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RNHA slams 'worrying' reports of forced tube feeding in care homes

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The RNHA has expressed surprise at the way the media interpreted a report suggesting that many care homes were refusing admission to new residents unless they came fitted with tubing to facilitate artificial feeding.

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The Registered Nursing Home Association (RNHA) said key advice in a report issued by the Royal College of Physicians (RCP) on problems associated with artificial tube feeding of patients with swallowing difficulties was at risk of being overlooked because of the confusing way in which the document had been presented to the news media.

Frank Ursell, chief executive officer of RNHA, said “The quotes we have seen in the press do not seem to reflect the wording of the RCP report itself. So it is difficult to fathom out exactly what messages are being put out by the college. 

“No figures and details are cited anywhere in the report to back up the claims about care homes imposing such a pre-condition for entry. Nor, on a national BBC radio current affairs programme that asked listeners to name any of the care homes concerned, did anyone come forward.”

He added: “It is worrying perhaps that a highly esteemed body such as the RCP should be relying on evidence that, by its own admission, is ‘anecdotal’ rather than based on validated research. The pity of it is that such an approach may detract from the value of a report which, in other respects, raises some important issues about the efficacy and risks of artificial feeding.

“As an association representing nursing homes, the RNHA supports the college’s recommendation that artificial tube feeding should never be undertaken lightly and that all options for oral feeding should be explored. 

“We also agree with the report that good nursing care is extremely important in ensuring that patients with swallowing difficulties are properly nourished and that artificial methods should be employed only if they can be demonstrated to improve the patient’s condition.”

The RNHA says it is disappointed that the report did not make clear that the insertion of tubes through the abdominal wall is a clinical procedure that has to be approved by doctors and is invariably carried out in hospital.

The RNHA is also questioning whether it is appropriate for the RCP to charge £20 per copy for a report which, it believes, should be made available to nursing homes to download free of charge from the College’s website.

Mr Ursell said: “We were very surprised to discover that copies of the oral feeding report were made available free of charge to the news media but that any nursing home wanting a copy will have to pay a fee for the privilege. We hope that the RCP will place the need to disseminate best practice above the need to sell copies of its publications.”

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Readers' comments (1)

  • A response to this article was sent to Nursing Times by Dr Rodney Burnham, Registrar, Royal College of Physicians. Which we have published in full below:

    Oral feeding difficulties and dilemmas
    Report of a working party, Royal College of Physicians

    Frank Ursell, the chief executive of the Registered Nursing Home Association (Nursing Times, 12 January 2010), commented adversely on the above report which reviews a wide range of issues including the clinical aspects and mechanisms for oral feeding, techniques for artificial nutrition, together with the ethical and legal aspects. Many medical, nursing and paramedical bodies have endorsed it. He complained that the press do not seem to reflect the wording in the report itself - a common problem, sadly beyond the control of the authors of any publication.

    The report points out that the insertion of a feeding tube through the stomach wall using endoscopy (a feeding gastrostomy) is associated with well-recognised complications and, in some patients, may not be possible or safe. This should only be carried out where there is a clear clinical need. Thus some patients who require tube feeding may need to continue nasogastric (NG) feeding. The report comments (page 27) that the blanket refusal by an organisation to accept a patient for care without a feeding gastrostomy is unethical.

    The report does not include anecdotal evidence that this occurs in patients on NG feeding, although sadly all nutrition teams can cite examples of this practice. The risk to the patient of placing an NG tube is less than that of a gastrostomy. The complexity of the procedure and the skill required to place a feeding gastrostomy is clearly described in the report. It did not seem necessary, therefore, to state that this has to be undertaken in the hospital setting, unlike a NG tube, which can normally be inserted by a trained nurse in most settings according to standard protocols. Most hospital nutrition teams would be willing to give telephone advice in case of difficulty.

    The report has been distributed free of charge to all Fellows of the Royal College of Physicians and members of the British Society of Gastroenterology. To recoup some of the considerable costs involved in the preparation, publishing, printing and distribution of the report, a charge has to be made for this valuable document, just as a nursing home has to charge for the care of its residents.

    We are pleased that the chief executive agrees that the report raises important issues about the efficacy and risks of artificial feeding.

    Dr Rodney Burnham
    Royal College of Physicians

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