BAPENs research has provided us with consistent information on the scale of malnutrition in the community for the first time. This work highlights the fact that on being admitted to a hospital or a care home it is important that every older person is given a nutritional screening which is reviewed on a regular basis.
That point relates not just to older people. It appears that there is some division on the matter. I see that
there is to be a nutrition action plan, but I can find little by way of an update on it since the announcement that it was being set up. I am not clear whether those involved have even met yet.
I was struck by an article called Behind the Medical Headlines by Dr. McKinlay, who is a consultant gastroenterologist at Aberdeen Royal infirmary. I do not think that malnutrition is any different a problem in Scotland; in fact, BAPEN said that it was fairly consistent across the four nations. The article was even more damning. It was based on a survey of prospective in-patients at a Dundee hospital and it said that more than 40 per cent. of acute admission patients are undernourished and 75 per cent. of patients lose weight during their hospital admission. That is a worrying statistic. The article goes on to discuss some of the reasons for that and we must also bear in mind that patients are not moving around and burning off energy.
Mr. Stephen OBrien: The hon. Lady highlights one of the points that has caused me the greatest anxiety. Since 1997, more people going into hospital are malnourished, either because is their usual state or because it is part of their illness. Not only do more people come out more malnourished or undernourished than when they went in, but the numbers of those who go in malnourished have grown compared with 10 years ago. The incidence of malnourishment as a phenomenon has increased over that period, which is why it is so crucial that the issue is added to the Bill. That would send a message from this place and put the issue on a par with health care-acquired infections.
In 2005, BAPEN published an economic analysis of the cost of disease-related malnutrition in the UK. The total cost was estimated to be £7.3 billion, with approximately £3.8 billion incurred in hospital and £2.8 billion in long-term facilities. I would have assumed that the Government were keen to address that avoidable cost by putting in place some simple measures. We have all seen the programmes with undercover filming in geriatric wards and nursing homes, in which people are not helped to eat or given inappropriate food. Tackling the problem, and ensuring that there is a clear code of behaviour, would also address some of the human rights aspects of the issue. As the hon. Gentleman rightly pointed out, this is a human rights issue, because many elderly people are not getting the care and attention they deserve, however many dignity strategies the Government introduce.
In the majority of inpatients, however, the most important single factor leading to malnutrition is probably loss of appetite and failure of intake.
If someone is unable to eat for any reason, there are things that can be done to minimise the results. There is little detail behind the amendments, but they are well intentioned. I hope that they will find some favour with the Government, because the problem is real and avoidable. There are no targets to address it and it is too often overlooked.
Kelvin Hopkins: I wish to contribute briefly to this debate. Traces of minerals and vitamins have been shown, even in the last week, to be of crucial importance in the onset and development of Alzheimers and of dementia in general. I urge the Minister to pursue that research because it could make a tremendous difference not only to the lives of millions of people who might not develop dementia if they have the right diet and vitamin and mineral intake, but to those who already have the disease, because it could be prevented from developing further.
Mr. Stephen OBrien: We need to be careful not to let the market get ahead of us, because we should be trying to lead on this issue, not follow. Interestingly, the sale of aluminium kettles and pans has collapsed since the suggestion that aluminium deposits in boiled water could contribute to the development of dementia.
Kelvin Hopkins: We are certainly well aware of the problem with aluminium, but some vitamins and trace elements are positive in their effects. I want to be sure that the Government are aware of the most up-to-date research and promote the use of those vitamins and minerals by those who are healthy as well as by those who are already in care, not only for the welfare of people in generalabout which we are all concernedbut for the sake of public expenditure. If fewer people become ill or can be kept healthier when in care, there will be a saving to the public exchequer
Sandra Gidley: Is the hon. Gentleman aware that research has shown that if the level of nutrition is generally higher, it reduces GPs workload? If we send people out of hospital in a better state of nutrition, it will reduce the GP bill.
Kelvin Hopkins: I am sure that we would all agree that it would be beneficial all round. Specifically, it would be beneficial to the public purse, as well as to the general wellbeing of the population. I urge my hon. Friend the Minister to do what he can to pursue the most modern research and promote good nutrition in the healthy, as well as in those who are already in care.
Angela Browning (Tiverton and Honiton) (Con): I am pleased to support the amendments as I spoke on the issue in Committee and I have raised it in the House in the past. The Government must take this opportunity.
A code of practice should ensure that people who are sick and who have been admitted to hospital are given a good, nutritionally balanced diet, but it should also go further. It should require that a patients particular medical condition is taken into account when balancing their nutrition. If people have suffered serious bone damage, it is important that they get certain vitamins and minerals, such as calcium phosphorus and vitamin D, to enable the growth of new bone. Of course, those vitamins and minerals are also important for healthy people, to try to offset osteoporosis and other problems.
