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Health and Social Care Bill

I am delighted to support my noble friend Lady Knight, who has been a doughty fighter on this subject. On every occasion she has tried to ensure that this matter is brought to our attention and that the food in hospitals is improved. I shall speak to Amendments Nos. 54 and 55. It is very disappointing that a voluntary organisation such as Age Concern should find it necessary to fight a campaign for nutrition in hospitals. As my noble friend Lord Howe mentioned, its report is very good indeed and I congratulate Age Concern on it. If only 45 per cent of all hospitals have taken action to tackle the shocking levels of malnutrition among older people, it is necessary to draw the attention of the nation to this subject. I cannot understand how one hospital can have delicious food and another uneatable; how one hospital can ensure that patients are properly fed and another ignore the importance of good nutrition. Good nutrition is not only essential for good recovery but is one of the very few things that punctuates a boring hospital day and is nearly always a talking point with visitors. My experience is not quite as black as that of my noble friend Lady Knight. I remember being involved with a hospital where the food was so good that the staff and others chose the hospital catering service for their wedding receptions at competitive rates; and yet I know there are others where the patients are so hungry that they have to phone out for pizzas to be delivered. As with so many other things, the Healthcare Commission takes the subject seriously. It sets two standards in accordance with the Better Hospital Food programme, which was introduced in May 2001. This programme outlines six requirements which should be implemented. In addition, the programme includes further advice and guidance relating to a balanced diet, a splendid NHS recipe book and national menu design. The Healthcare Commission’s core standard C15 A states that where food is provided, organisations should have systems in place to ensure that patients are given a choice, that food is prepared safely, and that it provides a balanced diet reflecting the needs, preferences and rights—including faith and cultural needs—of its population. It also requires that the preparation, distribution, handling and serving of food is carried out in accordance with food safety legislation and national guidance, including the Food Safety Act 1990, the Food Safety (General Food Hygiene) Regulations 1995 and EC Regulation 852/2004. So we are not short of guidance or regulations. The 1995 regulations require that organisations should ensure that the preparation, distribution, handling and offering for supply of food are carried out in a hygienic way. That seems sensible. Further, the organisation should identify any step which is, "““critical to ensuring food safety and ensure that adequate safety procedures are identified, implemented, maintained and reviewed””." The Healthcare Commission’s second core standard, C15 B, states that where food is provided healthcare organisations have systems in place to ensure that patients’ individual, "““nutritional, personal and clinical dietary requirements are met, including, where necessary, help with feeding and access to food and drink 24 hours a day””." In order to do this, some trusts are using the Essence of Care benchmarking tool, which includes food and nutrition. This is practice-based and used by nurses to ensure that patients who are already malnourished or at risk of becoming so are identified early on. It is optional, and some trusts are using other benchmarking systems. The commission standards also recommend protected mealtimes, when all non-urgent clinical activity should stop. During these times, patients should be able to eat without interruption and staff should be free to offer assistance. Therefore, although much is happening, there is still frustration that despite all the advice, guidance and regulation, a real problem exists here. Ultimately, this is a professional problem and it is about management. It relies on nurses being vigilant, caring and watchful, and ensuring that patients are treated with dignity and properly fed. However, I agree with the noble Lord, Lord Campbell-Savours: choice of food is a very personal thing and sometimes drugs, anaesthetics and treatment can alter one’s taste. Fast throughput of patients means that meals may have been chosen by the previous incumbent of the bed or, as we heard this afternoon, by relatives, and they are not always the choice of the individual. The Healthcare Commission states that on the whole the systems—the training, hygiene and so on—are in place. In my view, it is the professionalism—the delivery on the wards—that is lacking. It is my belief that regulation should have a light touch, as I have mentioned several times during our debates. I would not normally agree that what is essentially a management problem should be enshrined in legislation. However, I think that the concern is so great that there is a role here for the regulator. The Care Quality Commission will throw a spotlight on this subject. It will call people to account and make trusts think deeply about what can only be called a lack of good nursing care. I am sorry to say that because I have long been an admirer of the nursing profession, but in this area I think that there is a lack of professionalism. Yesterday, I visited a friend in hospital whose wife said to me, ““The cure is great. The care is wanting””. Nutrition is about care, but it also stimulates a cure and a speedy recovery. I strongly support the amendments.