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NHS: Malnutrition

Volume 698: debated on Wednesday 30 January 2008

asked Her Majesty’s Government:

How they will respond to the recent reports about the levels of malnourishment of patients in NHS hospitals.

My Lords, nutrition is important for all patients. In October 2007, we published Improving Nutritional Care: A Joint Action Plan to outline how nutritional care and hydration can be improved in NHS hospitals. We have introduced protected mealtimes and focused on nutritional screening.

My Lords, perhaps I may be the first to offer warm congratulations to the noble Baroness on the assumption of her new job. I hope that she enjoys great success and derives much satisfaction from it. However, is she as concerned as I am at the recent report that 140,000 patients recently discharged from NHS hospitals were found to be suffering from malnutrition? Although some of them may have been so suffering when they went in, her own department has shown that 8,500 were in a state of starvation when they came out. The Health Minister in the other place has admitted that starvation in our hospitals is really quite common. Will the noble Baroness please see that some urgency is injected into this very important matter, on which I have been pressing this House for many years?

My Lords, the noble Baroness has an admirable track record of campaigning on these issues and I thank her for drawing them to the attention of the House again. We know that some patients are admitted at risk of malnutrition. Often this is part of their clinical condition, especially where illness causes a loss of appetite and where there is malabsorption. It is important that staff recognise patients at risk and take the necessary steps to help improve their nutritional state. The noble Baroness is quite correct about that. Indeed, recognising and recording patients with a diagnosis of malnutrition is an essential first step to solving the problem. This is and has to be a priority, and it is a priority in the Nutritional Action Plan. The work of the National Patient Safety Agency is undertaken to build nutrition screening into all treatment plans as a proactive means of avoiding the risk of malnutrition.

My Lords, is not one practical problem the level of staffing on old people’s wards? What happens in practice is that at mealtimes food is dumped in front of patients who may be neither physically nor mentally capable of feeding themselves. Relatives to help these patients are often unwelcome on the ward. One of the real issues is to find ways of getting staff who can help patients to eat. Is there anything that the Government can do to try and stimulate health authorities and hospitals to do something about that?

My Lords, my noble friend is right to say that the Government’s job is to stimulate action at the local and hospital level. We have always placed caring at the centre of nursing, and indeed I have done a great deal to support the caring role of nurses. There is no excuse for anyone to be too busy to assist at mealtimes. The introduction of protected mealtimes is a key tool in ensuring that the right level of attention is given to ensuring that patients who can eat will enjoy their meals, while those who need assistance receive it.

My Lords, on behalf of my party, I, too, welcome the Minister to her post. Does she agree that, together with infections and the indignity of mixed wards, malnutrition now has to be added to the risks facing us when we go into an NHS hospital? Will she admit that this is a result of the Government’s targets culture in the NHS, which forces managers to think only about the number of patients they are treating and not the quality of care they receive?

No, my Lords, I do not accept that. Good nutrition places demands on a huge multidisciplinary team within a hospital. Although the noble Baroness is right that the key for improvement lies locally, the Government have put in place a range of national initiatives—such as the national action plan led by Gordon Lishman of Age Concern, and the Patient Environment Action Plan, which will be assessed twice in the coming year—that will give a national framework to be delivered locally by clinicians and nurses.

My Lords, I add my congratulations to the noble Baroness. Will this plan give people, particularly frail people, the reassurance they need that the unpleasant experience that so many have in hospital when they are given meals will not continue? Will it ensure that non-pureed food is not given to patients who cannot swallow, that vegetarians will not continue to be given meat dishes, that food trays will not be placed at the end of the bed and so on? Will the plan really cover those very important points?

My Lords, the answer is yes. It is unacceptable that some of our most vulnerable older patients and other patients with special requirements do not receive the help they need to eat or the food that they enjoy. It is very important and we are keen to respond to constructive criticism. The Nutritional Action Plan will help to deliver exactly what the noble Baroness seeks.

My Lords, I, too, congratulate the Minister on her appointment and I look forward to the good work that I am sure she will do in her role. One of the solutions, in addition to seeking to use families to assist with feeding, is to take up the opportunity of using more volunteers. I speak as a trustee of the Community Service Volunteers, and declare an interest. We have considerable difficulties in persuading trusts that greater use should be made of volunteers, even though there are many volunteers around and willing to do this work. Can my noble friend, as a new commitment in her new post, give an undertaking that she will look into this and endeavour to get greater freedom for volunteers to be used in this respect in the future?

My Lords, the Minister is aware that good nursing care depends not only on financial resource but also on the underlying attitudes of people in the profession to their patients. Can she tell the House what steps are being taken to assess current attitudes to the care of elderly people? What steps does she propose should be taken to improve those attitudes to ensure that older people are treated, as they should be, with the utmost respect?

My Lords, I thank the right reverend Prelate. There are three strong mechanisms for assessing the quality of food and nutritional care: the Healthcare Commission’s annual health check, in-patient services, and the annual Patient Environment Action Team inspections. These show how seriously the Government are taking the issue.