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Trust asks nurses to pick up slack after catering cut back

A leading London hospital has cut back on its catering contract and asked nursing staff to pick up the slack, Nursing Times has learnt.

Under a new system being trialled across eight wards at Imperial College Healthcare Trust, nurses and healthcare assistants are doing the jobs previously carried out by contract staff.

It follows a cut in the trust’s contract with catering and facilities supplier ISS, and the replacement of food cooked on site with food cooked off site.

Rather than food being delivered to patients by “hostesses” employed by ISS, the food is being delivered to the ward by an ISS employee and then distributed to patients by nursing staff.

However, Nursing Times understands no extra nursing staff have been employed on the wards to carry out the additional duties or cover for staff that are doing them.

The union Unison branded the move another attempt to save money, potentially at the expense of patient care.

Michael Walker, Unison’s London nursing officer, said: “We are aware that across London, attempts are being made to force nurses to carry out more and more non nursing duties.

“We fear that distractions from core nursing duties could result in serious implications for patient care.”

A trust spokesman said: “In order to better meet the needs of our patients, Imperial College Healthcare NHS Trust is exploring different types of food, and different ways of delivering them on the wards.

“We have trialled a variety of different options and will review the results of these trials with patients and staff.”

Whereas in the past nurses have been responsible for feeding patients, most trusts have now introduced hostesses to take over the role, as it is time consuming and easily disrupted by clinical incidents on the ward. Many trusts also make use of volunteers to help feed patients.

Nursing Times understands the use of nurses to carry out hostess roles is unlikely to be continued at Imperial.

Readers' comments (27)

  • why dont they stick a broom...you know the rest!!!!

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  • we have no hostess any more where I work so an HCA is allocated each day to serve breakfast, teas and lunch. We used to have a hostess but they were re-located to another ward.

    we have never had an evening or weekend hostess so nurses have always had to serve evening hot drinks, the evening meal and all food at the weekends.

    it usually takes at least 2 nurses to serve the food and yes it is time-consuming and we don't think it's very hygienic.

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  • In some cases it might be the most positive thing they can do for some patients as malnourishment is a serious problem for many patients. Some leave hospital weighing less than when they came in.

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  • The HCA give the food out in our Trust, but that doesnt always mean that vunerable patients get more attention at mealtimes, often the HCA is taken away from patients that already need attention to serve the food, leaving one less member of the team to care for patients, nursing numbers are strained enough as it is!
    I have been on shift when patients food has gotten cold even when a HCA is serving, they still dont have time to stop and help patients with thier meals!

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  • Do you know, I am amazed. I have only ever worked in one Trust where there was a hostess who served the main lunch time meal. Every other meal I have seen over the past 22 years of working in the NHS has been served by HCA's, students and qualified nurses. I did not realise that there were Trusts out there who employed people to do such things.

    I used to serve dinners and the such but then when I noticed HCA's having coffee breaks whilst I was handing out meals instead of caring for patients and providing medications I am afraid I refused to do any more. I did not get time for extra breaks and if there was work to be done it was done. These days I get told "You can't ask me to clean them up, I have been working hard all morning, I am reporting you". Similar situation with the meals.

    I say bring in staff in all trusts to give out the meals and let nursing staff give out care.

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  • nurses obviously play a vital role in monitoring patients food and fluid intake but there are not enough nurses to go round.
    Hostesses should serve the meals 7/7, nurses can help feed patients and monitor what they eat, refer to dietician etc.

    all we need to do is employ more nurses. what a surprise.

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  • Well I too have worked in the NHS for a long time and have handed out food, done tea rounds both as a student and as a SN. Where I work the food is given out by the domestic staff (they also clean so again not really hygenic is it??).
    As it is a busy MAU if we had to do it I know the patients wouldn't get fed as are too busy trying to do every scrap of admin, plus the actual care that is required. Also they reguarly want us to move the patients even though supposed to have 'protected meal time'!!!!
    The important thing it is a really important thing nutrition, but lets face it none of us have enough staff or the time to, feed, toilet, dress wounds, drug rounds, answer phones, talk to relatives, board rounds....etc, not forgetting the mountain of paperwork.
    So there will probably be more Panarama programmes bemoaning uncaring, uncompassionate nurses etc. Well I say to anyone outside of nursing come and spend a week in our shoes and see if can give all the care that we want to be able to deliver to our patients.

