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Food and drink

 

Key message

Food and drink must be available, easily accessible and of good nutritional quality. People should receive the level of assistance they need to make the most of the social and therapeutic opportunities that mealtimes provide.

 

Why we are interested in food and drink

As well as looking at the environment where meals were served we also asked staff about access to food and fluid and the assistance available to people. (We say more about the environment in dining areas later in this report).

We asked these questions because many concerns have been brought to our attention, and to the attention of the Scottish Public Services Ombudsman, about older people not having adequate food, fluid and nutrition whilst in hospital. In 2008 the Scottish Government launched their Food, Fluid and Nutrition programme and NHS Quality Improvement Scotland have in place clinical standards for food, fluid and nutritional care in hospitals.

What we would expect to find

We would expect that people would be able to easily access the food and drink they need and receive the level of assistance they need to ensure a healthy diet whilst in hospital.

What we found

On all wards we visited we observed the lunchtime meal serving.

We found that the overwhelming majority had a protected meal time system in place.This means that there are periods of time on a hospital ward when all non urgent clinical activity is stopped. During these times people are able to eat without being interrupted and staff can offer assistance. Everyone we spoke to told us that they think protected mealtimes are a very good idea and appear to be working well.We did though find differences in how strictly the practice is followed.

One nurse told us that in protected meal times

"Staff time is focused on the patients, we have quite a few people with depression where food intake can be a problem and staff have time to ensure they eat".

We visited some wards where although there was a protected meal time system in place, staff told us that this didn't work and the usual ward routine continued around the meal time. Nursing staff did comment that they found medical staff most likely not to comply with protected time requirements.

We also asked nursing staff if they felt they had enough time and staff at mealtimes to ensure everyone was able to get the assistance they needed.The majority of nursing staff answered that they thought they had adequate staff on duty at mealtimes and always ensured that a trained member of staff was involved in the mealtime.

One of our visitors who observed a lunch serving commented

"Meal time very hectic, nurse standing to feed someone in a wheelchair who then had two different members of staff for each course.Everybody had plastic bibs on regardless of whether they needed it".

Another visitor observed

"One lady was sitting not eating her food, a plate of meat and potatoes; everyone else was on their pudding so it was likely that her food was cold.She appeared agitated but was ignoring her food.I prompted her that her lunch was there.She attempted to eat with the knife but she needed some help to recognise the fork.At this time there were two nursing staff standing at the food trolley that had not up to this point thought to intervene"

In addition to looking at the dining areas, we asked nursing staff about the catering arrangements and in particular facilities for people to make drinks and snacks at any time of the day or night. We think that it is important for people to maintain their everyday skills wherever possible while in hospital.

Under half of the wards visited had facilities to make snacks at any time.In eighteen wards we found that drinking water was not easily accessible to people: they would need to ask staff to fetch a drink for them or wait to be offered it.

In one hospital we found a water fountain but it was in the dining room which was locked for large parts of the day.

It is not acceptable that in eighteen of the sites we visited patients did not have easy access to drinking water.This was usually because the main kitchen area was locked and patients and visitors would have to ask staff to open this for them and then help them to get what they wanted.

In one new PFI (private finance initiative) hospital the meals are served with up to three courses already placed on one tray.Staff thought it was confusing for some people to have all the courses served like this and also that there are a lot of issues with food but they are "stuck" with the catering contract.

We also asked about access to a dietician and were told overwhelmingly that it was quick and easy to refer and get access to a dietician.Only one ward we visited reported a problem with this and we brought this to the attention of the managers.

Action needed

  • All assessment wards for older people must try to ensure that people enjoy the dining experience and that they are given individual assistance that meets their individual needs.

  • All older people in assessment wards must have easy access to drinking water. This is particularly important for older people who are prone to dehydration.

  • Staff need to promote independent living skills. Limiting access to facilities and support for making drinks and snacks interferes with independent, everyday living skills and wards must improve access to these.