My Lords, I thank the noble Baroness, Lady Cumberlege, for this comprehensive Private Member’s Bill and I commend all speakers in this knowledgeable debate. Clearly, despite many initiatives and endeavour over a long period of time—it has to be said that there has been some improvement in the quality and nutritional value of hospital food because of the focus of the previous Government and this—this Bill and this debate show that there is still a great need for improvement. The Library note about the Bill was immensely helpful, as was the publication, Twenty Years of Hospital Food Failure, in February 2013 by the campaign group Sustain, an alliance of organisations. It outlined government hospital food initiatives since 1992. As my noble friend Lord Turnberg mentioned, an enormous number of initiatives have been taken.
I read with interest the Government’s guarded response to that report. The report said that,
“public spending on government voluntary initiatives has failed”,
and called on the Government to set mandatory health and sustainability standards for hospital food in England. The Department of Health issued a response to Sustain’s hospital food standards campaign, which states:
“The government’s preferred approach remains to encourage the adoption of Food GBS”—
government buying standards—
“within the NHS through incentives, signposting and assessments”.
That does not sound to me to be consistent with the noble Baroness’s Private Member’s Bill and the tone of this debate.
I volunteered to speak on this issue, partly because when I was appointed to a ministerial job in January 2008 as the health whip, my first question in your Lordships’ House concerned nourishment and nutrition in hospitals. I can still recall my nervousness at the time but the House was kind to their new Front-Bencher and I survived. We all know that the noble Baroness, Lady Knight, is very concerned with these issues and she asked the Government:
“How they will respond to the recent reports about the levels of malnourishment of patients in NHS hospitals”.
At the time, I spoke about the fact that the then Government had published in October 2007 Improving Nutritional Care: A Joint Action Plan to outline how nutritional care and hydration should be improved in
NHS hospitals and had introduced protected mealtimes and focused on nutritional screening. I concluded:
“There are three strong mechanisms for assessing the quality of food and nutritional care: the Healthcare Commission’s annual health check, in-patient services, and the annual Patient Environment Action Team inspections. These show how seriously the Government are taking the issue”.—[Official Report, 30/1/08; col. 619.]
I wonder whether the Minister is about to say something along the same lines in his response to this debate.
I was very struck by the huge list of initiatives over 20 years that have tried to raise the standards and quality of hospital food. My noble friend Lady Gibson told us a sorry and miserable story. Her example of Scarborough Hospital was most heart-warming. Recently, I met the head of catering for a hospital who explained to me how it produces high-quality meals, how it uses hotel nutritional and food standards, how much of its food is locally sourced and how much as it could possibly manage was freshly prepared.
My noble friend Lord Rea spoke about changing the whole hospital food system and he is right. We know that those beacons of good practice exist and that it is entirely possible to achieve a satisfactory outcome for patients and their families. My most recent experience of hospital food was when my daughter had a short stay following the birth of our first grandchild. I suppose that, because there are lots of relatives on maternity wards who bring food, cakes and all sorts of things, there might not be quite the same problem. However, I was very impressed by two things. First, there was access to the kitchen on the ward for patients and their families to make toast, warm drinks and so on. Secondly, the food was very plentiful and nourishing, and a lot of fruit was available. I am referring to a very large London teaching hospital. If large teaching hospitals can achieve that, I cannot see why any other hospital cannot do so.
My noble friend Lord Turnberg pointed to the problem of the voluntary approach so far. We know that voluntary approaches can work but they will work only if management and hospitals have the will to make them work. The issue that we face with this Private Member’s Bill is whether we have reached the end of the road of the voluntary approach on this matter.
I can understand why the noble Baroness exempts outlets in hospitals that sell food, including cafes, shops and such like. I wonder whether we might find ourselves in a similar position to that of Jamie Oliver when he introduced nutritional standards to school meals and stopped children from going out to buy their lunches. We then saw parents pushing burgers and pizzas through the railings of the school.
I have a serious question to ask the noble Baroness, Lady Cumberlege, and the Minister. Is this Private Member’s Bill and its proposal consistent with this Government’s resistance to statutory regulation, the setting of standards and the administration and monitoring of those standards in other areas of the NHS? I draw the attention of the noble Baroness and the Minister to the Government’s resistance to statutory regulation of healthcare assistants, which we believe would have a beneficial effect for patient care in the NHS. Will they explore the consistency of their arguments in this matter?
Finally, why is this Private Member’s Bill about only hospitals? Why is it not inclusive of the other areas, such as care homes, under the aegis of the CQC? I ask that question particularly given the campaigns of organisations such as Age UK on the nourishment of older people, people with mental health problems and such like in places of residential care.
On these Benches, we welcome the Bill. We believe that we have to keep pushing on this issue until we have it cracked and sorted. I hope that the noble Baroness will have some words of encouragement from the Minister in his response to her Private Member’s Bill.
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