Eating your way to recovery

There is considerable scientific research to prove that food can make a significant contribution to a patient’s progress and wellbeing whilst in hospital. The Better Hospital Food Programme was a Government initiative that certainly ensured the subject of hospital food no longer remained in the shadows but became a service that was as integral to patient health care as any treatment or medication.
    
There is also much evidence to support the view that the Better Hospital Food Programme helped to improve the standard of patient meals. Annual independent Patient Environment Action Teams (PEAT) surveys over the past few years have revealed unprecedented levels of satisfaction with hospital food. But does this mean that all is now well with the provision of hospital food in our hospitals?
    
The Hospital Caterers Association (HCA) believes there is still a long way to go in relation to improving food service, food consumption and nutritional intake at ward level. There is, after all, little point in improving the quality and presentation of food on the plate if the patient cannot eat it, for whatever reason.
      
Under-nourished patients
The HCA has been actively raising its concerns for some time over the unacceptable levels of malnutrition and under-nourishment amongst patients, particularly the elderly. With 40 per cent of patients malnourished upon entry to hospital and malnutrition costing the NHS around £7.3bn a year, there is clearly an urgent need for a more effective screening system on admission and a vigilant monitoring process throughout their stay. Screening is still not universally undertaken and many vulnerable patients slip through the net.  
    
The HCA believes that all hospitals should adopt the NICE guidelines issued in February 2006 and testing for malnutrition should be mandatory in England and Wales as it is in Scotland. These are in line with the requirements called for in the Council of Europe Resolution on Food and Nutritional Care in Hospitals, published in November 2002. The HCA was a founder member of the Council of Europe Alliance and has been a major player in developing the Alliance’s recently launched “10 Key Characteristics of Good Nutritional Care”.
    
The HCA has been urging hospital caterers to play a more pivotal role in ensuring that patients actually benefit from the food being delivered to hospital wards. Improving standards is far more than just about the quality of the food on the plate, it is about enhancing a patient’s whole mealtime experience.
    
Improving the quality of the food is also no good to anyone unless it gets into the mouths and stomachs of patients and that requires greater communication and collaboration between the dietetic, clinical and catering teams.
    
Working together
Caterers, nurses and dietitians all need to work much more closely together to improve the standard of food service on the wards as food can only be deemed nutritious if it is consumed and no food is consumed unless it tastes good.
    
If good service does not back this up, then we will fail to provide tasty and nutritious food to our patients. It is a straightforward argument but one that is difficult to deliver with our present NHS systems, policies and procedures. To create better service, these have to change.
    
Apart from the distress malnutrition can cause patients, it can also delay discharge and is associated with costly side effects such as pressure sores and infections. The NHS spends a considerable amount of money on enteral supplements and parenteral feeds. In the right format, ‘normal’ food is more appropriate and can be cheaper. Caterers need to play their role in ensuring that ‘normal’ food is always available when required.
    
Currently, there is evidence to suggest that patients, particularly vulnerable elderly patients, are not being given sufficient assistance to eat when meals are delivered to bedsides.
    
One of the ways to help address this issue and thereby tackle the problem of under-nourishment is for a greater number of NHS hospitals to adopt a policy of protected mealtimes. This would then ensure that patients can eat their food without unnecessary clinical interruption and that they receive the help to eat if they need it.
    
Food is without doubt the cheapest form of medicine and with clear medical evidence supporting the fact that good nutrition aids a patient’s recovery, greater focus must be placed on giving patients an appropriate level of support that is personal to their particular needs. Served at the right times, good food makes being in hospital more bearable, enhances patient satisfaction and performs a major function in the healing environment.
    
Quality of service
The HCA believes that it is now essential to examine, on a wider and more in depth scale, how patients receive their food. There has been enough emphasis on recipes and now there is a need to focus on the quality of the service. The HCA is strongly advocating that food should be provided by ward housekeepers or ‘hostesses’ working alongside nursing staff on every ward. As laid out under targets in The NHS Plan, many NHS Trusts already have housekeepers on at least some of their wards but it is the HCA’s view that the rest should now follow.
    
In April 2006, the Association published its Good Practice Guide for Healthcare Food and Beverage Service Standards. The Guide sets out the standards that patients should expect from Catering Services in all healthcare establishments and was compiled by an eminent team of experts drawn from NHS facilities and catering management nationwide including the British Dietetic Association, Royal College of Nursing, the Association of Domestic Managers and the British Medical Association.
    
Supporting individual needs
The Guide is designed as a ‘how to’ manual for delivering excellence in food and beverage service to patients and promotes outstanding service from the point at which food and beverages arrive in the service area to when the meal or refreshment service is concluded.
    
In conclusion, with clear medical evidence to support the fact that good nutrition aids recovery, our focus must now be on targeting patients with an effective level of support that is geared specifically to their individual needs on the wards.
    
Improving inter-team communication and co-operation is fundamental to ensuring patients’ nutritional needs are identified, monitored and maintained throughout their stay. Food still needs to be fully accepted by all members of the clinical team as being as important to patient wellbeing as their medical care and the HCA believes that its therapeutic role within the healing process should never be under-estimated.