Preventing malnutrition in later life

Reflecting on food standards in hospitals

Dianne Jeffrey400

In 2013, Dianne Jeffrey took up chairmanship of the Hospital Food Standards Panel, which in August 2014 published a selection of standards to improve hospital food. In this piece, Dianne, who is also chair of the Malnutrition Task Force, reflects on the progress made on hospital food standards since the Panel’s publication and looks to see what more needs to be done. 

Going into hospital can be very worrying.

You may be in pain and nervous about what’s going to happen next, feel disorientated by being in a busy environment, or find it distressing being away from loved ones.

All this can be compounded by having no control over food, or by being served food that’s unappetising and unappealing.

However, getting hospital food and drink right is critical. After all, good nutrition and hydration are a vital part of the healing and recovery process for all patients.

We mustn’t forget as well that 1 in 3 older people are already at risk of malnutrition and dehydration on admission to hospital, showing there should be no excuse in letting standards slip.

Hospital Food Standards Panel

December 2013 saw the coming together of the Hospital Food Standards Panel. Our aim was to provide clear direction on the common, non-negotiable standards that should underpin the expert guidance, and give them teeth.

We went through existing standards and gathered a small number of highly relevant ones to make it easier for those involved to commission, provide and monitor food.

Unlike past initiatives, we also wanted to look at food and drink as a totality, so our work took into account everything from sustainable procurement to high quality catering and patient care.

Lastly, we wanted to showcase good practice and provide detailed information on how to make the changes.

We’re making progress

It’s been just over two years since we announced these standards and I’m delighted to say progress is being made.

Shortly after the Panel’s Report came out, our standards were included within the NHS Standard Contract. This is a significant, legally binding lever which ensures that commissioners and hospitals can be clear during their discussions on the requirements of hospital food standards.

Yet it’s important not just to look at the legal details, but also to look at the fantastic initiatives that have emerged on the back of the Report which are making a real difference in hospitals.

For instance, we know that MUST (the Malnutrition Universal Screening Tool), a quick five-step tool to identify adults who are malnourished or at risk of malnutrition, is now being widely used in a number of hospitals.

Elsewhere, with people with dementia often suffering visual problems, the County Durham and Darlington NHS Foundation Trust has developed specially adapted coloured utensils to allow patients to see more clearly the food that they are eating.

For those with swallowing difficulties, I’m pleased to say many hospitals now provide crustless sandwiches as well as texture modified and soft food.

We are also aware that an increasing number of hospitals are ensuring the availability of high calorie finger foods and cakes in the afternoon for those who need small meals and snacks.

Lastly, we know of hospitals using Specially-trained Enhanced Mealtime Support Volunteers. This is a brilliant idea which allows volunteers to sit and support patients at mealtimes, whilst releasing trained staff to help those who need more intense care.

But we can’t be complacent

There’s no doubt that this marvellous work fills me with positivity.

But we must remember our job is far from complete.

A recent National Inpatient Diabetes Audit reported that over a third of inpatients with diabetes said hospitals didn’t always provide the right choice of food for them to manage their diabetes – a basic but critical health need.

This is worrying and underlines how big the challenge is for every hospital in ensuring all patients receive the level of help with eating and drinking they require, when they require it.

The Panel are not resting on their laurels either. I am happy to announce we too have recently reconvened to review our standards to see what progress has been made in the last two years.

After all, turning this situation around must be a top priority and no-one can afford complacency.

Panel recommendations so timely

Back in 2013, we had no national mandatory standards for hospital food in England, no national guidance for commissioners and no implementation programme.

So I’m pleased to see how far we’ve come.

With food and drink so important to recovery, and a large number of older people at risk of malnutrition on admission to hospital, we should all be passionate about improving food standards in hospitals.

It’s true we still have further to go, but this has only reaffirmed for me that our Panel’s standards are more timely than ever in supporting hospitals to look after patients.

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