Starving to death on NHS wards?

The Sun newspaper on Monday carries the headline "Kill by mouth: Two die in NHS each day of thirst or starvation".

A shocking claim, based on figures from the Office of National Statistics.

The data for England and Wales shows that in 2015, hunger and/or dehydration were a factor in 828 patient deaths in hospitals and care homes.

But that doesn't mean all of these patients starved to death or died of thirst, experts at the ONS were quick to point out when I spoke with them about it.

Malnutrition may be recorded on the death certificate as a factor contributing directly to a death when it was a complication of a different underlying cause, such as cancer of the stomach, for example.

If you are very sick, it might not be feasible or desirable to eat and drink. Having a disease such as advanced cancer can cause malnutrition.

That's not to say that patients who are terminally ill should have fluid and nutrients withheld. On the contrary, guidelines make it clear that even if a patient can't eat or drink they should still be provided for.

They were drawn up after reports revealed some patients at the end of life were being denied this basic right when they were put on a care protocol called the Liverpool Care Pathway.

The LCP was scrapped in 2015 after relatives complained that their loved ones had been put on it without their knowledge and denied fluids, which hastened their deaths.

Another dark period in history for the NHS was the Stafford Hospital Scandal, where hundreds of patients died amid appalling levels of care between 2005 and 2009.

An inquiry identified terrible and unnecessary suffering, including examples where patients had been provided with food and drink, but it had been left out of their reach.

Joan Morris suffered a heart attack and died four weeks after being admitted to Stafford General Hospital

Joan Morris, 83, was admitted to Stafford Hospital in December 2006 with a chest infection.

Her family said that food and water had been left on a table instead of being given to her.

Another patient, Tom Wilhelms, resorted to drinking from a vase.

In response to the Francis Inquiry into the failings at the Mid Staffordshire Foundation Trust, the government published new hospital standards including around nutritional and hydration care.

And it asked the Care Quality Commission to make sure that the hospitals and care homes it inspected were following these standards.

The CQC's first dedicated review was in 2012.

It inspected 500 care homes and 50 hospitals in England and found 83% of care homes and 88% of hospitals it inspected met people's nutritional needs, which means patients were provided a suitable choice of food and drink and given help to eat and drink when they needed it.

It says this shows things have improved.

Prof Sir Mike Richards, CQC Chief Inspector of Hospitals, said: "We expect the food provided to be nutritious, to meet people's dietary requirements, and for this to be included as part of patients care planning while in hospital, and we look closely at this on our inspections. Where we find this is not happening or identify concerns that people's nutritional needs are not being met we take action and have a range of enforcement powers at our disposal where required."

Age UK agrees that there's been progress, but says malnutrition in the NHS is still a big issue.

Lesley Carter, who works of the charity and is programme manager of the Malnutrition Task Force, says a third of people going into hospitals and care homes are already malnourished or at risk of malnutrition when they are admitted.

"That means they are already vulnerable to start with."

She said that on busy wards, mealtimes might get rushed or overlooked without the right staffing.

"Older people in particular might need help to eat and drink, and they aren't always getting this. Food can still be left out of reach.

"Some hospitals have employed nutrition nurses to spot those patients that need help, and nutrition assistants to help with the feeding, which is good.

"But it is time consuming to feed someone properly."

She says friends and families have a responsibility to keep a check on elderly loved ones too.

"We all need to realise that it's not natural to lose weight as we age."

Although elderly people should be encouraged to eat a healthy diet, she says this can backfire.

A salad might be worse than cake in terms of nutrition for someone who is old and frail and has a poor appetite, for example.

"Some residents in care homes are being given low fat yoghurt and semi-skimmed milk when instead they should get full fat milk."

Food for thought.

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