The hon. Member for Luton, North (Kelvin Hopkins) mentioned dementia, and we now know that certain vitamin and mineral deficiencies cause behavioural symptoms that are often misdiagnosed. It is important that a professional takes a close interest in how patients are eating and behaving, as well as in their physical
condition. I do not suggest that we want the professionals to have to tick lots of boxes on a piece of paper, because it could become so bureaucratic as to lose its purpose, but I hope that the Minister will be receptive to the firm plea from both sides of the House that a code of practice is included in the Bill.
The issue is not just the food, or even just the quantity, although it is important to monitor significant weight loss in people in residential and nursing homes or in-patients. That can tell a professional that something serious is going on. Also, particularly with elderly people, it is important to ensure that the code of practice identifies what we expect of the home or the hospital in assisting people, who might otherwise be unable to accept what is on the menu, to eat. Of course, that will start to involve assistance with eating and, as we all appreciate, that involves staff time, which is often rare in hospital wards.
In Committee, I mentioned the difficulty of dealing with elderly people in trauma wards who often cannot hold their knife and fork, or even a spoon, and who need somebody to sit with them and help them eat. If the Minister is prepared to be helpful on this point, I hope that the code of practice will consider not only the food and nutrients but what is done to assist people in getting that intake of food. Sometimes, such help is about listening and observing more than anything else.
In my experience of having elderly relatives in hospital, some at the end of their lives, when I have seen best practiceand I haveit has been extremely good. I am thinking particularly about my mother during her last weeks in the excellent Wokingham hospital. As she was unable to take solids, her food was mashed and later pureed. A lot of thought went into what consistency the food should be that she would be able to eat. In contrast, other relatives in other hospitals did not have that experience. It was extremely distressing. As a familyin this countrywe felt that we had to work a rota to ensure that elderly, frail relatives were fed at mealtimes in hospital.
Mr. Stephen O'Brien: My hon. Friend is giving moving evidence, which is an accurate observation that has, I am sure, been shared by many here and outside this place. She will be the first to accept that however important it is for family members, when they exist, to take part in a rota, an adjustment is needed in the expectations placed on nurses. They ought to be given the time to do the difficult task of getting the appropriate types of food into the mouths of those who are most vulnerable and unable to help themselves, and that use of their time should be valued. At the moment, many of the other targets drive nurses away from feeling that they have the time to do that.
That is obviously right. Families who have a loved one in hospital or sick want to do their best for them. I am not saying for one moment that relatives do not want to help, willingly, at mealtimes and other such times. However, there is a difference between the relative who sits by the bed and helps to deliver the meal to the patient and the family who feel that they have to be there at lunchtime and in the evening just to ensure that the patients gets some food. There is a fear that if families do not organise that
themselves, the patient will slip through the net. We should not accept that in this country in this day and age.
This is an important opportunity. As MPs, we have to deal with such casework from time to time and it is distressing to have to deal with cases that involve people who have not received help and support on nutrition and feeding, particularly when they become frail and vulnerable. As we get an older population, more people do not have any close friends or relatives. In those cases, it is important that the residential care home, the nursing home or the hospital ward not only protects peoples human rights but has a code of conduct that is in force and inspected to ensure that such cases occur fewer times, not more. The trend is going the wrong way. The Minister is a compassionate man. If he wants to show that compassion during any part of the Bill, now is the time.
Mr. Brian Jenkins (Tamworth) (Lab): As my hon. Friend the Minister knows, I was not going to speak on the Bill. However, alarm bells are ringing in my head as I sit here and listen to peoples speeches. I know that they speak with the best intentions, but clause 16(3)(b) clearly states that regulations may
make provision as to the manner in which a regulated activity is carried on.
We are discussing encompassing in that a regulator who will look after people and make provisions on how activity is conducted. I had grave doubts about telling people, You must stop infecting people as they enter your hospital. I do not think that any hospital intends to infect people. I do not want to tell doctors and nurses to wash their hands between going from patient to patient. That is a difficulty. If we are now to start telling the people who are running our health service, You must start feeding patients, something is dramatically wrong. If we are to start telling residential homes that they must start feeding their clients, that is wrong.
If we list 24 different items that are included, when number 25 comes up we will be unable to blame the bodies, because they will say, It wasnt on your list of 24, Minister. Surely, we are providing a general duty. If the Minister is going to add more to the Bill, he should be careful. Anything left off will be deemed unimportant because of its omission. I acknowledge every sentiment about the problem of malnutrition in our hospitals and residential homes, but I ask the Minister, please, to be careful before he starts telling those organisations what meals they need to have and what vitamins they should put in their food. I felt that concern as I heard the debate; the Minister should be wary of going down that path.
