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CQC carried out a period of listening activity at Brighton and Sussex University Hospitals NHS Trust in December 2013 and January 2014. The report from that exercise, which informed our inspection in May 2014, is available below.

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Inspection report

Date of Inspection: 5 July 2011
Date of Publication: 26 July 2011
Inspection Report published 26 July 2011 PDF | 154.43 KB

Food and drink should meet people's individual dietary needs (outcome 5)

Meeting this standard

We checked that people who use this service

  • Are supported to have adequate nutrition and hydration.

How this check was done

We reviewed all the information we hold about this provider, carried out a visit on 05/07/2011, checked the provider's records, observed how people were being cared for, looked at records of people who use services, reviewed information from people who use the service, talked to staff and talked to people who use services.

Our judgement

Overall we found that the hospital was compliant with this outcome although we had minor concerns that there was a lack of evidence to support that robust arrangements are in place to demonstrate that people who need their fluid and food intake are monitored.

Not all staff particularly consultants respect the provision of protected mealtimes.

User experience

In A&E we observed that some people who were receiving care in the treatment bays were being offered food and drink by staff. We saw a patient being transferred to a ward in a wheelchair and heard her being asked by the healthcare assistant if she had received any lunch or a hot drink. When the patient replied she had not the staff member responded by saying “well that’s what we must do first then”.

Patients on Jower Ward told us that they were able to choose their meals and that they were provided with sufficient food and drink. They said the food was good and that generally they had no complaints. One person told us “the food is always plentiful and very tasty – they must use lots of herbs and spices and it is always sufficient”.

Two patients told us that they had eaten cereal for breakfast but they had not been offered anything else to eat, although when they asked for toast it had been provided.

A patient who said that the food was not great further commented that you could always get a cup of tea and that staff had brought a salad for someone on the ward who had missed lunch.

The members of staff we spoke to told us that they thought the food served is of good quality. They said there was a good choice and that special diets are provided for by the kitchen, sometimes an individual menu will be developed with the dietitian and the catering team. One member of staff on Jowers ward told us that older patients were sometimes put off eating by portions which were too large and some of the food was not traditional enough for elderly people’s tastes. This was reinforced by a patient on this ward who also said “It’s not the food I’m used to but I try it anyway”.

Other evidence

The hospital was able to demonstrate that it has a robust process in place to determine patients’ medical, dietary and hydration requirements. All patients are assessed for nutritional support within the trust as a matter of course and the organisation has a protected mealtime’s policy in place. Systems are embedded with regular audits being undertaken and records kept of any actions taken to address shortfalls. The Patient Environment Action Teams (PEAT) inspections found that the hospital food scored excellent for choice, availability and presentation. PEAT is a benchmarking tool to ensure improvements are made in the non-clinical aspects of patient including environment, food, privacy and dignity. We were told during our visit that catering staff regularly and actively seek the views of patients and staff on the content and quality of the food.

Patients visiting A&E were able to access refreshments from a vending machine with water dispensers in both waiting rooms. A shop run by WRVS where patients and visitors could purchase snacks and refreshments was located near the A&E department.

We were told about a project to improve nutrition called Mission for Nutrition which has recently been introduced on Vallance ward and we saw a poster on the wall in the corridor inviting suggestions from patients, relatives and staff about how nutrition on the ward could be improved. Suggestions included having more staff available to feed patients, fully protected mealtimes and better choice of food. The ward manager described to us how she had recently met with the catering team to discuss menus. The head of the Patient Experience Team at the hospital has been involved in the nutrition project and we were told that potentially the trust has set aside a budget for implementing some of the ideas.

Specialist staff such as dieticians, speech and language therapists (SALT) and physiotherapy teams are available for advice, planning and support for patients and staff. The dietitian provides nutritional support for a variety of conditions such as diabetes. Patients with specialist feeding regimes such as Percutaneous Endoscopic Gastrostomy (PEG) or Nasogastric (NG) feeding are discussed at the multidisciplinary team meeting which includes allied healthcare professionals. The SALT team recommendations are adhered to and staff felt it provided good support for the ward staff and patients.

We spoke to senior members of ward staff who told us that the Malnutrition Universal Screening Tool (MUST) is used on admission of all patients to identify the patient’s level of risk of malnutrition. All inpatients are then screened weekly or more frequently if needed. Action taken depends on the MUST score, and could include monitoring of weight, completing food and fluid intake charts, or referral to the hospital dietitian and we did see evidence of this in patient notes. Staff told us that they had very good access to the specialist staff they need, and that specialist staff are involved and included in the multi-disciplinary team.

During our visit we checked patient records on various wards and found that in the majority of cases the MUST tool had been completed appropriately but we found one record that did not have a current assessment and throughout the hospital isolated incidents were noted where the MUST tool had not been reviewed or patient’s records updated in line with policy and procedure.

On the wards that we visited which accommodated elderly and more frail patients, staff were able to confidently talk to us and identify systems that were in place to support those people that had been assessed and identified as needing additional fluids or at risk of dehydration. The system of giving these particular patients water jugs with red lids was demonstrated and staff we spoke to on Jowers Ward immediately recognised that this indicated a person who was required to be encouraged and assisted to take fluids at every opportunity. However, when we review