A presentation from Caroline Lecko from the NHS Commissioning Board at the Department of Health Improving Hospital Food event about issues facing vulnerable patients.

1. Improving Hospital Food Event
11March 2013

2. NHS | Presentation to [XXXX Company] | [Type Date]2
Issues for our vulnerable patients
Caroline Lecko
Patient Safety Lead
NHS Commissioning Board

3. Fundamental Principles – implications to
our vulnerable patients
• Nutritious and appetising hospital food and drink is an essential part of the
personal package of care and hospitals should take all reasonable steps to
ensure that patient have a healthy food experience
• All patients should be able to choose from a reasonably varied menu which
compliments their clinical care requirements whilst meeting their social and
religious needs
• All patients should have access at all times to fresh drinking water, unless this
is contraindicated by their clinical condition
• Access to food and drink outside planned mealtimes should be available where
appropriate
3

4. Who are our vulnerable patients?
• Chronic disease – COPD, cancer,
inflammatory bowel disease, GI,
renal or liver disease
• Chronic progressive disease –
dementia, neurological conditions
e.g. Parkinson’s disease, MND
• Acute illness – food unlikely to be
consumed for 5 days
• Debility – frailty, immobility, old
age
4

6. High Profile Reports

7. CQC Dignity and Nutrition Inspections

8. The Malnutrition Task Force
• Independent group of experts from health, social care and
local government united to address preventable
malnutrition in all settings
• Aim to reduce malnutrition in older people to optimise their
health, reduce unnecessary costs improve quality of later
life
• Developed best practice principles and guidance including
one for hospitals – the principles are
• Raise awareness of the issue, costs and benefits
• Working together –clinicians and caters
• Identify malnutrition
• Personalised care, support and treatment
• Monitor and evaluate impact and progress
• Visit www.malnutritiontaskforce.org.uk
Malnutrition Task Force

9. Francis Report
At Stafford some patients were left food and drink and offered
inadequate or no assistance in consuming it. Even water or
the means to drink it could be hard to come by.
The experiences at Stafford to which witnesses testified are by
no means unique in the NHS in England, as has been shown
by the Care Quality Commission dignity and nutrition reports
since.
Recommendation
241 Provision of food and drink
The arrangements and best practice for providing food and drink to elderly
patients require constant review, monitoring and implementation.
9

10. For those not familiar with Francis……..
“Swallowing was a problem for Irene and I had to give her Fortisips
with a syringe. I was just trying to make sure Irene was eating.
However at 5pm you had to go. This was meal time. I could not see
whether Irene was eating or not. One time I visited I saw a trolley
with a dinner on it at the foot of her bed, out of Irene’s reach. I asked
the lady next to her whose dinner it was. She told me it was [my
wife’s]. It had been left uncovered and was stone cold. I found a
nurse and asked her whose dinner it was; she told me it was Irene’s I
said “you’re joking, Irene can’t eat a dinner”. The nursing staff should
have known about [her] eating requirements.”
10

11. 11
“the glasses on the ward, they were flimsy, they were the plastic glasses.
And mum’s eyesight was really, really bad, and anybody with bad eyesight
can’t pick the jug up and see where they’re pouring into they—by the time
you’ve picked that glass up you’ve crushed it, you know, its collapsed in
your hand.”
“… some of the people in there can’t even get out of bed; they can’t fill in
their own menu. You would find the food tray was 3 foot away from the
bed; they couldn’t get a drink. There was just nobody there. I remember a
conversation with one of the senior nurses who told me that she was on
her own and had 50 meals to serve. I’d have put an apron on myself and
gone and helped, that is what you felt you wanted to do.”

12. Going back to the principles - 1
• Nutritious and appetising hospital food and drink
is an essential part of the personal package of
care and hospitals should take all reasonable
steps to ensure that patient have a healthy food
experience
“Visits to hospitals indicated that there is a
heightened awareness of the need to get systems
in place to ensure proper nutrition and hydration for
all patients and a variety of local, frequently nurse-
inspired, initiatives were seen.”
12

13. Going back to the principles - 2
• All patients should be able to choose from a
reasonably varied menu which compliments their
clinical care requirements whilst meeting their
social and religious needs
• Do we really think about reasonably varied
menu’s for all?
13

14. Going back to the principles - 3
• All patients should have access at all times to
fresh drinking water, unless this is
contraindicated by their clinical condition
• Do we really think about what access means?
14

15. Going back to the principles - 4
• Access to food and drink outside planned
mealtimes should be available where appropriate
• Is accessible food really suitable for all?
15

16. Some other challenges to consider
• Meal times – who do they suit?
• Fit for purpose packaging!!!
16

17. Thank you
caroline.lecko@nhs.uk
17