Putting nutrition at the heart of caring for older people

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Last week the Care Quality Commission (CQC [1]) released the first of its inspection reports into the care of older people in NHS hospitals. They found a great deal to be concerned about, as some hospitals did not even meet their legal requirements for nutritional care. We have to ask, how is it that we can treat people with so little respect and dignity?

For those of us working in older people’s nutrition, the reports are more depressing than surprising. Despite some extraordinary work and the efforts of many, things have been slow to change. This is not due to a lack of guidance (NICE [2] and DH [3] both have clear guidance), but perhaps due to a lack of understanding or appreciation of the role of nutrition and hydration in improving health and well-being. Too many working in this sector do not consider nutrition to be a part of healthcare.
So how can we address this imbalance? Is the system broken as some would suggest? Recent media reports would certainly have us think so, but the reality is somewhat different, as many people at all levels are working to ensure better care and nutrition for older people.
The first challenge is to re-establish the basics; nutrition is a vital part of care. Not an afterthought or a regulatory requirement, but a vital and vibrant part of hospital life with staff of all levels involved and proud to be so. We should not be a position where doctors find it necessary to prescribe water to ensure people are getting enough to drink. Indeed, it should be offered so frequently that it is done without thinking.
There are many examples of excellent care and dedicated staff throughout the NHS. We should champion these, incentivising others to join in and penalise where appropriate those who do not make nutrition an essential part of the care of older people. It is vital that patients have someone fighting their corner.
We should spend more on food and support nursing staff to help older people with eating. Often wards are so understaffed that those needing feeding support are forced to ‘queue’ until staff can get to them and in the meantime trays are removed as catering staff think people aren’t hungry. The need for communication and a joined up approach is critical.
We need training on nutrition, not just on screening and we need to ensure that staff have enough of that most precious of resources; time. Time to sit with patients who need help, provide company to those eating alone, thus reducing the isolating experience of hospital, and ensuring people are eating and drinking enough for their needs. This is not a complex issue; it is about care pure and simple. It is about caring for an older generation to whom we owe so much and caring about someone in need. It is about caring that people have good quality food and opportunities to drink while they recover from illness.
Maybe our care services need reminding that nutrition is a core part of their purpose and the fact that this issue is being discussed is a start. The CQC need to continue to highlight good work and bad, but we need to be sure that when doing so it has meaning and leads to improved care, not just another news headline.
Dr Lisa Wilson
Lisa Wilson is a registered public health nutritionist.
[1] http://www.cqc.org.uk/
[2] http://guidance.nice.org.uk/CG32
[3] http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_079931

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