Food Champions

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With patient nutrition a concern, Kathy Oxtoby finds out how nurses in Yorkshire are improving hospital meals

For a hospital patient who is feeling sick and anxious, food is probably the last thing on their mind. Yet failing to eat can affect their health, well-being and recovery. 

While the benefits of good hospital food are well documented, so are the failures to deliver it. In 2006 the National Patient Safety Agency (NPSA) found the practice of protected mealtimes was still 'sporadic' and national headlines regularly shout about the poor quality of NHS food.

Lack of staff and resources pose a problem but Judith Connor, clinical matron for cardiothoracic services at South Tees Hospitals NHS Trust in Yorkshire, says the real difficulty is the way hospitals work to suit wards and departments rather than the patients themselves.

'We need to change the hospital culture, so the ward environment is conducive to making the patient's eating experience the best it can be,' she explains.

To do this, Ms Connor is championing three ways to encourage patients to eat and drink properly – protected mealtimes, assisted feeding and a new meal service.

Last year the trust was involved in a number of nutrition projects. Working with the Institute for Innovation and Improvement, it took part in the Productive Ward initiative, which reviews ward processes to release nurses' time for patient care. This revealed nurses should spend more time giving hands-on care, particularly at mealtimes. Feedback from the trust's Private Finance Initiative partners also showed quality of food was an issue.

At the same time, Ms Connor, a matron on the trust's Essence of Care steering group, was involved with the scheme's nutrition benchmarking process. A patient questionnaire showed meals were being disrupted and their quality varied due to the plated system, where food is heated up on a plate in a large cupboard or 'hot lock'. 'Warm salads and "brown soup" were common complaints,' she recalls.

In response, a bulk ordering service was piloted. This involves food being tailored to patients' needs and served on a trolley to their bedside. It was so successful that it has been rolled out across the trust.

'Patients can see what's on the trolley, smell it and say if they want it,' says Ms Connor. 'And they can control portions, down to the number of potatoes they want, depending on their appetite.'

Having to move a bulky trolley around the wards meant there was a need to restrict visiting while food was being served. This helped inspire protected mealtimes on the wards.

The nutrition benchmarking process also highlighted other disruptions associated with mealtimes, such as patients being taken for X-rays. Now there is a notice on all wards stating that mealtimes are protected between 5pm and 6pm.

In addition, the nutrition benchmarking process revealed staff felt they needed more colleagues to assist them with feeding patients. Now nurses no longer go for breaks when patients are having their meals. And trays with red napkins on them show nurses which patients need assistance with feeding.

Ms Connor, along with other matrons at the trust, has pushed for these initiatives while carrying out her daily duties.

'I wrote the policy, presented the papers and had the arguments with the clinicians,' she says. 'The challenge has been influencing people to realise that nutrition is an essential element of care.'

The focus on food has meant the need for extra hostess staff and a new caterer but it pays for itself, she says. Savings on food wastage are 'substantial' and the visual evidence of how these schemes have benefited patients is captured on a 'before and after' DVD. This shows how the time it takes to serve meals has been reduced from 40 to 15 minutes.

Patient feedback speaks volumes. 'Patients are enjoying their food and mealtimes are calmer and quieter,'

Ms Connor says. 'One older gentleman said to me "it's more like it was in the old days" and patients are now saying to their relatives, "Why don't you go for a cup of tea while I have my dinner?".'

Achieving these results is about persistence, she believes. 'Remember to put the patient at the
centre of care and be passionate about what you're trying to achieve,' she advocates.

'Sometimes you will have to put your head above the parapet.'