Part of current thinking about dignity in old age, it was also a response to the Age Concern programme Hungry to be Heard, which focuses on malnutrition among older people in hospitals. Its list of horrors has included food left out of reach and people being unable to feed themselves.
Hungry to be Heard calls for a change in the way the NHS monitors meal times and for an automatic assessment for malnutrition on admission. Age Concern has been much in the news recently, but this campaign is one of which it should be proud, coming as it does alongside a report by the Commission for Social Care and Inspection, Highlight of the Day?, about meals in care homes, and the English Community Care Association's high-level symposium last year. Help the Aged, the Commission for Public and Patient Involvement in Health, and Which? have all had their say on this. There is a growing chorus that the food is not good enough, that people do not eat it, that people are not given help with eating and that there is a tendency to use the high-tech solution of a plug in the stomach, rather than to persevere with feeding the normal way, because it's easier to push gloop into a tube than patiently spoon food into someone's mouth when they are unaware of what is going on.
All this has led to newspaper headlines about starving older people - 750,000 face a starvation risk in hospital, according to the Daily Express. Although guidelines to improve the way the NHS deals with malnutrition among its patients were introduced in February last year, they are still not being widely used. Malnutrition in general costs the UK more than £7.3bn a year, more than double the bill for obesity, according to the British Association for Parenteral and Enteral Nutrition.
A cultural change is needed, recognising that food is an important part of life and vital to healing. So Age Concern recommended recruiting an army of volunteers to help feed older people in hospital. As chair of the Commission on the Future of Volunteering, I was really interested in the idea, but the numbers needed would be enormous. Nine out of 10 nurses say they do not have time to feed patients, so recruiting, training, retaining, appreciating and monitoring volunteers to carry out the task would be a vast undertaking. It is a good idea, however, and government seems interested. There are doubtless many people who would enjoy doing it and would give their time willingly, but the complexity needs to be fully understood. You cannot just say "we'll get volunteers to do it". Feeding disabled, frail and confused people is specialised work. If volunteers are to do it, they will need training and monitoring. Does government recognise that? And will it pay for it? Will we see volunteers tending older people who have no family in the same way as families increasingly visit at meal times to see that their relatives are fed? This would involve volunteers carrying out public services - but if they do not, no one will.
AND WHILE WE'RE ON THE SUBJECT...
- According to Age Concern, as many as six out of 10 older people are at risk of becoming malnourished in hospital. Four out of 10 people admitted to hospital are already malnourished, it says. Patients who are malnourished tend to stay in hospital longer, need more medication and are more likely to suffer from infections, says the charity.
- The British Association for Parenteral and Enteral Nutrition set up a working party in the 90s to look into establishing standards for the nutritional care of patients in hospital. It found healthcare professionals and managers in general lacked awareness of the problems caused by malnutrition in British hospitals.
- The association points out that, as long ago as 1859, Florence Nightingale, the pioneer of modern nursing, said "thousands of patients are annually starved in the midst of plenty from want of attention to the ways which make it possible for them to take food. I say to the nurse: 'Have a rule of thought about your patient's diet.'"
- The Daily Telegraph recently reported that the Government was considering introducing a 'red-tray' system - the colour would signify that the tray should not be taken away until the patient had finished eating the meal or had been helped to do so. Age Concern said this would not be enough to solve the problem.