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Setting aside time to enable patients to eat in peace

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Alison McCree.

National Chairman, Hospital Caterers' Association

Food can have a major impact on a patient's progress and well-being in hospital, and the Government's Better Hospital Food Programme has helped ensure that catering is seen as an integral aspect of health care as important as treatment or medication.

Food can have a major impact on a patient's progress and well-being in hospital, and the Government's Better Hospital Food Programme has helped ensure that catering is seen as an integral aspect of health care as important as treatment or medication.

The Better Hospital Food Programme has helped to improve the standard of patient meals, a fact confirmed by the Government's 2003 PEAT (Patient Environment Action Teams) findings. With 43% of hospitals regarded as good and the rest as acceptable or better, this indicates an unprecedented level of patient satisfaction with hospital food, just three years since the programme's launch.

But improving hospital food is not solely about what we put on the plates, it is also about improving mealtimes. There is little point in improving the quality and presentation of food if a patient is unable to eat it. Patients, particularly in acute hospitals, often find mealtimes interrupted by ward activities such as cleaning, maintenance, bed changing and ward rounds.

There is increasing concern that interrupted mealtimes undermine appetite and that if patients cannot finish or miss a meal this can have a detrimental effect on their nutritional intake. The principle of 'protected mealtimes' is about ensuring that patients are given support to eat in as conducive an environment as possible.

This should be a priority for all hospitals as it increases the potential for better nutritional intake, improves responses to treatment and speeds up recovery.

In 1859, Florence Nightingale stated: 'Nothing shall be done in the ward while the patients are having their meal.' Yet, since then, patients have often found hospital mealtimes anything but interruption free.

But a major change is taking place as a result of a collaboration between hospital caterers and nurses. This year, the Hospital Caterers' Association was behind a major campaign to encourage NHS trusts to adopt a protected mealtimes policy, culminating in a National Protected Mealtimes Day in March.

The HCA believes that, where appropriate and practicable, non-essential clinical procedures or routine tasks should be rescheduled to avoid disturbing patients unnecessarily. This, in turn, can enable ward teams to provide patients with vital support at mealtimes.

Such was the support for the Food First: Prioritising Patient Mealtimes campaign that 350 hospitals (about 20% of the total number) embraced the concept and held their own National Protected Mealtimes Day.

While protected mealtimes are recognised as contributing to quality nursing care in community and mental health hospitals, this is not always the case in acute settings. The HCA wanted to see a change here but recognised that implementation of protected mealtimes is not a simple issue.

It is vital for all hospital staff to acknowledge the role food plays in patient care and the part they themselves play in ensuring patients enjoy mealtimes.

However, to achieve this requires a big cultural shift. To assist trusts, the HCA has produced guidelines on devising a protected mealtimes policy, endorsed by the RCN. Since March, a joint NHS Estates and RCN Protected Mealtimes Roadshow has successfully promoted the concept to more than 40 multidisciplinary groups, involving some 1500 people.

Maybe now we are finally delivering Florence Nightingale's ideal of providing patients with an adequate, undisturbed time to eat. This is a strong indication that, at last, in the 21st century, NHS hospital schedules are being driven by patient need and not by the needs of the system.

- The Protected Mealtimes Policy can be found at: www.hospitalcaterers.org/pages/library.html

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