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Dignity and nutrition for older people
Throughout summer 2012, we carried out an inspection programme that looked at the care provided to older people in care homes and NHS hospitals. The programme focused on whether they are treated with respect and dignity and get the food and drink that meets their needs.
This inspection programme looked at the performance of 50 NHS hospitals and whether they were treating people with dignity and meeting their nutritional needs.
About the inspection programme
The inspections took place between July and August 2012 and ran alongside our ongoing inspections of hospitals.
We identified 50 NHS hospitals (37 from acute trusts and 13 from mental health trusts) to take part in the review.
Download the reports in our A-Z of NHS reports.
This is a follow-up to the programme we carried out in 2011 which looked at the care in 100 NHS hospitals. You can find out more about the first inspection programme in Dignity and nutrition 2011.
The inspections teams
Before each hospital was inspected, we reviewed all the information we held about the service.
Each inspection was led by a CQC inspector who visited at least two wards or units per inspection.
Inspectors also worked with 31 practising professionals (including geriatricians, nurses and dietitians) and 35 Experts by Experience (people with experience of care services).
Experts by Experience took an active part in the inspections and talked to patients and relatives using the service. They also looked at the environment and atmosphere at the service and observed how staff and patients interacted with each other.
Read Helen's story to find out more about the role of an Expert by Experience.
Have services improved compared to the 2011 programme?
The chart below shows you the percentage of NHS hospitals that met the needs of their patients in specific areas relating to dignity and nutrition. If you hover over the bars of the chart, you can see the figures involved.
There were nine hospitals that were inspected in both 2011 and 2012. Of these hospitals, seven had improved or were continuing to provide care that met people’s needs. The remaining two hospitals were identified due to issues regarding staffing and record-keeping.
What did we find?
Our inspectors found many examples of hospitals that were providing good care in relation to dignity and nutrition.
The examples below reflect a culture that puts patients first. Hospitals can learn from these examples and apply them to their own service.
- Staff documented patients’ wishes and preferences, or involved relatives when the patient did not have the capacity to, and regularly updated and reviewed the information.
- Patients were asked how they wanted to be addressed.
- Staff were familiar with patients’ needs which meant they could anticipate their care requirements.
- Hospitals made sure that patients’ privacy was respected, for example when bedside curtains were closed – some hospitals did this by using ‘Do not enter’ signs.
- Hospitals provided flexible catering such as a choice of meals, portion sizes and when they could be ordered.
We also found that hospitals providing good care had systems firmly in place to record and monitor patients’ needs. These hospitals regularly updated patient care plans, the amount of food they ate and their weight, and also completed nutritional risk assessments on a regular basis.
There were some common failings across hospitals that were not sufficiently meeting people’s needs.
We found that many of these issues arose in services that put the completion of tasks before the needs of patients.
In some cases, patients did not always have a suitable choice of food that met their individual needs. Many of them were not given the opportunity to wash their hands before or after eating either.
Some patients told our inspectors that they waited a long time before staff answered call bells.
We witnessed staff who:
- were not involving patients in care planning or recording their preferences and dislikes.
- were not giving patients the help they needed to eat and drink, or weren't accurately recording what they eat and drink.
- were discussing confidential information about patients in public areas.
- were talking over patients.
In addition, some staff did not have full knowledge of training in areas like safeguarding, the Mental Capacity Act 2005 or the Deprivation of Liberty Safeguards.
From what we've seen during our inspections and the things that people have told us, hospitals must now:
- implement the best systems to ensure people’s nutritional needs are identified and met and reviewed on a regular basis.
- make sure that all staff understand safeguarding and their responsibilities in protecting patients from the risk of abuse - this includes having an understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.
- improve the standard of record keeping, with staff maintaining accurate, appropriate information to support patient care.
Read the findings from our inspection programme of 500 care homes to find out whether they are respecting the dignity of their patients and meeting their nutritional needs.
About the inspection programme
This inspection programme focused on the care provided to older people across 500 care homes between April and October 2012.
