One of the things discovered by the Panorama team when they worked in the Royal Sussex County Hospital, was that some patients on the acute ward where we filmed were not being encouraged to eat or being helped if they needed it.
In 2000, the NHS plan noted that 'getting the basics right' in terms of hospital facilities like food and cleanliness, was amongst the top ten things that the public wanted to see in the NHS. It also acknowledged that hospital food "is variable in quality, it is not provided in a way which is sufficiently responsive to patients, and too much of it is wasted as a result."
It set aside an extra £10 million to provide for improvements in food alone. This would include as 24 hour catering, new menus and in half of all hospitals 'ward housekeepers' who would ensure that the quality, presentation and quantity of meals was meeting patient needs and that "patients particularly elderly people, are able to eat the meals on offer."
For more information see sections 4.16-4.18 of the NHS Plan which is available for download via the link below
The Better Hospital Food Initiative was launched as a result of this plan in May 2001. On launching a new 'NHS Recipe Book', Alan Milburn, then Secretary of State for Health state that "Patients have a right to expect good quality, nutritious food, served to them at times which suit them, by staff who understand the important role that food plays in the care patients receive."
The programme redesigned the NHS menu, both in terms of new recipes and how choice was presented to the patient.
The Royal Sussex County Hospital is part of the Government's Better Hospital Food programme. This means the hospital is committed to providing high quality food and food services to patients. The hospital has a daily menu offering a choice of four hot meals but there is also a wider range of food available which has to be ordered specially. However, our undercover hostess, Shabnam Grewal was sometimes discouraged from offering patients a full choice, because food not on the main daily menu had to be collected separately from the hospital kitchens and could delay delivery of other meals.
40% of patients enter British hospitals in a malnourished state - meaning they have not been eating well enough to keep themselves healthy. And intake of nutritious food is crucial for patients who are recovering from the effects of medical or surgical procedures. According to NHS Estates, patients who receive good nutrition may have shorter hospital stays, fewer post-operative complications and less need for drugs and other interventions.
As part of the Better Hospital Food initiative, trusts are also being encouraged to introduce 'protected mealtimes' in hospitals. These are times on each ward set aside for eating, so that patients do not find their meals interrupted by non-urgent drugs or doctors' rounds. It should also be easier for nursing staff to focus on eating, during these times and ensure that people are properly fed.
In wards caring for elderly people, there are likely to be patients who need help with feeding or cutting food. Whilst providing food can be done by other hospital staff, helping patients to eat properly is a key part of a nurse's duties. A 2001 Standing Nursing and Midwifery Advisory Committee report, stated that "ensuring each patient has an adequate daily intake of food and fluid is a nursing responsibility."
And in a Royal College of Nursing (RCN) publication "Caring in partnership: older people and nursing staff working towards the future" it states that nurses will achieve good quality care by:
"recognising that older people may need help and encouragement to eat, drink and maintain their personal hygiene, and providing that help in a sensitive and appropriate manner
More recently 'Modern Matrons', who are nursing staff, were given the responsibility of 'ensuring patients' nutritional needs are met'.
A RCN report which reviewed these developments concluded that "current policy and professional literatures advocate a strong nursing contribution to nutritional care, and represent this as an integral (if neglected) part of nurses' therapeutic role."
In July 2004, the government published a new set of national standards for healthcare in the NHS. There are 24 core standards which set out 'the minimum level of service patients and service users have a right to expect'.
These standards matter to hospitals, because in September 2006, each trust's performance against them will be published by the healthcare commission. On this basis, in place of the current system of star ratings, the public will learn how each trust rates on a four point scale ranging from weak to excellent.
For a full list see "Standards for Better Health":
Food is included in standard C15:
"Where food is provided, health care organisations have systems in place to ensure that a) patients are provided with a choice and that it is prepared safely and provides a balanced diet and b) patients' individual nutritional, personal and clinical dietary requirements are met, including any necessary help with feeding and access to food 24 hours a day."
Whether or not a trust is meeting this standard will be in part determined by PEAT inspections. PEAT are 'Patient Environment Action Teams' which are formed by each trust and consist of hospital staff and representatives from patient groups. This year they will be scoring trusts out of five on nine standards: menu, choice, availability, quality, quantity, temperature, presentation, service and beverages.
Overall, of the hospitals covered by these inspections in 2004, 58% were rated as either excellent or good, 35% as acceptable and only 7%.
Brighton and Sussex University NHS Trust has been rated by PEAT assessments since 2002. It was initially given an amber rating, in a traffic light system where red was below standard and green was good. It moved up to Green in 2003. Most recently it got a 'good' rating on a five point scale, where excellent was the top indicator.