Eat up and get well

Over the last few years there has been a consistent interest in food served to patients in hospitals and more recently this has extended to food served in care homes. The British Dietetic Association (BDA), the professional body representing registered dietitians, has long recognised the importance of food as a vital part of recovery and healing. Food Counts, a BDA specialist group, was established in 2000 and has grown stronger as a voice for food in hospitals and care homes as the first choice for nutrition support.
    
The BDA and Food Counts were at the forefront of the development of the Council of Europe Ten Key Characteristics, which shows how good nutrition should be implemented and delivered in all parts of healthcare. The Department of Health has taken this agenda forward and developed Improving Nutritional Care, a joint action plan.

Improving Nutritional Care
Improving Nutritional Care is the result of collaboration between the Department of Health and a wide range of stakeholders committed to improving nutritional care across the NHS and Social Care. Summit meetings were held in 2007 and five key priorities for action were agreed:

• To raise awareness of the link between nutrition and good health and that malnutrition can be prevented.
• To ensure that accessible guidance is available across all sectors and that the most relevant guidance is appropriate and user-friendly. 
• To encourage nutritional screening for all people using health and social care services, paying particular attention to those groups that are known to be vulnerable.
• To encourage provision and access to relevant training for front-line staff and managers on the importance of nutrition for good health and nutritional care.
• To clarify standards and strengthen inspection and regulation.

Many readers will be aware of this statement of intent published by the Department of Health in England at the end of October 2007. Having enough to eat and drink is one of the most basic of human needs. And yet we know from the Department of Health’s, Dignity in Care Campaign, recent media articles, research reports and official complaints, that some vulnerable people are not having these basic needs met. The very people who are being cared for by health and social care services are at times not getting the right nutritional care to support them in eating and drinking adequately.
    
Gordon Lishman, Director General of Age Concern, leads the Delivery Board and it has until December 2008 to deliver the improvements described in the Action Plan and work is underway in several sectors to secure this. Dietitans will be involved in the working groups where appropriate with Rick Wilson, Director of Nutrition and Dietetics, Kings College Hospital, leading the awareness group.

Council of Europe Alliance
Following on from the launch of the Council of Europe’s Ten Key Characteristics, more is being done on the first of the characteristics: namely to identify patients at risk of malnutrition. Hence screening is one of the major themes of the Nutrition Action Plan. Many dietitians were involved in the BAPEN National Screening week in 2007, the results of which have now been published suggests that malnutrition affects almost one in three people being admitted to either hospital, care homes or mental health units. As nutrition screening policies and practices vary it is possible that much malnutrition is unrecognised and therefore under treated. As much of the malnutrition originates in the community, strategies need to be developed to identify, prevent and treat malnutrition in all care settings.
    
Dietitians have long been involved in hospitals and dietitians are also working with care home owners to help them develop appropriate nutrition strategies. For example, freelance dietitian, Penny Doyle recently helped launch a Nutrition Focus Campaign, which provides new nutritional advice, staff training and new menus for Quantum Care Home’s mangers and staff. Quantum Care Homes, which provide residential care for the over 65s in 30 homes across Hertfordshire, specialise in the care of people with dementia. The illness affects one in 88 people in the UK and recently gained further prominence when fantasy author Terry Pratchett announced he had Alzheimer’s disease.
    
At the launch Penny spoke to delegates, including care home managers and chefs, about the nutritional needs of the elderly with a focus on dementia care. She also ran workshops where delegates could learn new skills including nutrition screening, smoothie making, and sample some healthy snack recipes developed by Quantum’s own chef managers. So things are beginning to change but more has to be done!
    
Following screening it is important that care plans are put in place for those at risk of malnutrition. Access to nutrition advice must be available and dietitians are the best-trained professionals to provide this advice, either directly to patients or through appropriate training for other professionals and carers. Dietitians also have a role in ensuring that menus are appropriate and appealing with Delivering Nutritional Care through Food and Beverage Services, a toolkit for dietitians available freely on the BDA website and offering guidance in all areas of menu planning and working with caterers in all care settings.

Practical benefits
The National Patient Safety Agency (NPSA) is also working with key stakeholders to review the impact catering services has on patient safety. Nutrition is considered a patient safety issue as missing a meal is as important as missing medicine. Both professional organisations and private sector providers are involved and the focus of the work is to analyse the issues and take a patient centered approach in developing potential solutions. They agreed that the first focus of its activities would be on the development of a Best Practice Toolkit consisting of ten fact sheets each focusing on one of the Ten Key Characteristics of Good Nutritional Care in Hospitals.
    
The ultimate aim is to provide a practical resource that will assist NHS organisations in the implementation of the ten key characteristics. Three fact sheets have already been developed and were launched at the RCN Congress in April. They include:

• Food service and nutritional care is delivered to the patient safely
• The hospital supports a multidisciplinary approach to nutritional care and values the contribution of all staff groups working in partnership with patients and service users
• The ward implements protected mealtimes to provide an environment conducive to patients enjoying and being able to eat their food.

Further fact sheets will be developed and will be launched over the next year.
    
The NPSA is also carrying out work on identifying some of the other safety issues and potential solutions to address these such as national signage and training.
    
Dietitians both at strategic and operational levels are continuing to be instrumental in delivering nutritional care by working with clinical and catering colleagues. The delivery of the nutrition action plan is working to a very tight deadline but this only emphasises the need for good nutrition within all care settings.