Hospitals face fines for poor food

Cornish hospitals have shown that patients fed on high quality food recover more quickly. Other trusts are set to follow. By Jane Merrick, Political Editor

Hospitals that serve their patients poor food face fines or even closure under government plans to revolutionise meals on NHS wards.

Ministers want NHS trusts to use fresher, locally sourced ingredients in their kitchens after official figures showed dozens of institutions offer poor or barely acceptable nutrition. Hospitals and care homes persistently failing to provide patients with a high enough standard could be issued warning notices of suspension or fines or be closed.

The radical move will be backed up by as yet unpublished Department of Health research into how healthy food on hospital wards can speed recovery.

It comes as hospitals in Cornwall have reported patients' health improving more quickly after they switched to food sourced from local farmers, butchers and fishermen, while the Royal Brompton Hospital, London, has introduced mainly organic food cooked by leading chefs – again to beneficial effect. In both cases patient satisfaction rates soared.

The figures will be published later this year, but they are expected to show a significant link between standards of food, particularly if it is fresh, organic or local, and recovery rates.

The health minister Ben Bradshaw said the era of the reheated meal consisting of soggy chips and cardboard fish fingers should be consigned to the past. He told The Independent on Sunday that while waiting times and infection rates had fallen, the quality of food has not shown a dramatic increase.

"A good, varied diet is all the more important when you are poorly," he said. "We want to see more hospitals and care homes emulating the best. There are still some that are not acceptable."

Ministers are concerned that about 60 trusts are serving food classed as "poor". And a report by the Healthcare Commission last week found that elderly patients were effectively being left to starve by negligent trusts.

The report into more than 10,000 complaints against the NHS between August 2006 and July 2007 found one of the biggest problems was poor nutrition, including a lack of choice of meals, inedible food and nursing staff failing to help frail patients to eat.

Research by Age Concern shows that six out of 10 older people are at risk of malnourishment, or their condition getting worse, in hospital. "Ending the scandal of malnourished older people in hospitals will save lives," an Age Concern spokeswoman said. The drive for better food in hospitals is backed by the Soil Association.

From this month, patients in England will be free to choose any hospital in the country for their operation, and NHS adverts in local newspapers will make clear that food quality may have a bearing on where someone chooses to be treated.

Mr Bradshaw added: "Of course the general reputation of a hospital, its waiting times and infection rates are still going to be uppermost in most people's minds, but increasingly, the public's perception of the NHS is coloured by what is called 'patient experience' – things like the helpfulness of the staff and the quality of meals."

The plans for a clampdown on bad food are contained in a consultation document and will be added to the Health and Social Care Bill already before Parliament. It will introduce new requirements for nutrition.

The Bill will establish the Care Quality Commission which from April 2009 will replace the Healthcare Commission and the Commission for Social Care Inspection. It will have new legal enforcement powers to monitor food standards.

A delivery board, chaired by Gordon Lishmann of Age Concern, is monitoring the Government's "Improving Nutritional Care" action plan, launched last October. Five NHS trusts in Cornwall, including the Royal Cornwall in Truro, changed its suppliers from central catering services to local producers four years ago. Today 80 per cent of ingredients are locally sourced, compared with 30 per cent in 2004.

If recovery rates were speeded up, cutting the length of time a patient stayed in hospital, it would also be cheaper in the long term, Mr Bradshaw said.

He added that early evidence from the project in Cornwall showed that the high-quality food was helping patients to recover more rapidly. "They also like the feeling that they are supporting their local producers," he said.

Welsh hospitals are banning vending machines from their grounds and the Soil Association is urging ministers to introduce a similar bar in England. Peter Melchett, policy director of the Soil Association, said: "The Cornwall Food Programme is beneficial on a number of levels. Patients are helped to recover by eating decent food; the livelihoods of local fishermen, farmers and local producers are sustained, and food miles are reduced to help curb climate change."

But critics will point out that the Government has attempted to improve the situation in the nation's hospital kitchens before. In 2001 when it launched the Better Hospital Food Initiative, headed by Loyd Grossman, some £20m was spent, but campaigners complained there was too much emphasis on "posh" restaurant food, when what was needed was simple, fresh fare.

One of the new requirements policed by the Care Quality Commission will be "making sure people get the nourishment they need". This involves "access to safe and sufficient nourishment" and "the prevention of harm through lack of access to sufficient nutrition and hydration". Hospital and care home staff "must be able to spot people at risk of malnutrition, provide adequate nutrition that meets their cultural or religious requirements, and ensure that they do not suffer from malnutrition or dehydration".

New standards include allowing sufficient time for people to finish their meals. Staff must record the number of people needing treatment for dehydration or malnutrition, where that was not the reason for their admission, and the number of complaints received about nutrition or hydration, support with meals or quality of food.

"Where people do not eat meals offered to them, their views or the views of their carers must be sought, and nutritional support or alternative meals offered," the Department of Health document says.

Those with food allergies or digestive disorders must be offered alternative, nutritionally balanced meals they are able to eat.

The commission will take action if a hospital or care home "persistently fails to identify people who are at high risk of malnourishment and/or dehydration" or "persistently fails to provide appropriate nutritional and/or hydration support to people who are at high risk".

Additional reporting by Cathal Sheerin

Case study: 'Jelly and mash is hardly a balanced diet'

Shirley Murgraff, 77, a retired teacher from east London, was admitted to hospital as an emergency three times in 2007, but left feeling weaker than when she went in. She blames the poor standard of nutrition at the hospital. "No question about it – it affected my recovery. After leaving hospital on one occasion, I was so weak that I couldn't walk for more than 10 yards without having to lean against a wall for support," she said.

Suffering from a severe bowel disorder,she was restricted in what she could eat. Put on a liquid diet by doctors, she was told she could eat clear soup – but this was never on the menu. When she asked for it, for three days she was given hot water and a soup cube. When she moved on to soft food, there were few options. "The only choices were mashed potato, jelly and ice cream. Not a balanced diet," she said.

"No one came to talk to me about my dietary requirements. And I had to specifically ask to see a dietician who came only on my last day." The advice was also contradictory. "I got two leaflets, but there was no consistency with regard to chocolate, cheese and fibre content."

Cathal Sheerin

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