Recommendation 241

Providing food and drink to elderly patients

Accepted

The arrangements and best practice for providing food and drink to elderly patients require constant review, monitoring and implementation.
In its initial response to the inquiry, Patients First and Foremost, the government committed to draw up a new set of fundamental standards of care that will sit within the legal requirements that providers of health and adult social care must meet to be registered with the Care Quality Commission. In June 2013, the Care Quality Commission issued A new start – Consultation on changes to the way CQC regulates, inspects and monitors care.This document started the public discussion on what the fundamental standards of care should be. The Department of Health has issued draft regulations for consultation, which set these fundamental standards of care in legislation as outcomes that must be avoided, as well as streamlining and improving the clarity of requirements which must be positively achieved in order for a provider to register with the Care Quality Commission. The Care Quality Commission, through its chief inspectors, is engaging with providers, professionals and the public on what guidance it should publish on complying with these regulations and how they should relate to the Care Quality Commission’s broader assessments of the quality of services. The new regulations setting out fundamental standards of care, and the Care Quality Commission’s associated guidance for providers on them, will come into effect during 2014, subject to parliamentary approval. The final set of standards is likely to cover areas such as: care and safety of patients and service users; abuse, including neglect; respecting and involving service users, nutrition; consent; governance; cleanliness and safety of premises and equipment; and staffing. Local Healthwatch organisations are using their ‘enter and view’ powers to get a clear picture of how health and care services are meeting the needs of the public, and their place on every local health and wellbeing board will ensure that voices of people using services is at the heart of local planning and decision-making. Local Healthwatch will also enhance the new inspection regimes. They will make sure inspection teams get a comprehensive picture of local people’s opinions and concerns, and will maintain a focus on service quality issues after the inspection team has moved on. The Department of Health is awarding grant funding to the Malnutrition Taskforce, led by Age UK, to run stage 1 of a pilot programme to test a framework to reduce malnutrition among older people in a range of health and care settings. The Malnutrition Taskforce’s pilot will bring together the relevant professionals from a range of care settings, to work together to improve the care of older people at risk of malnutrition, raise awareness to help prevent people becoming malnourished in the first place, and help carers and clinicians identify and treat people with malnutrition more effectively. The Malnutrition Taskforce have published a series of guides offering expert advice on the prevention and early intervention of malnutrition in later life. These guides draw together principles of best practice to offer a framework developed to help those in a wide range of health and care settings make the changes needed to counter malnutrition. Trusts are encouraged to implement Protected Mealtimes which the National Patient Safety Agency issued guidance on in 2007. Shifts should be organised so that staff are not taking breaks at the same time as patients are being served meals, to ensure that staff are available at mealtimes to help patients eat and drink – this is particularly important for older patients and people with dementia.

Update

The Department of Health is working with Age UK and funding a programme of work, which will help to reduce malnutrition among older people within hospitals, in other care settings and their homes. This work is also part of a wider programme of actions initiated by this Government that will improve the care of older people – fundamental standards of care, below which care should never fall; improving and enabling nurse leadership; and embedding a caring culture that prioritises the quality of care. The Department of Health granted funding to the Malnutrition Taskforce, led by Age UK, to run a pilot programme to test a framework to reduce malnutrition among older people in a range of health and care settings. Stage 1 of this pilot scheme ran from October 2013 and completed at the end of March 2014 and stage 2 will run from April 2014 to March 2015. The Malnutrition Taskforce proposal aims to test and evaluate a collaborative, supported change management programme and then to extract the learning and disseminate it across England, with the overall objective of reducing malnutrition among older people, within hospitals, other care settings and their own homes. The Malnutrition Taskforce is an independent group of experts, formed with the aim of reducing the prevalence of malnutrition and dehydration among older people. The Taskforce is co-chaired by Dianne Jeffrey (Chair of Age UK) and Dr Mike Stroud (consultant gastroenterologist and Chair of the British Association for Parental and Enteral Nutrition). The group includes providers and commissioners of health and social care, older people and carers, academics, professionals and the industry. In the first phase of its work, the Taskforce engaged with experts, frontline professionals, older people and carers to rigorously evaluate evidence to develop a number of best practice approaches and a framework designed to help make the changes needed to counter malnutrition among older people. There was good progress of the programme against the proposals originally submitted to the Department and Age UK has confirmed that the milestones for stage 1 of the programme were achieved. This included:

  • two pilot sites established in Lambeth/Southwark and Salford;
  • the change management programme underway in the two sites;
  • Programme Steering Group established, which meets quarterly;
  • qualitative research carried out among older people, carers and healthcare professionals to inform development of the marketing messages;

Stage 2 of the programme includes:

  • refinement and continuation of the change management programme and social marketing campaign plus extension of the programme and campaign to three further areas;
  • engagement of community networks to continue local dissemination of learning following the end of the programme;
  • communications to spread learning across public and professional networks, including online and social media; and
  • three regional, professional-facing events to showcase learning and share good practice.

Currently Age UK is on target to provide the final evaluation report at the end of the programme in March 2015. The Department of Health established the Hospital Food Standards Panel to examine the variation in the quality of hospital food and drink across the country. The Panel recommended that all NHS hospitals develop and maintain a food and drink strategy which should include how it will address the nutritional care of patients. They recommended that this will be monitored through the annual Patient-led Assessments of the Care Environment and that it should be enhanced to take account of this and enable a more detailed evaluation of hospital food. The Department of Health has begun working with NHS England and the Health and Social Care Information Centre to take this forward