Observations on hospitals

''Don't leave him alone in hospital, he'll starve," the residential home manager warned when my grandfather landed in an NHS ward. Surrounded by clucking relatives ministering food and drink, he was fine.

What if he had been on his own? Everybody is currently preoccupied by MRSA bugs and the need for hygiene, but people in hospital can die of malnutrition as well as infection. The elderly patient opposite my grandfather slept through mealtimes and did not touch any of the water in the heavy ceramic jug by his bed. For a whole weekend, trays were deposited out of his reach and, half an hour later, scooped into a bin by the catering staff. The forbidding power of medical authority held us back from asking if we should wake him. In any case, apart from distant sightings, there were no nurses to ask.

We eventually told the assistant serving meals that we hadn't seen the man drink for days. "I'm not allowed to feed him," she said. "The managers don't let us." Later a consultant pronounced him "dangerously dehydrated".

Two years ago, a report found 60 per cent of UK hospital patients are malnourished and two-thirds lose weight during their hospital stay. Carl Dunford, a Birmingham GP, says: "It was once the matron's duty to check whether patients had eaten, but now, in general wards, and when there are meals left at the beds, it often isn't even recorded." It is estimated that more than 10 per cent of meals go uneaten.

The government responded to concerns with "bring back matron" proposals and a bit of celebrity gloss. A task force led by Loyd Grossman recommended saffron couscous to replace the usual stodge, and snacks to fill the gaps between meals. Many hospitals now have "protected mealtimes", during which wards are locked to visitors so that nurses can concentrate on feeding patients. Better training has been pledged for medical students, who at present can complete their degrees without ever studying nutrition.

However, nutrition will remain a problem in hospitals as long as catering services are contracted out to the cheapest supplier and they remain the first target for cuts. Rick Wilson, director of nutrition and dietetics at King's College Hospital in London, says that "catering has long been regarded as a below-stairs activity - a luxury we didn't have to do if we couldn't afford it". On average, the NHS spends £3.70 a day on each patient to cover three meals and snacks. As most hospitals use food precooked off-site and reheated in hospital, a high proportion of these costs goes on transport and freezing rather than on good-quality ingredients. With no kitchens on the premises, special meals for those struggling to eat the food on the menu have virtually disappeared.

Rigid contracts and staff cuts remove the slack for proper patient care. Catering staff, like the cleaners, have been rationalised. A union report quotes a Norwich hospital worker saying: "Privatisation has taken the care out of our jobs. Do I help you put butter on your piece of bread and jam, or make sure the other patients at least get the food put in front of them?" And recently, workers at one PFI hospital found they couldn't take bereaved relatives cups of tea because the hospital had forgotten to include any "personal patient contact" in the contract small print.

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