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NHS: Feeding

Volume 716: debated on Wednesday 6 January 2010


Asked By

To ask Her Majesty’s Government on what grounds decisions are made to forbid hospital staff and carers from helping patients to eat.

My Lords, unless there are clinical reasons for withholding them, patients are entitled to food and drink of adequate quantity and quality and to help to ensure that they eat and drink. Hospital staff should ensure that a patient’s oral nutrition and hydration are being provided in a way that meets the patient’s needs, and that any problems, such as difficulty in swallowing, are managed effectively.

My Lords, is the Minister aware that following the admission of a Mrs Beryl Alice Waters to Queen’s Hospital in Burton-upon-Trent on 30 September, her family were informed by a staff nurse Willis that nurses and carers were forbidden to help patients to eat. This information was given in front of a consultant and two other doctors in the course of a ward round, and they in no way denied it. Why are such orders issued?

My Lords, the noble Baroness has been very concerned about this issue, and I agree with her that this can be very distressing indeed for families and carers. As I have already said, there may sometimes be clinical reasons for withholding food and drink from a patient. However, if such a message were ever given other than for clinical reasons, it would certainly not be endorsed by the Department of Health, and local managers would need to investigate and account for it. Ensuring that patients have adequate nourishment is part of the core caring of nursing.

My Lords, I declare an interest as a trustee of Community Service Volunteers. We have a fair number of our volunteers working in a variety of hospitals, doing a variety of tasks. Could the Minister tell me why they are not permitted to help people feed themselves?

My Lords, my noble friend knows that we have long recognised and supported the enormous value of friends groups and volunteers, and the contribution they make to patients’ experiences in the NHS. Indeed, some trusts are using volunteers to help patients to eat and drink. Volunteers who do this have to receive training and supervision, particularly when patients have difficulty chewing or swallowing. I believe that we should encourage voluntary organisations that provide this wide range of important services to encourage their members to receive this training, and to put pressure on their health authorities. If they have got volunteers who want to help in this way, they certainly should be able to do so.

My Lords, the Minister must know that lack of help with feeding and, indeed, inadequate cleaning in a lot of our hospitals are often due to lack of time because of government-imposed targets and management rules. What advice would she give to NHS staff who face disciplinary action, suspension and often damage to their careers when they expose malpractice that has been imposed by their own managers?

The noble Baroness knows—we have discussed this in the Chamber—that the NHS has a well developed procedure for dealing with whistleblowers and for protecting people who bring such problems to the attention of their hospital administration. We do not accept that there is a link between targets and issues of feeding and nourishment because, apart from anything else, this Government have increased the number of nurses by 89,000 since 1997.

My Lords, is the noble Baroness aware that the Answer that she gave to my noble friend Lady Knight was to some of us puzzling and disappointing? Is it not clear that such instructions as my noble friend referred to have been given, should not have been given and should now be countermanded?

I hope that I gave the impression that I absolutely agree with that point and want the issue to be investigated.

The example given by the noble Baroness, Lady Knight, was but one of certainly more than 100 that are available. Will the Government now invite the General Medical Council and the other regulators to create a code of practice so that these awful examples can no longer occur?

I am not sure from where the noble Lord received the figure of 100; he might please let me know. However, I am glad to be able to inform him that from 2010-11 the Care Quality Commission will be operating a new registration system, which will cover both health and adult social care providers. One of the proposed registration requirements is ensuring that people get the nourishment that they need to prevent harm through lack of sufficient nutrition and hydration.

My Lords, does the Minister think that this is a question of training? What is being done to ensure that nourishment is on the training agenda? I declare an interest as the chair of Livability, a large charity that deals with disabled people. We have had the opposite experience of having our staff invited to go into the hospital to help with feeding because some hospital staff have been uncertain about how to treat some of our very disabled patients.

The noble Baroness makes an important point. The Nursing and Midwifery Council has made it a requirement for nutrition principles to be taught and assessed in practice as part of the pre-registration nursing programme. Skills for Care and Development has undertaken a review of its occupational standards with the Food Standards Agency and is introducing nutrition and healthy eating standards. We have endorsed the British Association for Parenteral and Enteral Nutrition screening week, which establishes the extent of nutrition on admission to hospitals and care homes, for example. We acknowledge that there are issues, which we are trying to anticipate. We are trying to make sure that we minimise the effects of malnutrition as people come into hospital and certainly that they receive the right kind of nourishment while they are there.

My Lords, in answer to my noble friend, the Minister appeared to be saying that hospital volunteers should not be permitted to help a patient to eat, however great the need, unless they had had special training. Does she really mean that?

Yes, I think that we do mean that. The reason why we mean it is that, for example, someone who has had a stroke and has problems with swallowing will need specialist help with eating. A volunteer can certainly help that person—that is quite right—but they need to be taught how to do that in the proper way. Patient safety has to be at the heart of this, but we would like volunteers to do that.