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Supporting the dignity of the patient throughout the process is also imperative to its success and acceptance.

Provision of food and nutrition in a hospital setting

Many factors, including being in hospital, need to be taken into consideration when planning nutritional support. Within the Essence of Care framework (DH 2001b), food and nutrition were identified by patients as a fundamental area of care that is frequently unsatisfactory within the NHS.

Good nutritional care, adequate hydration and enjoyable mealtimes can dramatically improve the general health and well-being of patients who are unable to feed themselves, and can be particularly relevant to older people (Nutrition Summit Stakeholder Group and DH 2007). Unfortunately, it is evident that assistance with meals for those that require it does not always occur. The 2006 inpatient survey undertaken by the Healthcare Commission identified that of those patients who said they needed help to eat their meals, 18% said they did not get enough help and 21% said that they only got enough help sometimes (Healthcare Commission 2007).

Clinical benchmarking (DH 2001b) and clinical initiatives such as protected mealtimes aim to address common problems that patients experience whilst in hospital. Box 8.1 outlines the benchmark for food and nutrition, identifying specific factors that need to be considered when reviewing service provision, in order to promote better practice. The Department of Health and the Nutrition Summit Stakeholder Group have worked together to produce an action plan based on the 10 key characteristics of good nutritional care in hospitals. These are outlined in Box 8.2.

Box 8.1 Food and nutrition benchmark (‘food’ includes drinks)

Agreed patient/client-focused outcome: patients/clients are enabled to consume food (orally) which meets their individual needs

Indicators/information that highlight concerns which may trigger the need for benchmarking activity:

Patient satisfaction surveys

Complaints figures and analysis

Audit results: including catering audit, nutritional risk assessments, documentation audit, environmental audit (including dining facilities)

Contract monitoring, for example wastage of food, food handling and/or food hygiene training records

Ordering of dietary supplements/special diets

Audit of available equipment and utensils

Educational audits/student placement feedback

Litigation/Clinical Negligence Scheme for Trusts

Professional concern

Media reports

Sustainable Food and the NHS (King’s Fund 2005), Food and Nutritional Care in Hospitals (Council of Europe 2003)

1 Screening/assessment to identify patients’/clients’ nutritional needs

Nutritional screening progresses to further assessment for all patients/clients identified as ‘at risk’ using a screening tool that assesses Body Mass Index and weight changes, for example MUST (NCCAC 2006)

2 Planning, implementation and evaluation

Plans of care based on ongoing nutritional assessments are of care for those patients who require advised, implemented and evaluated nutritional assessment

3 A conducive environment (acceptable sights, smells and sounds)

The environment is conducive to enabling the individual patients/clients to eat. Implementation of Protected Mealtimes

4 Assistance to eat and drink

Patients/clients receive the care and assistance they require with eating and drinking. Provision of eating aids where appropriate

5 Obtaining food

Patients/clients/carers, whatever their communication needs, have sufficient information to enable them to obtain their food. Examples include the NHS menu provision and utilizing menu translation services

6 Food provided

Food that is provided by the service meets the needs and preferences of individual patients/clients through audit of patient feedback and equality and diversity co-operatives

7 Food availability

Patients/clients have set mealtimes. Flexibility is also important, ensuring a replacement meal is offered if a meal