In response to Andrew Lansley’s promise that NHS hospital food will improve, BAPEN calls for the Health Secretary to work directly with them to eliminate avoidable malnutrition in England. Although BAPEN welcomes the Government’s promise, it warns that hospital food is only part of the problem and that - what is needed, is a national malnutrition and hydration strategy to improve all aspects of nutrition provision across the NHS and Social Care. This will not be achieved if the focus is limited to hospital food alone.
It is clear to BAPEN that there are some key gaps in nutritional care that need to be addressed as a priority. In Bapen’s Nutrition Screening Week surveys, it was reported that, "The high prevalence of ‘malnutrition’ on admission to hospital and during a hospital stay is not a trivial problem that can be ignored and is not, as commonly cited, a problem caused by ‘hospital food’.”
Dr Ailsa Brotherton, BAPEN’s Honorary Secretary said, “There is a clear need for system-wide approaches and improvement to detect malnutrition early in both community and acute settings and to ensure that individuals who are ‘at risk’ receive appropriate nutritional care. In addition to appropriate, good quality hospital food, good nutritional care includes nutritional screening (and repeat screening as appropriate), a detailed nutritional assessment for ‘at risk’ patients and the development and implementation of an appropriate personalised nutritional care plan, which may include oral nutritional supplements, enteral tube feeding or in some cases parenteral nutrition. Developing highly reliable systems of integrated nutritional care has become a priority focus for BAPEN and we are developing a number of resources, including a Nutrition Improvement Guide that will help NHS and Social Care organisations to deliver improved care. However, to deliver improvements at pace and scale, BAPEN recognises the importance of the Department of Health developing a national nutrition and hydration strategy and the appointment of a National Clinical Director for Malnutrition to lead this work for the NHS.”
Dr Mike Stroud, Chair of BAPEN’s quality improvement committee and Chair of the NICE guidance development groups for both nutritional support in adults and IV fluids, stated, “The Department of Health is fully aware of the importance of nutrition and is currently considering the improvements required. Nevertheless, we are now asking Andrew Lansley to take personal responsibility for eliminating avoidable malnutrition in the NHS. In order to achieve this, good nutritional care must become a priority for the Department of Health with approaches including all elements of good nutritional care rather than simply focusing on hospital food. We also need the new executive agency, ‘Public Health England’, to make malnutrition amongst patients, the elderly and the vulnerable, the focus of an early awareness campaign, and the National Commissioning Board to develop clear outcome measures to monitor prevalence of malnutrition and the quality of nutritional care that is provided.”
Anne Holdoway, Chair of the Parenteral and Nutrition Group of the BDA welcomed Andrew Lansley’s acknowledgement of the importance of good food and nutrition for patients in hospital, ensuring that patients get the right nutrition and that it is ‘personalised’. She said, “Registered Dietitians are leading on many initiatives across the UK and collaborating with catering teams and healthcare professionals to ensure that hospital diets are nutritious and appropriate for the diverse patient groups. Sadly patients are still denied access to individual advice as a result of lack of resources and low numbers of Dietitians employed in the hospital and community sector. With less than 7,000 Dietitians working to fulfil the needs of the entire UK population patients are unable to receive the education and information that would empower them to improve and self manage their nutrition in the long term”.
Liz Evans, Chair of the National Nurses Nutrition group agreed, adding, “ It must be acknowledged that BAPEN screening weeks show the prevalence of malnutrition in the community and it therefore is vital that vulnerable patients are not further nutritionally compromised during their stay in hospital. Whilst I am pleased that Mr Lansley acknowledges the importance of good, nourishing food as a key part of recovery, it is also important that there is recognition of the role that nurses play in the delivery of this part of treatment. Food provision should not be seen as a ‘hotel service’ but as an integral part of a person’s recovery from illness. As such, organisational routines in hospitals should be arranged so that nurses can participate fully in feeding and hydrating patients. Sadly, despite innovations such as Protected Mealtimes and Red Trays, this is still not happening in many areas”.
Dr Tim Bowling, Chair of BAPEN concluded, “We are committed to working with the Government and the Department of Health to improve the nutritional care individuals receive. BAPEN is making a major contribution to improving the quality of patient care and saving money through its development of resources and the support we are able to provide for NHS and care organisations as they strive to prevent and treat malnutrition.”
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