Age UK Sutton User and Carer Involvement Group for Older People Hospital Meals & Mealtimes monitoring project Jill Shillito and Gem Wason

Funding and First steps Age Concern Sutton’s User & Carer Involvement Group (UCIG) received a number of complaints from local residents about the meals and mealtimes at St. Helier Hospital In 2007 a co-ordinator from AC Sutton was appointed to develop a mealtimes monitoring project with UCIG volunteers. The co-ordinator contacted and liaised with the Patient Experience Manager at St.Helier to agree how the project would run. The Patient Experience Manager agreed with the co-ordinator which days visits would be made, the wards which would be visited and she liaised with ward staff. 4 Volunteers from the UCIG were recruited to take part. We received training at St.Helier about the meals service and the roles of the people on the wards. We also learnt about infection control and health & safety.

The Project Aims and Objectives Aim: To evaluate the effectiveness of the protected mealtime and red tray systems at St.Helier hospital, and to ask older patients what their needs and expectations were with respect of the hospital food that was served at the hospital. Objective: To enable the UCIG and St.Helier to work in partnership to involve older patients at the consultative and informing level, in order to ensure the required changes were made for older patients to derive maximum benefit and nutrition from the meals served at the hospital.

How we did it The patients on the two wards we were to visit were aged mostly 80+. A questionnaire was drawn up. We spent the first few sessions on the wards observing how mealtimes were run and getting to know who was who. Ward staff indicated who be the most suitable to be interviewed. Once we started the interview process, we left patients to eat their meals first and then approached them to ask if we might talk.

The questionnaire The questionnaire covered three aspects of meals and mealtimes: 1.Protected mealtimes 2.Assistance with eating 3. Meals

Protected mealtimes Some of the questions we asked: Did anyone interrupt you during your mealtime? If so, what was the reason, and how long did the interruption last? Did this affect you? Were you able to carry on with your meal? If you need assistance with eating, was someone available to help you afterwards? Are you able to eat your meal without off-putting smells? If not, what was the smell? Is your table free of clutter when you eat? Does the level of noise on the ward affect your mealtime?

Assistance with Eating Some of the questions we asked: Do you receive assistance with eating and drinking if you need it? Is the assistance given in a dignified way that is helpful and sensitive to you? Are enough cutlery and condiments provided? Are you able to access fluids between meals? If not, will someone assist you? Is there any other assistance that would make your stay in hospital more comfortable?

Meals Some of the questions we asked: Is there a satisfactory range of meal options for you to chose from on the menu? If you order your meal from a menu, do you receive the meal you selected? Do you get enough to eat at mealtimes? Do you get enough to drink at mealtimes? Are your meals served at a good temperature? If you are on a special diet, is the special meal always available to you? How well do you think your meals are presented? How do you rate the food you are given in the hospital? Is there anything you would like to see on the menu that is not there?

What we found Several patients were interrupted during their mealtime. Mostly food was kept warm for them, but several found their meal cold afterwards. Not all nurses seemed to know what the red tray system meant. A few patients said they had not had help to eat when they needed it, but of those that did, most felt it was well given. Most people thought that meals and choice were good, and that they received the food they chose and it was well presented. Most felt they had enough to eat and drink, in fact a good few said they felt there was too much on their plate. Several people commented that they would like to have fresh fruit as a desert option.

Our conclusions and recommendation We were pleased that the red tray system and protected mealtimes had been introduced, but it was not official hospital policy at the time of the interviews. Because of this, communication about how it worked was patchy. We recommended that the system should be fully integrated into policy and procedures. Doctors were sometimes a barrier to making protected mealtimes work well. Patients were unwilling to complain about these interruptions. We recommended that a multi-disciplinary approach should be adopted so that all staff – including doctors – respect protected mealtimes. We felt that a mealtimes audit ought to be repeated periodically.

The results St. Helier Hospital has now integrated the red tray system and protected mealtimes into hospital policy. St.Helier was not one of the hospitals visited by the CQC in the recent inspections, so we don’t know how well the mealtimes are working now. We think it’s important that a watch is maintained. Thank you.