Poor standards of nutrition and dignity in hospitals

Poor or inconsistent standards of dignity and nutrition for older people shown to be widespread in English hospitals by new in-depth analysis

LSE report concludes poor and inconsistent standards of dignity and help with eating are a 'significant problem' affecting the 'vast majority' of English NHS acute hospital trusts.

Older hospital patients in England face a 'widespread and systematic' pattern of inadequate care. An estimated one million people in later life are affected by poor or inconsistent standards of dignity or help with eating in hospitals, according to a detailed statistical analysis of inpatient experience data in NHS hospitals in England[1].

Research by Dr Polly Vizard and Dr Tania Burchardt of the Centre for Analysis of Social Exclusion at the London School of Economics 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[2]. Given that a substantial proportion of hospital patients in England are over the age of 60, this report provides critical new insights.

Major findings from the analysis include:

• Experiences of poor or inconsistent standards of dignity and help with eating were too high in the 'vast majority' of NHS trusts
• 23% of people reported experiencing poor or inconsistent standards of dignity and respect. This is equivalent to 2.8 million people annually, of whom 1 million are aged 65 and over.
• Of those who did need help eating, more than 1 in 3 patients did not receive enough assistance. This is equivalent to 1.3 million people on an annual basis, of whom 640,000 are aged 65 and over.
• Amongst 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.
• For patients who experienced a high risk individual ‘journey' through hospital (for example, staying in three or more wards, or having a long stay) the risks were even higher.
• 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.
• There has been 'remarkably little change' in the percentage of individuals reporting inconsistent and poor standards of care over a substantial period time.

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 of whom will be frail and suffering from multiple conditions
• A renewed focus on implementation and enforcement of the new fundamental standards concerning dignity and meeting individual nutritional needs introduced in the wake of the Mid-Staffordshire NHS Foundation Trust Public inquiry.
• A new and improved approach for identifying hospitals where poor quality care is a cause for concern, for example, separate monitoring of the care provided to older disabled women
• A new and improved approach when using patient experience data to identify hospitals where care is a cause for concern. 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.'

-ENDS

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Notes to editors

• Contact: Liz Fairweather
• Telephone: 020 3033 1718
• Out of hours: 07071 243 243

For media enquiries relating to Wales, Scotland and Northern Ireland please contact the appropriate national office: Age Scotland on 0131 668 8055, Age Cymru on 029 2043 1562 and Age NI on 028 9024 5729.

[1] Vizard, P., and Burchardt, T (2015) ‘Older people's experiences of dignity and nutrition during hospital stays: Secondary data analysis using the Adult Inpatient Survey' CASEreport 91. London: Centre for Analysis of Social Exclusion, London School of Economics (pages, 91 and 149)

[2] Vizard, P., and Burchardt, T (2015) ‘Older people's experiences of dignity and nutrition during hospital stays: Secondary data analysis using the Adult Inpatient Survey' CASEreport 91. London: Centre for Analysis of Social Exclusion, London School of Economics. (page 91)

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