Poor standards of nutrition and dignity in hospitals

New report finds poor or inconsistent standards of dignity and nutrition for older people is widespread in English hospitals, and calls for a sustained effort to improve standards.

An in-depth analysis by the London School of Economics (LSE) concludes that older patients in England face a 'widespread and systematic' pattern of inadequate care that affects an estimated 1 million people in later life.

Research by Dr Polly Vizard and Dr Tania Burchardt of the Centre for Analysis of Social Exclusion at LSE broke down data in the Adult Inpatient Survey for 2012-13 to provide a fresh detailed picture of older people's reported experiences during hospital stays.

They found that 23% of people reported experiencing poor or inconsistent standards of dignity and respect. And of those who did need help eating, more than 1 in 3 patients did not receive enough assistance.

Among older people, poor or inconsistent care was more likely to be experienced by women, and those aged over 80. The risks were also higher for those with a long-standing illness or disability such as deafness of blindness.

Risks were even higher for those who faced a 'high risk individual journey' through hospital, e.g. staying in 3 or more wards or having a long stay.

The analysis found 'remarkably little change' in the percentage of individuals reporting inconsistent and poor standards of care over a substantial period.

The quantity and quality of nursing care, and whether or not there was a choice of food, had a large, statistically significant association with the probability of experiencing poor standards of help with eating. These are key policy levers for meeting individual nutritional needs.

Improving standards

The report calls for sustained efforts to ensure improvement in standards of dignity and support with eating for hospital patients - the majority of whom are aged 60 and over, many whom will be frail and suffering from multiple conditions.

It asks for a new and improved approach for identifying hospitals where poor quality care is a case for concern (e.g. separate monitoring of the care provided to older disabled women) and a renewed focus on implementation and enforcement of the new fundamental standards concerning dignity and nutrition introduced in the wake of the Mid-Staffordshire NHS Foundation Trust Public inquiry.

It calls for a new and improved approach when using patient experience data to identify hospitals where care is a cause for concern, and that hospitals should be judged on their absolute levels of poor or inconsistent care (a 'minimum threshold approach').

Equality and human rights standards should be embedded into the monitoring, inspection and regulation of all health care.

Caroline Abrahams, Age UK's Charity Director, said: 'This new in-depth analysis of older people's reported experiences shows just how big the challenge is in ensuring every older person in hospital receives the dignity they deserve and help with eating if they require it.

'It must be recognised that the data this research is based on is two years old now and that the newest figures suggest some welcome improvement, especially as regards older people's experiences of dignity, but this sobering report certainly shows that hospitals need to redouble their efforts.

'Above all it is really worrying, if perhaps not altogether surprising, that the more vulnerable an older person is, the greater their risk of not being treated as we would all wish for ourselves or our loved ones. Turning this situation around ought to be a top priority and no hospital can afford to be complacent.'

Polly Vizard of the LSE's Centre For Analysis of Social Exclusion said: 'It's the first time we have analysed an NHS patient survey in such detail and the findings are very disturbing. What really stands out is not just the large number of patients who say they aren't always being cared for in a dignified way or helped to eat - but also that there has been remarkably little change in the percentage of individuals reporting inconsistent and poor standards of care over a substantial period time.

'An important message arising from the Francis Inquiry into the tragedy at the Mid-Staffordshire NHS Foundation Trust concerned the need to make "better use" of patient experience data in the future.

'Treatment with dignity and respect, and help with eating for those who need it, are key markers of quality of care. Our analysis across NHS hospitals suggests that experiences of poor or inconsistent standards of dignity and help with eating during hospital stays are endemic across the vast majority of trusts.'

Looking forward, the new fundamental standards of quality of care introduced following the Francis Inquiry are an important development. In making judgements about the implementation of these standards, there needs to be an emphasis on systematic disaggregation of patient experience data and monitoring the position of "high risk" subgroups such as older people with multiple conditions.

'Judgements about quality of care should focus on "minimum thresholds" - with questions asked of all organisations who sit above that line.'