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Added: 8th November 2013

The British Dietetic Association wholly supports the need for high quality hospital. Dietitians across the UK in conjunction the Specialist Group ‘Food Counts’ have done much work to promote standards. However in sick individuals in hospital, subjected to invasive procedures and with medical conditions that often interfere with appetite, food alone is often insufficient and specialist nutritional products such as nutrient dense drinks and tube feeds and intravenous nutrition may be required to improve outcomes and in some cases prevent death from malnutrition and starvation.

Alarmist data highlighting the total cost of nutritional products without putting into context their value is unhelpful. Without such products the cost of care including readmissions, infections, prolonged length of stay far outweigh the cost of the products, all at the expense of the patient’s well-being and experience. The argument for good hospital food should therefore not be at the demise of specialist nutritional products which have been designed and are indeed essential in plugging the nutritional gap when dietary intake from food alone is minimal or limited.

Registered Dietitians want to support the system in getting it right and we would not wish specialist nutritional supplements be used to make up for poor quality food, afterall good quality food is not just about the nutrients, it is all part of an eating experience. Good nutritional care includes good quality food, fortified food, oral nutritional supplements, enteral feeding and intravenous (parenteral) feeding. As an example intravenous nutrition may be costly per case compared with food but if the gut isn’t working then it is a life-saving treatment for providing nutrition, the alternative – death from starvation.

One of the key aspects of good nutritional care is to identify patients who are likely to experience eating difficulties or have existing nutritional problems and provide a tailored nutritional care plan which may include a combination of nutritional therapies. Dietitians are skilled practitioners who work with doctors, pharmacists, nurses to advise patients and their carers how best to improve nutritional intake. Specialist nutritional products are part of their toolkit, as is good quality hospital food but any strategy has to take into account the specific challenges affecting appetite, the desire to eat and the patient’s medical condition.

It’s great to see hospital food getting the focus it deserves, it can help recovery and improve the patient experience particularly when supported by protected meal times and assistance to feed patients but it’s not the only solution.

- Anne Holdoway

Chair of the Parenteral and Enteral Nutrition Group of the British Dietetic Association

Dr Tim Bowling, Chairman of BAPEN*, commented: “BAPEN is fully supportive of any campaign to improve hospital food, and agrees wholeheartedly that there should not be a situation where hungry patients are prescribed nutritional supplements in favour of food because of the poor quality meals being served in hospitals. We would emphasise, however, that while there is often a clinical need for such supplements, they should be used together with food, rather than in competition, under the guidance and support of health care professionals such as dietitians and nurses in order to provide the best possible outcome for patients. We would also point out that of the quoted figure of £300m spent by the NHS in 2012, it appears that at least 2/3 of this (£224,785,117) was spent on enteral nutrition for tube feeding, ie for those patients who, usually for medical reasons, are unable to eat. Therefore the amount spent just on oral supplements seems to be considerably less than the quoted headline figure of £300 million.

*British Association for Parenteral and Enteral Nutrition

BAPEN is a Charitable Association that raises awareness of malnutrition and works to advance the nutritional care of patients and those at risk from malnutrition in the wider community.