Why hospitals are reufsing to take complaints about food lying down

THE dreaded subject of hospital food.

Like stories of bad school dinners, rumours of over-cooked veg and soggy puddings circulate around hospital corridors like Chinese whispers.

But whatever hospital grub tastes like, when you're ill, you need nutrients to build up your strength.

So Age Concern's revelation that some older patients may be suffering because nurses are too busy to help them eat, has alarmed patients around the country.

The charity's director general, Gordon Lishman, this week warned thousands of vulnerable patients were being overlooked.

It was claimed that nine out of ten nurses did not have the time to feed older patients.

"Hospitals are in danger of becoming bad for the health of older people," Mr Lishman said.

"The majority of older patients are being denied some of the basic care they need, leaving hundreds of thousands of older patients malnourished."

However, York Hospital is ahead of its game.

Florence Nightingale, that pioneer of the importance of nursing care, writing as long ago as 1859, said: "Nothing shall be done in the ward while patients are having their meals."

Last December, a pilot scheme at York Hospital aimed to test just that.

Meal times have become "protected", giving older patients a chance to eat their evening meal in peace, free from interruptions by visitors or doctors.

It means visiting times, which used to be from 3pm to 8pm, have been cut down so that relatives and friends of people in hospital are discouraged from calling in between 4.30pm and 6.30pm.

The idea now runs on eight elderly medicine wards.

According to Jill Leadley, a matron in elderly medicine at the hospital, it has been a great success.

"What it means is at lunch time, when the patients get their dinner, nothing else happens," she says.

"The idea is that because nothing else is happening, the nursing staff are more available. They're not doing doctors' rounds.

"There are more of them available at the time of meals. They (patients) are getting their dinner and are able to eat it in peace without somebody coming to stick a needle in their arm."

In a survey of patients, 89 per cent said they were allowed enough time to eat their meals, and 78 per cent said they were happy with the change to visiting hours.

Now the hospital is planning to extend the scheme throughout all its wards - but Jill said there would be flexibility for visitors who actually helped their relatives to eat.

"Nothing is set in tablets of stone," she says. "If somebody is in hospital visiting and turns up at 4.20pm - you're not going to say at 4.30pm: tough, you can't visit.

"What the nurses would say is that it's a protected meal time - if you would like to just go down into the Mallard Restaurant and have a cup of coffee for 20 minutes and granny will have finished her tea."

Sally Hutchinson, chief officer at Age Concern in York, whole-heartedly supports York Hospital's efforts.

"They are working very hard," she said.

"But as well as looking after people in hospital, we need to make sure older people in the community are looked after.

"At Age Concern, we endeavour to ensure that when people go home from hospital they have sufficient food in their home to be able to continue to eat well in their home.

"However, if older people don't have anyone to help them with their shopping, which is often the case, then any good work which has been done in hospital can be lost if they can't continue to eat properly at home."

The dietician

MUCH care and attention is given to help older patients eat well in hospital, says Anne Robinson, a dietician at York Hospital.

In fact, since protected meal times came into force, 97 per cent of patients have felt nurses have had more time to help them eat.

That, says Anne, shows the hospital's dedication to improving diet.

Nutrition is high up the hospital's agenda.

When a patient is admitted, they undergo a nutritional screening.

"A lot of older people have difficulty swallowing, so we assess what they can swallow and from that we can make a recommendation about whether their food needs to be textured differently," explains Anne.

"If they could only swallow a few teaspoons, we would try them with that, then look at how we could help. Perhaps they would need to be tube fed."

The quality of food is good, she says, and the national initiative Better Hospital Food has improved that.

"There is a good choice to suit everybody's tastes and everybody's cultural or religious needs," she said.

"In addition to that, if a patient needs a meal at a different time, they can.

"The kitchen will prepare an appropriate meal for anybody at any time and we also have snack boxes for people to have at any time."

The Care Of The Elderly Service provides snacks to patients at any time, she said, recognising that elderly people like to eat little and often.

Despite every effort, a patient's nutritional state can still deteriorate in hospital, she said.

"We've got millions of different ways of feeding people, but if you have some kind of trauma and come in malnourished, and then you have to have surgery, which is huge trauma to your body, the weight loss can be huge."

Menus are chosen in conjunction with dieticians in a way that offers nutrition, good presentation and choice.

Care is taken to provide tasty food, but age, drugs and illness can obscure flavour.

Up to 70 per cent of taste can be lost in older people, said Anne, and drugs can mean you won't enjoy your food as much.

Anne accepts some people will complain about food, but stresses the hospital does its best.

"Even if you can find a few patients who for one reason or another have had a difficult experience, you can assure people that we've got many initiatives in places to improve it. We do care, we have many professional staff here and all of them care."

The patients

WHEN Ethel Bramwell was in hospital, she was grateful to be served good, hot food.

After breaking her hip in an accident, she spent ten days on the orthopaedic ward, recovering from an operation.

After hearing horror stories of "disgusting" hospital food, she was surprised how good meals were.

"There was a good choice and if it was supposed to be hot then it was," she remembers.

"I remember having fish and chips one day and there were always two or three things to choose from every day.

"You could also have soup, or fruit juice and there were small portions, just enough for anyone in hospital.

"I'd heard about hospital food and how awful it was but when I was there, I didn't think it was awful at all."

There were some elderly patients who weren't eating, but they weren't very well at all, said Ethel.

The nurses were incredibly busy, but they took time to help a woman with Alzheimer's to eat.

"She wasn't eating much so she needed someone to help her," she added.

Overall, she is incredibly grateful to the team at York Hospital.

"The staff were very nice, right from the moment the ambulance came to the point I went home, and the wards were very clean.

"I think people should think more about how lucky we are that we've got the hospital when we need it."

THAT wasn't the experience of leukaemia patient Jane Corner.

Jane, who did not want us to use her real name, spent three months in York Hospital in 2004.

She was unable to stomach the "cold, hard" food offered on the trolley, so chose not to eat much.

Although she says the "terrible" smell of the food trolley hampered her appetite, she admits it was partly due to her illness.

"I was having chemo so my mouth tasted foul and I didn't really want to eat that much," she said.

Jane, 57, was offered toast or cereal for breakfast, but says the toast was cold and rubbery.

Lunch and evening meals were mainly mince and mash potato-based, she says, with frozen veg.

That would not reflect her choice of food at home, and seemed even less unappetising in hospital.

But if she had not been as ill, she could have found ways round it.

"I could have asked my husband to bring food in from home, or I could have eaten sandwiches or salads," she said.

Happily, a more recent stay in hospital was better.

"I had food from the canteen rather than the trolley, because of my illness.

"It was much nicer and I could request anything I fancied."

Jane says some people may need more help to eat food, but was glad it wasn't forced upon her.

"If people aren't eating because they're being awkward, maybe they should be helped to eat, but I wouldn't have wanted people to force me to eat when I was there."

The politicians

Vulnerable patients who are not eating as well as they should be helped by nursing staff, agrees York MP Hugh Bayley.

But the Government is working to improve it, he says.

"There's been a sharp increase in the number of nurses under the Labour Government but the simple truth is that you can always do with more."

Vale of York MP Anne McIntosh criticised the Government for giving hospital staff too many directives.

"If the Government would back off and allow the doctors and nurses to administer to patients and put clinical needs first then everyone would be a lot better off."