Those two areas of work are being pursued by the National Patient Safety Agency. The Royal College of Nursing has recently signalled its commitment to addressing the issue and has launched its nutrition now campaign, which aims to help all nurses at all levels to improve the nutrition and hydration of patients. The Nursing and Midwifery Council, the regulatory body for nurses, has identified nutrition as one of the core skill areas to be singled out for special assessment of competence before nurses are admitted to the register, a move that we warmly welcome. As I mentioned in Committee, last October the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), launched a nutrition action plan to build further on that work. The plan is being developed with leading stakeholders. Indeed, Opposition Members referred to the Age Concern report, ““Hungry to be Heard””, and they will be pleased to learn that Gordon Lishman, the director of Age Concern who is responsible for pioneering work in the field of nutrition, has agreed to chair the national action plan delivery board. I also described in Committee the detailed standards in nutrition that apply to the NHS under the standards for better health and the national minimum standards that apply for registered health and adult social care providers. They are core standard 15a, which states:"““Where food is provided, health care organisations have systems in place to ensure that…patients are provided with a choice and that it is prepared safely and provides a balanced diet””." Core standard 15b states the need that"““patients' individual nutritional, personal and clinical dietary requirements are met, including any necessary help with feeding and access to food 24 hours a day.””" For assessment against core standard 15, the Healthcare Commission will use the criteria, which were signed off by the Secretary of State for Health in 2007-08, that patients should be offered a choice of food in line with the requirements of a balanced diet, reflecting the needs, preferences and rights, including faith and cultural needs, of the service user population. I also went on to describe how the Healthcare Commission's national in-patient survey had shown that 53 per cent. of adults now rated the food that they ate in hospital as good or very good. The better hospital food programme, which was launched in 2001, introduced five key improvements: 24-hour service, NHS snack boxes, additional snacks twice a day, a hot meal in the evening and menus including three dishes created by leading chefs. So an awful lot is happening with food and nutrition, but I accept the points made by hon. Members that more needs to be done. In December, we published our annual operating framework, which recognised for the first time the importance of including regard for the patient experience as one of the NHS's five main priorities. If there is one thing that comes up time and again in consultations and when hon. Members' talk to their constituents about their experience as patients, the quality of food is very high on the list, as well as issues such as how people are treated by staff and receptionists. It is very important that, by including the issue in the five main priorities that the Government have given to the health service, we will see further improvements. Indeed, I held a meeting last week to find out how we could best spread the really good practice that hon. Members are aware of happening throughout the country. I recently visited Cornwall, where the local hospitals are doing an excellent job in serving, I believe, 80 per cent. of locally bought produce, fresh from local farmers, butchers, dairy farmers and fishermen. That is going down very well with patients there, and it is improving recovery rates. I want to deal with the claim made by the hon. Member for Eddisbury (Mr. O'Brien) both here and in Committee about patients allegedly being discharged with malnutrition. He made that claim, both generally and in Committee, in reference to my local excellent hospital. It surprised me, and it also surprised the chief executive of the Royal Devon and Exeter hospital. It might be based on a misunderstanding of the definition of episodes. If he will bear with me, it is important that this is put on the record, as the allegations are quite serious. For the purpose of the hospital episode statistics, a patient's stay in hospital is referred to as a spell and each period under the care of one consultant is known as a episode. So a patient who is under the care of several consultants during the spell in hospital has several episodes. Someone under the care of only one consultant throughout the stay has only one episode. For the purpose of the statistics from which the hon. Gentleman draws his allegations, the first episode is known as the patient admission episode and the last episode is known as the discharge episode. If someone has only one episode in hospital and if they remain under the care of only one consultant during their stay in hospital, their patient admission episode and their discharge episode would be the same. So someone admitted, for example, for the treatment of a nosebleed would have ““nosebleed”” recorded as their admission episode and their discharge episode. That does not mean that they leave hospital with a bleeding nose. Similarly, someone whose final treatment episode is registered as being for malnutrition does not leave hospital with malnutrition, as the hon. Gentleman suggested earlier. They are not discharged with malnutrition. There may be a number of reasons why malnutrition, for example, is not picked up when someone is admitted to hospital. It might be part of a more serious condition for which they are being treated or operated on, and it is diagnosed only when they are recovering from the more serious condition for which they are being treated or operated on. That explains why their final treatment episode might be for malnutrition, when their initial treatment was not. Hence the allegation made by the hon. Gentleman that people were becoming malnourished in hospital is not the case. Similarly, it might be that, when recovering from a serious operation, a patients loses their appetite, so their final treatment in hospital is for malnutrition, but that does not mean that they are discharged with malnutrition. So I hope that that helps to clear up that point.