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Hospitals and Care Homes: Hydration

Volume 732: debated on Monday 7 November 2011


Asked By

To ask Her Majesty’s Government whether they have plans to implement a hydration policy in hospitals and care homes.

My Lords, all providers of regulated activities, including hospitals and care homes, are required by law to have policies in place that protect people from the risks of dehydration. The Care Quality Commission can take action if these requirements are not being met. It is for health and social care providers to develop local hydration policies. There are a number of best practice resources available to help providers to do this.

My Lords, evidence has clearly demonstrated that adequate, and indeed good, hydration can lead to fewer falls, through less dizziness, less constipation, less renal and urinary tract problems, and can bring a host of other benefits, particularly among elderly people in hospitals and care homes. Could Her Majesty’s Government introduce firm guidelines on this for all key providers of care, whether in NHS hospitals or in care homes?

My Lords, I think that mandating a blanket approach to hydration from the centre, as it were, will not have the effect that we want, which is to deliver the person-centred improvements that we all want to see. Having said that, I know that there have been some important developments. As I have just said, providers are now required by law to have policies in place that protect people in hospital, and the regulatory body charged with overseeing compliance—the CQC—has been equipped with tough powers of enforcement. My right honourable friend the Secretary of State instigated a whole succession of unannounced inspections of NHS trusts, and there are further ones on the way. We are also looking at changing the NHS constitution in relation to the issue of whistleblowing. So a lot is going on, but there is a limit to what central government can do. It is in the end up to staff and managers on the ground.

Is my noble friend confident that today’s nursing training understands and re-emphasises the great importance of having a hydration policy?

My Lords, I asked my officials that very same question. I thank my noble friend. My advice is that all preregistration training for nurses contains instruction and information about hydration and how to make sure that people have enough to eat and drink while in a care setting.

My Lords, the Minister said that the CQC has enforcement powers. How long after a CQC inspection reveals abuse of vulnerable people is it required to take enforcement action?

I think that my noble friend asked about the period of time after an inspection. The CQC has flexibility depending on what it finds. As my noble friend will know, there is a whole succession of increasingly strong measures that it can take, depending on the concern. It can mandate immediate action to be taken, and in those circumstances it will return, typically, for a further inspection within a fairly short space of time to ascertain whether the action has been carried out.

Is not this hands-off attitude to dealing with this matter costing the health service a fortune on urinary tract infections?

My Lords, the noble Lord is right to express concern about urinary tract infections. There is a programme of work designed to bear down on that, as there is for hospital-acquired infections generally. He is absolutely right to raise that concern, which has a direct bearing on the Question on the Order Paper and the need for proper hydration at all times.

My Lords, could I suggest to my noble friend an experiment being done by a hospital that I know of—namely, that within 24 hours each patient should be assessed as to whether they are likely to have any difficulties drinking or eating? When that is found to be the case, they have specially marked jugs and trays in red, which immediately alerts staff on duty to the need for extra care.

My noble friend raises a very good idea. I have heard of similar ideas in different trusts, all designed to meet the same objective. The key point my noble friend makes is that patients who may be malnourished when they enter hospital or have difficulty feeding or accessing drink for themselves should have their condition assessed straightaway so that the nursing care is there for them when they need it.

Could the Minister assure the House that the Government will do everything possible to increase the number of unannounced inspections, both in hospital and in care homes, to make sure that these basic and very important matters are being properly attended to?

My Lords, since the publication of the CQC summary inspection report, my right honourable friend the Secretary of State has requested a further 500 inspections of dignity and nutrition in care homes and 50 further visits to hospitals, which will start in the new year.

My Lords, I was disturbed by the Minister’s first response to this Question because it sounded as if the Government are washing their hands of a hydration policy. Can the Minister say whether that is indeed the case? It seems to me vital that the Government should be providing leadership in ensuring that, at every level of health and social care, they are following through on the policies that are in existence and that have been disseminated over many years, and that they should not say that this is a matter for the policy of individual hospitals.

No, my Lords, the Government are very far from washing their hands of this extremely important issue. As the noble Baroness will know, the new registration system under the Health and Social Care Act 2008 covers all providers of health and adult social care regulated activities. There is an outcome in that set of regulations which requires providers to adhere to the highest standards of nutrition and hydration. It is because of that that my right honourable friend has been so concerned to instigate these unannounced inspections by the CQC.