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An appetite for change? – Patient experiences of nutrition and hydration

11 March 2024

Ann Nutt was a former member of the Shaping Our Lives National User Group, and Graham Price is a current director. Ann is chair of the Patient Panel at her local Hospital and Graham is a member of the nutrition and hydration group at Sandwell and West Birmingham Hospital Trust.

Staying hydrated and eating well are the cornerstones of good health. Not only that, but respect, choice, and inclusivity when it comes to food and drink provision in healthcare settings is also vital to dignity and independence.

So why is it that hospitals so often fail patients on these vital issues?

  • Patients left in A&E for over 24 hours without so much as a drink.
  • Patients on wards who are unable to eat the food provided because no accessible cutlery is given to them.
  • Patients with eating disorders whose needs are not being considered.
  • Parents who are staying with young children who are not given food for themselves but cannot leave their child to go and buy something (or cannot afford to).
  • Food that is inedible, inadequately nutritious, or not inclusive of cultural or religious practices.
  • Very limited choices for those with allergies or intolerances.

All of these are problems where listening to patient experiences is vital. And patients should not just be consulted, but directly involved in problem solving, determining policies, and delivering training.

Ann’s patient panel have done just that – funded by NHS England they have investigated the problems of hydration and nutrition from a patient perspective, resulting in a report and training videos.

While you might think only of the wards when it comes to patient nutrition, Ann’s panel have included A&E in their work too. Ann recently had the misfortune to spend 26 hours in A&E, relying on family members to bring food and drink.

“I had experienced about a 26 hour wait, and there were people older than me that were sitting in the waiting room- no blankets, no pillows, I mean, even Ryanair gives you that on a night flight, and nowhere to get food or drink. I was lucky because my daughter came in and brought food for me.”

Ann’s patient panel has been looking into these issues in more depth, drawing on the varied experiences of people in the panel.

She references her Vice Chair’s recent experience as a carer for her Disabled husband, taking him to A&E where he was forced to wait in a corridor. In a corridor or the ambulance patients may be missed by the tea trolley, and she was unable to leave him to get food for him or herself. With Type One Diabetes, that put her own health at risk as well.

In many hospitals A&E is split into two parts – the waiting area and the majors, where you are moved to once you are seen by doctors and need treatment. In most hospitals there will be no refreshments in the waiting room, where you could spend a very long time, and there may be limited refreshments in the majors. As Ann points out, who packs sandwiches or snacks when they must rush to A&E? Patients are arriving unprepared for the lengthy waits that they may face, often with no option but simply to put up with mounting hunger and thirst in addition to the problem for which they went to A&E in the first place. Even if they can go to get food, in many hospitals the canteens and shops close at night and patients may only have the option of a vending machine – which are expensive and cannot cater to all dietary requirements.

Graham’s group were surprised that he brought up hydration and nutrition issues relating to A&E. They had not thought to look at it. The hospital was seen to be comprised of two entities, Wards, and A&E.  But as Graham says, “People become a patient the minute they walk through that door”. As a result of their work, the A&E manager of the hospital will be talking to his patient advisory group about nutrition and hydration issues at their next meeting.

Did you enjoy your meal?

The problem isn’t just in overstretched busy A&E units though. It extends to the wards. Food may be provided, but patients can’t always eat it.

Ann continues: “When we did a place assessment and we asked housekeepers “do you have accessible cutlery and crockery?” We got a blank look and one of them said “are you talking about this funny stuff in the cupboard?” The hospital has provided it, but the staff do not seem to think they need to be handing it out.”

Food may be provided but it is no good asking people if they enjoyed their meal if they cannot eat it. Some examples of how meals may be inaccessible to people include:

  • Tiny packets of salt and pepper which are hard to open for people with conditions which affect the use of their hands
  • Adult sized cutlery and plates – which are not useable or safe for small children
  • Cutlery which is inaccessible for Disabled people
  • Providing a cooked meal to a child but no suitable chair, table, or highchair for them to use on the children’s ward means eating food in the cots/ beds and being told off for messing up the sheets.
  • Providing solid food to those on liquid diets
  • Providing food to people but not the assistance they need to eat it

And as Ann says, special diets need to be catered for, and not “just a salad everyday” if you are a coeliac, and provision made for those with eating disorders. “One of the members of our group has an eating disorder, and when he goes into hospital nobody knows about it and nobody asks about it until a meal is delivered and he has to turn around and apologise that he can’t eat it.”

Solutions based on patient experiences

Arguably the best way to tackle these issues is to hear from patients themselves, value their voices, and try innovative solutions. Ann’s patient group, for example, are going to trial using buzzers in A&E.

“We’ve talked about issuing buzzers to patients so if they want to go to the staff restaurant they can pick some food up, or they can sit in costa coffee for half hour and as soon as the buzzer goes, they can go back to A&E which will keep the waiting room flowing nicely, rather than just people sitting there grumbling.”

Ann also highlights the importance of solutions which enable patients to exercise choice and independence: 

“Why is it when you come into hospital you suddenly become Disabled? We are quite capable at home of making a tea or make a slice of toast so why the moment we get into hospital do they think we’re likely to pour boiling water over ourselves or stick our fingers in the toaster? We are looking at facilities so people can make their own tea or toast rather than waiting for the trolley to come round.”

Graham’s group of patients will be going round the hospital, during a meal time, to talk to patients and determine positive changes that can be made so patient experience is heard and acted upon. He is hopeful they can find some solutions which the patients themselves have proposed. 

Graham and Ann are heartened by the enthusiasm shown by the hospital trusts to take on board and implement the well-founded changes asked for by the patient advisory groups. As Graham says: “It augers well for patients to feel they have been well fed when attending or staying in hospital. I appreciate it’ll be a long haul, but I sense there is a mood for better food and delivered in a timelier manner in the Emergency Department.”

Ann and Graham’s work demonstrates that where patient experience is valued, heard, and acted upon, without tokenism, real improvements can be made. When it comes to adequate, timely, inclusive, and accessible food and hydration, the impact on patients isn’t just about having a full stomach, the additional consequence is that patients will feel cared for, listened to, and respected, all of which are significant for their sense of health and wellbeing.

Find out more about Shaping Our Lives and how we can help you with patient and public involvement.