We enjoyed a long and detailed debate on this issue in Committee. As I said then, I have a great deal of sympathy with the motives behind the amendments, but there are good reasons why they are unnecessary. As most hon. Members have recognised, we are making significant progress. We have been working closely with the Food Standards Agency to improve the nutritional quality of hospital meals. We have launched the better hospital food programme, which is having an impact. The patient environment action team assessments show
that there has been an increase from 17 per cent. of food being described as good in 2002 to 44 per cent. being rated excellent in 2006-07.
We also recognise that older people in hospital are particularly vulnerable to malnutrition. To identify and deal with that risk, we have introduced protected meal times. We are putting particular emphasis on the screening that has been advocated by a number of hon. Members in this afternoons debate. Those two areas of work are being pursued by the National Patient Safety Agency.
The Royal College of Nursing has recently signalled its commitment to addressing the issue and has launched its nutrition now campaign, which aims to help all nurses at all levels to improve the nutrition and hydration of patients. The Nursing and Midwifery Council, the regulatory body for nurses, has identified nutrition as one of the core skill areas to be singled out for special assessment of competence before nurses are admitted to the register, a move that we warmly welcome.
As I mentioned in Committee, last October the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), launched a nutrition action plan to build further on that work. The plan is being developed with leading stakeholders. Indeed, Opposition Members referred to the Age Concern report, Hungry to be Heard, and they will be pleased to learn that Gordon Lishman, the director of Age Concern who is responsible for pioneering work in the field of nutrition, has agreed to chair the national action plan delivery board.
I also described in Committee the detailed standards in nutrition that apply to the NHS under the standards for better health and the national minimum standards that apply for registered health and adult social care providers. They are core standard 15a, which states:
Where food is provided, health care organisations have systems in place to ensure that...patients are provided with a choice and that it is prepared safely and provides a balanced diet.
patients individual nutritional, personal and clinical dietary requirements are met, including any necessary help with feeding and access to food 24 hours a day.
For assessment against core standard 15, the Healthcare Commission will use the criteria, which were signed off by the Secretary of State for Health in 2007-08, that patients should be offered a choice of food in line with the requirements of a balanced diet, reflecting the needs, preferences and rights, including faith and cultural needs, of the service user population.
I also went on to describe how the Healthcare Commissions national in-patient survey had shown that 53 per cent. of adults now rated the food that they ate in hospital as good or very good. The better hospital food programme, which was launched in 2001, introduced five key improvements: 24-hour service, NHS snack boxes, additional snacks twice a day, a hot meal in the evening and menus including three dishes created by leading chefs. So an awful lot is happening with food and nutrition, but I accept the points made by hon. Members that more needs to be done.
In December, we published our annual operating framework, which recognised for the first time the
importance of including regard for the patient experience as one of the NHSs five main priorities. If there is one thing that comes up time and again in consultations and when hon. Members talk to their constituents about their experience as patients, the quality of food is very high on the list, as well as issues such as how people are treated by staff and receptionists. It is very important that, by including the issue in the five main priorities that the Government have given to the health service, we will see further improvements. Indeed, I held a meeting last week to find out how we could best spread the really good practice that hon. Members are aware of happening throughout the country. I recently visited Cornwall, where the local hospitals are doing an excellent job in serving, I believe, 80 per cent. of locally bought produce, fresh from local farmers, butchers, dairy farmers and fishermen. That is going down very well with patients there, and it is improving recovery rates.
I want to deal with the claim made by the hon. Member for Eddisbury (Mr. O'Brien) both here and in Committee about patients allegedly being discharged with malnutrition. He made that claim, both generally and in Committee, in reference to my local excellent hospital. It surprised me, and it also surprised the chief executive of the Royal Devon and Exeter hospital. It might be based on a misunderstanding of the definition of episodes. If he will bear with me, it is important that this is put on the record, as the allegations are quite serious.
For the purpose of the hospital episode statistics, a patients stay in hospital is referred to as a spell and each period under the care of one consultant is known as a episode. So a patient who is under the care of several consultants during the spell in hospital has several episodes. Someone under the care of only one consultant throughout the stay has only one episode. For the purpose of the statistics from which the hon. Gentleman draws his allegations, the first episode is known as the patient admission episode and the last episode is known as the discharge episode.
If someone has only one episode in hospital and if they remain under the care of only one consultant during their stay in hospital, their patient admission episode and their discharge episode would be the same. So someone admitted, for example, for the treatment of a nosebleed would have nosebleed recorded as their admission episode and their discharge episode. That does not mean that they leave hospital with a bleeding nose. Similarly, someone whose final treatment episode is registered as being for malnutrition does not leave hospital with malnutrition, as the hon. Gentleman suggested earlier. They are not discharged with malnutrition.