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Health and Social Care: Malnutrition

Volume 800: debated on Tuesday 5 November 2019


Asked by

To ask Her Majesty’s Government what assessment they have made of the prevalence and impact of malnutrition among people in health and social care settings; and what steps they are taking to prevent it.

My Lords, malnutrition is a common clinical health problem affecting all ages and all health and care settings. The Government are committed to better screening for malnutrition and improved food standards in hospitals. Hospitals and care homes must screen people for malnutrition on admission and meet high standards of nutrition care. We have announced a root and branch review of hospital food to ensure that patients receive the right nutrition and hydration.

My Lords, I thank the noble Baroness for that response. Even here in the UK, malnutrition is shockingly underrecognised and undertreated. Some 3 million people live with malnutrition, including one in 10 older people. One in six patients admitted to hospital, and about 40% of those entering care homes, are malnourished or at risk. Disease-related malnutrition is estimated to cost over £20 billion a year. What steps will the Government take to improve identification and treatment of malnutrition, not just by promoting screening in care homes and GP surgeries, which I very much welcome, but also by improving the training of GPs and other health professionals on this issue?

The noble Lord is absolutely right that this is an issue which is on the rise. The causes are complex and can be clinical, social or economic, but we are committed to improving this situation. That is why we have brought in the hospital food review, to ensure the safety of the food available for patients, visitors and staff, but also to look at how we can provide the highest level of care possible for patients, which includes the quality and nutritional value of the food served to them. The review will also look at the best possible methods of screening and training staff.

My Lords, in a rich country such as ours, it is shameful that anyone does not have enough to eat. Yet over £3 billion is spent on managing malnutrition and its effects. NHS trusts already have a duty to ensure that they meet patients’ nutritional and hydration needs. However, the Campaign for Better Hospital Food has said that, despite the introduction of food standards, at least half of all hospitals are not complying and the current Government are failing to encourage progress. Labour has committed to mandatory nutritional standards being regulated. I invite the Minister to join us in supporting this sensible policy.

The noble Baroness is absolutely right that it is critical that people have good and healthy food in hospitals. That is exactly why there are very strict food standards in hospitals and health and care settings which are already enforced by the CQC. It is also why we appointed the former head of the Hospital Caterers Association, Philip Shelley, to look at what more could be done to improve the situation with the hospital foods review, to look at the safety of food available to patients, visitors and staff, improve nutrition and make available healthier choices, and ensure that we can improve the expertise of caterers, suppliers, staff and those who work in hospitals, to ensure that we raise standards and reduce the incidence of malnutrition across the system.

My Lords, in the light of the very real pressures on care services in communities, could the Minister say what steps the Government are taking to ensure that the elderly and vulnerable living in their own homes are not suffering from malnutrition due to poverty and neglect?

The noble Baroness is right to raise the important issue of malnutrition in the community. We have put together a malnutrition task force, which has published a series of guides of expert advice on prevention and early identification of malnutrition in later life. These guides draw together principles of good practice and offer a framework for making sure that the situation which the noble Baroness has identified does not arise. We have also published a guide for care homes on integrating good nutrition into daily practice. This includes screening, initiating nutritional care plans and considering fortifying food and using oral nutritional supplements when appropriate.

My Lords, does the Minister realise that there is a huge problem of pressure ulcers due to bad nutrition? It costs the country millions, if not billions, of pounds. Could she do something about this? It is very difficult to encourage people who do not want to eat to do so.

The noble Baroness is absolutely right to identify some of the very significant health consequences of malnutrition. This is one of the reasons why it has been taken on board as a top priority by not only NHS England but the care system from top to bottom. The start is to have the right screening and to gather the right data so that we can identify where this needs to be improved. She is right that it needs to be integrated into nursing practice so that we not only prevent malnutrition in the first place but, where it does occur, provide the right support to put it right and the right care where there are health consequences for individuals due to clinical, social or economic problems.

My Lords, I must confess to the House that I am president of the Hospital Caterers Association. Would the noble Baroness agree that there is no shortage of good advice on dealing with malnutrition and good food in the health service; nor is there a shortage of good catering professionals? The issue is trust boards that will not invest sufficiently in this area. Will she start to instruct the NHS to get serious about this if we are going to deal with this big problem?

The noble Lord is quite right that this is about leadership not only at board level but from the very top. It has been instructive that not only the Secretary of State but the chief executive of NHS England, Simon Stevens, have made it one of their priorities to ensure that the quality of food and food safety standards throughout the hospital and care systems should be improved. This is one of the key ways that we will drive out malnutrition from our health and care sector.

Could my noble friend please take a look at the frail elderly living alone at home who are not necessarily regularly seen by doctors because they do not present with symptoms? Very often, the older people get the more difficult it is, as the body starts to age, for them to absorb nutrients, even when they are eating a mixed diet. Could she take a look at that particular group, in the way that we look at people who have regular check-ups with a GP for heart problems and diabetes, to ensure that they are not just deteriorating? It is not until they deteriorate to the point where they become ill and symptomatic that people start to notice that there is a problem.

My noble friend is absolutely right. Evidence is on the rise that malnutrition is worse among older age groups and is both a cause and consequence of ill health. We must make sure that we are identifying and intervening as early as possible to make sure we are not leading to some of the challenges raised by the noble Baroness. That is why the malnutrition universal screening tool has been developed by the Malnutrition Advisory Group to assist those in nursing and in general practice to intervene as early as possible to prevent some of the challenges that she has identified.