Still ‘Hungry to be Heard’

Four years on from the launch of Age UK’s ‘Hungry to be Heard’ Campaign, positive steps have been taken to tackle malnutrition in older people in hospital. But the latest report from Age UK, ‘Still Hungry to be Heard’, highlights that nearly one-third of nurses(1) are not confident that it would be noticed if a relative of theirs was malnourished when entering hospital.

Michelle Mitchell, Charity Director at Age UK - the new force combining Age Concern and Help the Aged - states that more needs to be done to ensure people in later life receive food they can eat, and calls on hospital caterers to help raise the profile of the issue.

In 2006 the ‘Hungry to be Heard’ campaign was created because too many people in later life were malnourished in hospitals. Older patients were either admitted to hospital malnourished and nothing was done about it, or became malnourished in hospital because they didn’t get the right food or the help needed to eat it.

The campaign outlined seven key steps that hospitals urgently need to implement to ensure that people in later life do not become malnourished in hospital and that the £7.3 billion(2) per year cost to the NHS is reduced.

In the past four years politicians have acknowledged the seriousness of this issue and many NHS trusts have started to improve mealtimes for older patients. However, more needs to be done to eradicate the problem.

Guidelines state that hospitals are supposed to screen people in later life for malnutrition on arrival and during their stay. Currently, there is inconsistency from hospital to hospital and between wards. Some patients are screened inaccurately; others are screened accurately but no action is taken, and some are not screened at all.

Responsibility for putting an end to the scandal of older people going hungry in hospital lies with many parties including Government, the Care Quality Commission, hospital managers, ward staff and caterers.

Caterers play an important role in ensuring people in later life receive food they can eat. Age UK is calling for caterers to promote the seven steps, specifically steps 2 and 3, to help Age UK raise the profile of the issue and facilitate change on the ground.

The seven steps to better nutrition:

1. Hospital staff must listen to us, our relatives and our carers

2. All ward staff must become food aware

3. Hospital staff must follow their own professional codes and guidance from other bodies

4. We must be assessed for the signs or danger of malnourishment on admission and at regular intervals during our hospital stay

5. Hospitals should introduce ‘protected mealtimes’, so that staff cannot carry out routine tests or rounds when patients are eating their meals

6. Hospitals should implement a ‘red tray’ system, where people who need help with eating are given food on a red tray so that nurses and health assistants can easily identify them. Hospitals must monitor their ‘red tray’ systems and ensure that it works in practice

7. Hospitals should use trained volunteers where appropriate

Step 2 of the seven steps encourages all ward staff to become food aware. Missing a meal can be just as important as a missed medication. Ward staff need to understand that every meal is important and it is not acceptable for patients to miss even one meal as this increases the risk of becoming malnourished. Caterers play a role in promoting the importance of food to Ward Managers and Nutrition Steering Groups, helping deliver Step 2 in practice.

Step 3 encourages hospital staff to follow guidance and codes from other professional bodies, putting Catering Managers in a good position to pass best practice and important information to Steering Groups and staff on the wards. It is also vital that any feedback from ward staff and Steering Groups is responded to and action is taken by Catering Managers to ensure that problems are dealt with and solutions found.

The importance of good quality and frequent food is vital in aiding the recovery of patients in hospital. Age UK urges Catering Managers to communicate feedback from patients on the type of food being served and the method of delivery to ensure that people in later life get meals that will not only help them get better, but that they will also enjoy.

Malnutrition can cause longer or avoidable hospital stays, the need for more medication and higher risk of infection. In order to improve the quality of care, wards must tackle malnutrition as a matter of urgency. The Still Hungry to be Heard report continues to push the adoption of Age UK’s seven recommended steps which provide simple but effective solutions wards can adopt to ensure people in later life get the food and help they need at mealtimes. With the help of Catering Managers more can be done to tackle this scandal and ensure that no more older people suffer needlessly in hospital.

Download a copy of ‘Still Hungry to be Heard’,

For more information, contact Age UK, telephone: 0800 169 87 87, or e-mail: HTBH@ageuk.org.uk or visit www.ageuk.org.uk/htbh

Age UK’s ‘Still Hungry to Be Heard’ report acknowledges that many NHS Trusts have taken steps to improve mealtimes for people in later life and highlights the following examples:

• Cambridge University Hospitals NHS Foundation Trust, supported by Age UK Cambridgeshire, which has developed pictorial menus to make it easier for older people to choose their meals.
• The Pennine Acute Hospitals NHS Trust, where a specific nutrition training programme - ‘Mission Nutrition’ - has been developed to make staff food-aware. It covers effective screening, how to record a person’s food and fluid intake and the importance of nutritional care.
• The Whittington Hospital, London, where a programme has been developed to make staff aware of the importance of screening and the need to use the screening tool accurately.
• Salisbury NHS Foundation Trust, where protected mealtimes has been introduced to ensure that patients are not interrupted during meals and that they receive the support they need.
• Guy’s and St Thomas’ NHS Foundation Trust, which has introduced a red-tray system to identify patients who need help during mealtimes.
• Norfolk and Norwich University Hospitals NHS Trust, which recruits and trains volunteers to provide people in later life with extra support at mealtimes.

References

(1) ICM Research interviewed a national sample of 1,000 nurses routinely treating patients over 65 during July and August 2010. ‘Nearly one-third’ refers to 29.4 per cent (294 out of 1,000) nurses polled.

(2) Malnutrition Among Older People in the Community: Policy Recommendations for Change, European Nutrition for Health Alliance and British Association for Parenteral and Enteral Nutrition, 2006.