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  • wouldn't you just love it if journalists and tv companies came and worked on a ward for a month and did the job of an hca.

    should nurses be serving meals? I've seen patients asking for commodes/bedpans in the middle of meals being served and every day I have to remove urine bottles from patients tables (patients who are able to walk to the loo but don't want to), gross.

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  • Many years ago, when hospitals cooked patients food 'on-site' it was delivered to wards in large heated 'trolleys'. Patients had soup to start with then a selection of fresh vegetables/meats/gravy and desserts and was plated/served by the staff nurse or ward sister from the trolley. Patients were individually asked what they would like and how much (portions served according to the needs of the patient). This included special diets such as diabetic or 'soft diets' for patients unable to chew food. The food was taken to the patients by student nurses/ HCA's who would ensure patients unable to feed themselves were fed. We also ensured they had fluids with their meals and that this was recorded on their fluid balance charts! Meal times were an important part of the ward routine, overseen by senior nurses. I dont ever recall elderly/infirm patients being left to fend for themselves plus the food served was more palatable and attractive than todays rubbish served by outside caterers. This is a positive step in the right direction with regards nursing staff serving the food. Meal times are protected, so all nursing staff on the ward should be available to assist at meal times. At least nursing staff could monitor what food was being eaten and that it was appropriate to the needs of the patient. However, its a backwards step to have food cooked 'off site'. In my days you could always obtain food from the hospital kitchen anytime of the day for patients admitted later in the day. Now, patients have to make do with a dry sandwich (if they are lucky), cos they hadnt ordered their food the day before!

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  • tinkerbell

    i don't understand nursing anymore, i don't recognise it as nursing anymore. Which bit don't i get, any of it. It's all gone completely bonkers. I am in a regular state of befuddlement where i can barely remember my own name. I use to think the 'impossible we do at once, miracles take a little longer', now i am not even that optimistic.

    Please somebody tell me what it is i don't do rather than all the new things i am expected to do on top of what i am already doing.

    I am losing the plot!

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  • Just to add to my comment above....

    Elderly/infirm patients were toileted before meal times and nursing staff serving meals/feeding patients would wear a fresh, disposable plastic apron. I dont see how nurses serving/feeding patients is unhygienic so long as they wash their hands and follow infection control protocols (there were less hospital acquired infections back then). Whilst some readers might think I am not in the real world - this WAS the real world and it worked, putting patients first and applying common sense. And yes, we were short staffed back then. The NHS needs to get back to basics and reduce all the admin/bureaucracy and let nurses nurse.

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  • tinkerbell

    Anonymous | 5-Dec-2012 1:25 pm

    same here. I was usually the only qualified on a late or early shift, as well as being the ward sister for 20 highly needy people. It was all hands to the pump. We washed, changed, fed what use to be called patients. We nursed the most severely congnitively impaired and challenging dementia patients. We called it 'nursing' i feel over the years we have become glorified admin assistants ontop of everything else we are asked to do. No one came in to assist us with the serving and feeding of the patients and then i also had to write up all the notes and do the meds and, and, and then handover and and and, then go home have a lie down and something to eat, other way round actually, and then do that for 10 shifts in a row, hardly ever a management day to catch up doing staff supervision and paperwork etc. audits etc, and do portering work and repairs to the ward whilst waiting endlessly for a maintenance guy to come and do the repair.

    I am now on secondment to the community for 6 months and i have a laptop strapped to my ankle(well it feels that way) which i have to drag everywhere with me,spend endless time on the phone to IT about it) and am expected to catch up on my assessments paperwork which is unbelievable to say the least, on my days off as there isn't enough time to do it all and the assessments, and the paperwork and take phone calls, and and and.

    Somebodys taking the mick.

    As the first poster said and i often said whilst on the ward, 'just stick a broom up my ..................................................'

    This job is turning into 'mission impossible'
    and if it were possible is getting worse.

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  • Surely patient nutrition is a nursing issue? How can we improve nutrition and hydration if feeding is passed on to other staff. Have someone else fill in the paper work. I would rather help my patients with their dinner!

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  • Tinkerbell on the ball as always!!

    Anonymous 12:16 pm and 1:25pm

    You have hit the nail on the head. I remember the "olden" days. Admittedly patient turnover was not as rapid as it is today which no doubt adds to the workload. But we did manage to feed our patients even though we were short staffed.

    Making sure a patient is fed and watered and that intake documented is the very basics of compassionate nursing.

    That the nursing hierarchy are having to launch the Compassion in practice strategy shows just how badly standards have fallen and how they have taken their eye off the ball for too long.

