This week National Patient Safety Agency (NPSA) and Patient Safety First, a campaign group which focuses on improving patient safety in the NHS, launched nutrition and hydration week to highlight the importance of nutrition and hydration in delivering safe care.
Poor nutrition and hydration leads to poor health, increased and prolonged hospital admissions, and increased costs to the NHS. The personal consequences for patients can include increased risk of infection, delayed wound healing, decreased muscle strength, depression and, sadly, in some cases, premature death.
The initiative from NPSA and Patient Safety First is both timely and welcome, given that the latest figures published by the Office of National Statistics (ONS) reveal that, in 2010, dehydration caused the death of 155 patients while a further 48 patients died from malnutrition.
Behind these figures is often an elderly patient with a long term condition – someone’s grandmother or grandfather who should and deserves to be treated with dignity and respect. Care in the NHS should not end with clinical treatment and for many patients what matters the most is the simple things. As the Alzheimer’s Society observed in today’s Times: “Hospitals can be frightening places for people with dementia. Too often their basic needs are not met.”
Worryingly, the problem is not isolated to a few hospitals across the country. Last year the Care Quality Commission (CQC) conducted its first ever inspection programme looking at the nutritional care offered in 100 hospitals in England. The regulator found that many hospitals are still failing to get the basics right resulting in patients struggling to, or being unable to, eat and drink.
But how would you know, as a patient or carer, where to look for information to find out whether your local hospital provides good nutritional care? The CQC’s individual inspection reports are available to the general public, but would many patients or carers be aware of this? And I’d question if it is reasonable to expect people to start trawling through the internet to check whether their local hospital meets what should be basic standards of compassionate care when a member of their family is admitted to the hospital.
Following the CQC’s initial inspections and damning reports from the Patients Association, the Secretary of State for Health, Andrew Lansley, announced that he would ask the CQC to undertake a further 700 inspections. These will look at the quality of nutritional care that hospitals and, just as importantly, care homes provide. The Government also envisages that local HealthWatch groups, to be operational from April 2013, will be able to carry out unannounced inspections to check on the quality of nutritional care provided by local hospitals and care homes. If you were worried that a family member was not getting good nutritional care in hospital you could ask the local HealthWatch to investigate.
However, is not yet clear to me whether local HealthWatch groups will have enough resources and expertise to inspect local hospitals and care homes on a regular basis. Furthermore, there is only so much further inspections will tell us.
The fundamental point is this: no patient should be dying of malnutrition or dehydration in NHS hospitals. The NHS Constitution clearly sets out that every patient has “the right to be treated with a professional standard of care, by appropriately qualified and experienced staff, in a properly approved or registered organisation that meets required levels of safety and quality”. There are a number of simple steps hospitals can take to end malnutrition – starting from systematic nutritional screening when a patient is admitted to a hospital, through putting in place nutritional care plans and implementing them during their time as an inpatient, and ensuring they have a clear follow up plan and support in place for discharge.