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Home-cooked care

Some hospitals encourage visitors to bring in food for their relatives, but others ban the practice. Erin Dean spoke to nurses on both sides of the debate

Relatives and friends visiting patients at Buckinghamshire Healthcare NHS Trust are encouraged to bring in sandwiches, yoghurts and other foods they know their loved one will enjoy. It may not sound that radical - after all a bunch of grapes is the classic 'get well soon' gift - but some hospitals do not allow visitors to bring food on to wards.

Hospitals across the UK have a wide variety of policies on food gifts, each with different specifications about the type of food permitted, how it should be stored and whether it can be prepared or heated.

Buckinghamshire Healthcare nutrition nurse specialist Liz Evans and her trust's infection control team have worked hard on policies that allow people to bring in a wide range of edible products. She points out that a third of patients who arrive at hospital are malnourished, so it is vital there is food available for them during their stay that they will enjoy.

'Bringing food on to wards is a contentious issue,' says Ms Evans, who is chair of the National Nurses Nutrition Group. 'We have a common-sense approach - we encourage relatives and friends to bring in food.'

She adds that allowing food from outside is particularly beneficial to patients in the trust's national spinal injuries centre. 'Some people are in there for years, so menu fatigue can set in,' she says. Visitors to the trust can keep cold food such as sandwiches, salads and puddings on the ward, providing it is shop-bought and sealed. Staff write the patient's name on the item when it arrives and store it in the fridge. The ward housekeepers check fridges daily and throw away any food that is out of date.

Home-cooked food can be brought in, provided it is eaten immediately. At the moment, the trust does not allow food to be reheated, but it is considering allowing ready meals to be prepared for patients at high risk of malnutrition.

Healthcare assistants and ward housekeepers have statutory training on food hygiene, which means they are allowed to handle and prepare simple food. Something as basic as mashed-up banana can make a difference to older patients who may prefer to eat small portions at frequent intervals.

Nutrition in hospitals is a major issue, and one that frequently hits the headlines. According to the Still Hungry to be Heard report, published by the charity Age UK in 2010, more people are going into and leaving hospital with malnutrition.

Problems identified by the charity include patients not being given the meals they would like or assistance with eating when required. In addition, hospital food has been criticised for its lack of quality, nutritional value and variety.

Age UK director general Michelle Mitchell says that poor nutrition can delay recovery in older patients. 'Hospitals have a responsibility for the nutritional care of patients. It would be a real shame if relatives could not bring in a patient's favourite food, if appropriate, and be there to help and encourage them to eat. Relatives should be seen as partners in care.'

Environmental hazards

However, achieving this can be complicated. Hospital teams have to navigate the best way to use limited kitchen facilities and adhere to rules around infection control and safety, while meeting patients' needs.

This can be confusing for both nurses and visitors.

The Food Standards Agency says each trust decides what food can be brought into hospitals. Food that is prepared on site may be inspected by an environmental health officer from the local authority.

Kettering General Hospital NHS Foundation Trust states on its website that it is does not encourage visitors to bring in food - the only exceptions are fresh fruit and juices.

NHS Lanarkshire has published an in-depth guide for visitors, stressing that food cannot be reheated. It lists fresh fruit, pre-wrapped chocolate and biscuits, homemade cakes and canned drinks as suitable foods for bringing in for patients. Unsuitable and high-risk foods include cooked rice, sandwiches, rolls, yoghurts and cooked meat.

Permission required

Shrewsbury and Telford hospital NHS Trust discourages people from bringing food on site, and says visitors need permission from a senior nurse or consultant before taking anything in.

RCN acute and emergency care adviser JP Nolan says that family and friends can play an important role in a patient's care. 'But local policies on food being brought to patients by visitors vary,' he adds.

'Nurses have a duty to encourage an appropriate nutritional intake, while being mindful of food safety in the hospital environment. They have a role in advising patients about inappropriate food, for example among the renal and diabetic populations. The most desirable situation is that a balanced nutritional diet, which is appealing to patients, is provided by the hospital itself.'

Wendy-Ling Relph, matron for nutrition and quality improvement at East Kent hospitals University NHS Foundation Trust, says that banning visitors from bringing food can put nurses in a difficult position.

'Sometimes they can feel pressured to do things that flout the policy,' says Ms Relph, who is a member of the executive committee of the British association for Parenteral and Enteral Nutrition. 'Relatives like to bring something because it is part of being caring'.

Feature | July 18 2012 | vol 26 no 46

The RCN Publishing Company is a wholly owned subsidiary of the Royal College of Nursing, the world's largest organisation for nurses. RCN Publishing produces one weekly, eight monthly and two quarterly nursing publications. Nursing Standard, the flagship journal, is the UK's biggest selling weekly for nursing. It is produced by RCN Publishing Company along with a suite of specialist nursing journals - Cancer Nursing Practice, Mental Health Practice, Learning Disability Practice, Nursing Children and Young People, Nursing Management, Emergency Nurse, Nursing Older People, Nurse Researcher and Primary Health Care. RCN Publishing Company also produce the RCN Bulletin, a major source of up-to-the-minute information for RCN members in all specialities, grades and working environments. With the latest nurse vacancies from trusts nationwide, it has become the most cost-effective nurse recruitment magazine available.