    Hopefully they will combine this with a massive reduction in unnecessary duplicated paperwork and we might be to return to how nursing should be.

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  • ffs - yeah, would be great if hostesses were everywhere, helping to serve and feed - everyone should be helping out, that includes all those doing sitting on their backsides, doing audits, checking emails + paperwork. If mealtimes are protected, then all staff, various managers, consultants, medics, students + visitors can all chip-in to help before the food gets cold. While we're at it, the theatre staff + non-clinical staff can help out their nearest wards. There should be nobody being moved anywhere, treated or being asked loads of questions whilst trying to eat/drink, unless there's a life-threatening event.
    If there isnt enough people to help patients who needs assistance to eat/drink, then the trust should do something about it.
    Happy to spend an hour helping to feed people, then give me time to eat + drink myself, but don't tell me to do a loads of other things at the same time or forgotten to fill in the food-charts and so the patients must be starving. I can fill a line in afterwards that to say my patients have eaten well (or not). I'm happy knowing my patients are well fed, it means that they're well on the way to being discharged.

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  • Tinkerbell on the ball as always!!

    Anonymous 12:16 pm and 1:25pm

    You have hit the nail on the head. I remember the "olden" days. Admittedly patient turnover was not as rapid as it is today which no doubt adds to the workload. But we did manage to feed our patients even though we were short staffed.

    Making sure a patient is fed and watered and that intake documented is the very basics of compassionate nursing.

    That the nursing hierarchy are having to launch the Compassion in practice strategy shows just how badly standards have fallen and how they have taken their eye off the ball for too long.

    Hopefully they will combine this with a massive reduction in unnecessary duplicated paperwork and we might be to return to how nursing should be.

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  • Sorry about the above duplication, computer error

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  • Tinkerbell, what do you mean additional duties? I totally agree with some of the respondents, that nutrition should be co-ordinated by the nursing staff and is a key function of health, well being and recovery. I too remember when nurses did serve out portions of food and could serve large or small portions depending on the person and ensure their special dietary needs as per dietitians were provided. As it is we have headlines where patients are left starving. Only in the past few weeks a friend of mine was in this very Trust that has changed to this new system and the food was delivered by the hostess. She was in a side ward having had bowel surgery and was missed on most occasions and not given anything to eat once the trolley had been removed!! We all took food in for her and she had to ask for supplement drinks herself as no-one had monitored her intake. Not only that, her pain and constipation were not controlled either. She heard the ward sister actually lie to the Doctors about what had been happening to my friend! My friend who is also an NHS employee was so ill that she could not feel she could whistleblow although I have encouraged her to write in now. I think nursing needs to take back this important role as dietitians surely are part of the MDT on every ward and nurses may be the first staff to notice issues and refer on.

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  • (This list is not exhaustive)
    Admission and discharge paperwork
    drug rounds
    physio and OT assessments before they will come and review patients
    chasing doctors for TTO's
    ward rounds
    audit paperwork
    obs rounds
    mealtimes
    toileting prn
    constant phone call enquiries from relatives
    chasing doctors to come and do their jobs
    washing and backs rounds
    IV drugs for several patients

    On a medical ward it's often that one registered nurse will have 15 patients. All it takes is for one of them to go off and everything else goes out of the window. The HCA's can dish out dinners and help with feeding, but you might have two to fifteen patients. One of them will be dishing out food, the other possibly feeding someone or running about with the commode (I'm sure most people have seen the amazing laxative properties of dinner time). There are not enough staff to ensure patients get fed, this is not because nurses see it as beneath them or are uncaring, its because there is not enough staff at the coal face and the vast majority of relatives are too busy with their lives or don't want to help out.

    A lot of the time staff on the wards are fighting an unwinnable battle, tasks will be missed because we're unable to be everywhere at once. We need more nurses on the wards delivering care and supporting each other.

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  • tinkerbell

    Anonymous | 6-Dec-2012 5:18 pm

    I always fed washed and dressed my patients along with my colleagues, i usually dished up the meals too to make sure they received a hot plate of food rather than some luke warm plate of gunk. As not many of my colleagues liked the dishing up bit and i did for some strange reason, maybe a disher upper in a previous life, I considered it a priority to know people had been fed and watered to a good standard, so am in total agreement.

    I would also not dispense meds until i knew they had some food in their bellies,that included breakfast, dinner and supper, unless of course they had to take meds before food.

    Then i would sometimes eat my supper with them as it helped encourage those who had a poor appetite.

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