Hospital Food

Baroness Primarolo Excerpts

Tuesday 14th June 2011 Commons Chamber

Motion made, and Question proposed, That this House do now adjourn.—(Angela Watkinson.)

[Madam Deputy Speaker (Dawn Primarolo)]

I am sorry for the interruption, but the procedure caught up with us. Please, continue.

[Joan Walley]

I am most grateful for the explanation, Madam Deputy Speaker. I was confused by the fact that this Adjournment debate started before 10 o’clock. That might explain some of my slight nervousness, as I was unsure about whether I was speaking in order with the proceedings of the House. I am grateful.

Sustainable food procurement links to health and to hospital food, too. I want the Government to set out the role that food plays in patient pathways and the priority I believe that hospitals should give to ensuring that, where required, patients are assisted to eat the food that is served. We have heard too many shocking accounts of malnutrition and dehydration as well as the plain criticism that hospital food is bad and unappetising. We should be doing something about that.

At the core of this debate is a central contradiction. The Government are happy to rail against regulation and boast about their bonfire of red tape, but they are equally proud—and rightly so—of their standards for the procurement of sustainable food for the Olympics and of their intentions for there to be a Government buying standard for food. They promote their localism agenda aggressively, leaving choice to those at a local level, but the net effect, I believe, is that no overall quality standard applies to the food served in hospitals. I do not see how such a postcode lottery can be justified and I want to consider that in more detail.

Let me turn first to malnutrition. It is not just a matter of having appetising food for patients; this can literally be a matter of life and death. In its 2009 report submitted to the Department of Health, the Nutrition Action Plan Delivery Board showed that in the region of 47,800 people had died with malnutrition while in English hospitals in 2007. Of those, 239 patients died directly because of malnutrition—that is an important distinction to make. In the report, the delivery board recommended as a key priority that the Government should clarify nutrition

“standards and strengthen inspection and regulation”

to address this problem. The issue is being flagged up.

In its recent report, “Still Hungry to be Heard”, Age UK found that the number of people leaving hospital malnourished is on the increase. A recent answer to a parliamentary question from my hon. Friend the Member for Islington South and Finsbury (Emily Thornberry), placed in the Library of the House of Commons, acknowledged that from 2006-07 to 2009-10, instances of malnutrition increased in total from 2,581 to 3,773 and, as regards discharged episodes, from 2,883 to 4,412. That inevitably leads to further serious consequences, including longer stays in hospital, the need to take more medication and an increased risk of infection and even death.

To put it in purely financial terms, the estimated cost of malnutrition to the NHS in 2006 was £7.3 billion a year. Although we do not have an accurate figure for how much it costs the NHS today, given the fact that malnutrition is on the increase it is likely to be higher still. I believe that the Department of Health should have up-to-date figures on the cost of malnutrition, and I urge the Minister to look into the matter and give us an indication of what the costs are.

Dealing with malnutrition in hospitals is not simply about making food taste better. Even if we could do that, a whole range of other issues must be addressed. First, hospital staff must be aware of what food patients can and cannot eat. They need to be able to identify which patients need help with eating their meals and to be willing and able to provide that help or, if they cannot provide it, to have a robust system of volunteers to assist. Age UK has produced a seven-step guide to eradicating malnutrition in hospitals, to which I urge the Minister to give his attention. There is also an issue with dehydration and it is important to make sure that patients in hospital have proper access to water. That simply cannot be taken for granted.

It is not only nutrition and malnutrition that need to be addressed. There must be recognition by Government of the role that healthy food plays in healthy lives. The Government estimate that 70,000 preventable deaths each year in the UK are caused by diet-related ill health. One simple thing that the Government could do to tackle that problem is to ensure that the food served to patients in hospital is nutritious. That sounds simple but the issue is how it will be done. It is also important that the Government prioritise the role of public health.

I also want to mention the dignity and nutrition reports—[Interruption.] I am most grateful. Talking of dehydration, it is important that I refer to the dignity and nutrition reports recently published by the Care Quality Commission.

[Madam Deputy Speaker (Dawn Primarolo)]

Order. If the hon. Member wishes to take a seat and take some more water so as not to strain her voice, I am sure that the Chamber will not mind waiting a few seconds more.

[Joan Walley]

I am most grateful Madam Deputy Speaker.

The first tranche of what will be 100 dignity and nutrition reports into individual hospitals found that in four of the 10 hospitals investigated, the nutritional needs of patients were not being met. The reports also stated that the quality of hospital food remains a long-standing concern. This highlights both the extent of the problem and the importance of the Care Quality Commission’s role in monitoring and reporting on hospital performance in relation to nutrition. I believe that its resources should be increased so that it can carry out more such checks and fulfil the delivery board’s recommendation of strengthening inspection and regulation. I also believe that the CQC should be made fully accountable for how that work is done.

I want to discuss regulation because that is ultimately the best means of improving hospital food. It is remarkable that there are still absolutely no legal standards governing the quality of the 330 million meals served in the NHS each year. In its report, “Yet more hospital food failure”, published earlier this year, Sustain’s “Good Food for Our Money” campaign surveyed dozens of Government-backed initiatives to improve the quality of hospital food. Alas, it found that those initiatives have cost at least £54 million of taxpayers money and have achieved improvements in only very few isolated cases. The reason is simple: they have all been voluntary, so except in those few isolated cases they have been largely ignored. Let us contrast that with the successful attempts to improve the food served in schools, where meals have to meet legal nutritional standards. A survey by Consensus Action on Salt and Health—CASH—in October 2010 showed that most meals served to children in hospital could not legally be served in a school because they contained too high a level of salt and saturated fat. The reason for the success in schools is simple: minimum nutritional standards in schools are legally binding, but in hospitals they are purely voluntary.

To date, successive Governments have failed to send a clear message to hospital caterers that the quality of their food is critical to patient health and the sustainability of our food system. It is not asking for the impossible. For many years, the Royal Brompton hospital in Chelsea has practised a progressive approach to its food procurement, providing nutritious and appetising meals prepared from fresh ingredients, which enables patients to recover faster.

Unfortunately, the Government’s ideological commitment not to introduce more regulation, regardless of its merit, is a serious block to improving hospital food. I return to Government buying standards. The coalition Government have at least recognised that voluntary initiatives have limited effect; they do not work across the board and over time. As a result, they will introduce Government buying standards that set compulsory minimum standards for food served in central Government institutions. I hope it will be soon, as the standards were promised for March 2011, and we have waited for more than a year. They were promised by the Conservative party pre-election; they were welcomed by the coalition Government and were the subject of a great deal of Department for Environment, Food and Rural Affairs civil servant attention throughout 2010. The work also involved the Department of Health to integrate badly needed health standards for food served in central Government institutions. The integration of health and sustainability standards for food bought with public money was an innovative and much needed approach, and should act as an inspiration for the wider catering sector to follow suit. Tackling health, ethical and environmental issues together should save the country money and be of great benefit to food producers and the environment.

The real issue for me is that even when the Cabinet Office home affairs committee signs off the Government buying standards, they will not apply to hospitals and hospital food. That is the heart of the concern. On the day the Government are revising the Health and Social Care Bill and recommitting it to further scrutiny, should the Health Minister not be exploring with colleagues at DEFRA and in the Cabinet how the long-promised Government buying standards can be extended to hospital food? If that is ruled out, surely there should be urgent discussions with the NHS Future Forum, the National Audit Office and expert groups, such as Age Concern and Sustain, which have a track record on this matter, with a view to tabling amendments to the Bill so that we have minimum standards for nutrition in hospital food.