In the sample, we included homes that had improved the way they respected people in their care and the way they met people’s nutritional needs. The remaining homes were selected at random.
Download the reports in our A-Z of adult social care reports.
The inspection teams
CQC inspectors were supported by 86 practising professionals and 96 Experts by Experience (people who have experience of receiving care or caring for someone who has).
Read Helen's story to find out more about the role of an Expert by Experience.
All of the inspections were unannounced and took place at times when inspectors could observe mealtimes. Four hundred and fifty-three inspections took place over lunchtime, 17 over dinner and 30 over both mealtimes.
Overall performance of care homes
The chart below shows you the percentage of care homes in the programme that are meeting the needs of the people they are caring for. If you hover over the bars of the chart, you can see the figures involved.
Our inspectors found many examples of good care being provided by care homes. The following promote a culture of putting patients' needs first.
- Staff clearly understood the preferences and needs of their residents.
- Care home providers made sure the ways staff talked to and cared for people were respectful and appropriate.
- Staff saw residents as individuals and supported them to live as independently as possible.
- Care home providers made sure that interactions between staff and residents were just as important as providing practical care needs.
Homes that recorded people’s choices and decisions about their care were more likely to be involving people (91 per cent) than those that had not (41 per cent).
Additionally, homes that had recorded people’s individual food and drink preferences were more likely to be giving people a choice of food and drink (88 per cent) than those that had not (41 per cent).
We also found that homes meeting the standards were adopting the right systems. They kept accurate records of each resident’s care, were identifying people at risk of malnutrition and had the right processes in place to protect people from the risk of abuse.
There were some common failings among services that were not meeting the needs of people in its care.
We found that people living in one in six of the care homes (80 homes) that we had inspected did not always have their privacy and dignity respected or were not involved in their own care.
Some members of staff and managers in homes:
- talked to people using inappropriate words or manners.
- did not use doors and screens when providing personal care
- did not give people somewhere to keep their possessions secure.
- did not find out how people preferred to be cared for or spend their time.
- failed to provide choices of activities and options for people to support their independence – particularly for people with dementia.
One in six care homes (87 homes) were not always supporting people to eat and drink sufficient amounts. Some staff failed to identify or provide the support to people who were at risk of malnutrition.
Homes caring for people with dementia, including those with a dedicated dementia unit, were less likely to be respecting people’s dignity and protecting them from abuse. This may be because some of the staff did not have the appropriate skills, knowledge and experience in the Deprivation of Liberty Safeguards and the Mental Capacity Act 2005.
In order to raise standards, care homes need to make sure that:
- older people are treated with dignity and that they are shown respect at all times.
- individual needs and preferences are identified and documented on admission and regularly reviewed, with input from the individual and their relatives.
- staffing levels and knowledge must reflect and meet people’s needs.
- staff caring for people with dementia have the appropriate skills, knowledge and experience through appropriate training and access to other sources of information and support, particularly in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.
Dignity and nutrition in 2011
This review looks at whether older people are treated with respect and whether they get food and drink that meets their needs.
The original review of 100 NHS hospitals took place between March and June 2011. In November 2011, we announced we would be inspecting a further 50 NHS trusts and 500 adult social care services during 2012.
For the original review we inspected 100 NHS hospitals selected partly based on what we already knew about their performance and partly at random.
All the inspections were unannounced and were carried out between March and June 2011.
We found that, of the 100 hospitals we inspected:
- 45 hospitals met both standards (they were ‘fully compliant’).
- 35 met both standards but needed to improve in one or both (they were ‘fully compliant, with improvements suggested’).
- 20 hospitals did not meet one or both standards (they were ‘non-compliant, with improvements required’).
Where we did find problems, some of the important issues were:
- Patients’ privacy not being respected – for example, curtains and screens not being closed properly.
- Call bells being put out of patients’ reach, or not answered soon enough.
- Staff speaking to patients in a dismissive or disrespectful way.
- Patients not being given the help they needed to eat.
- Patients being interrupted during meals and having to leave their food unfinished.
We have also brought together our findings in a national report.
- Last updated:
- 29 May 2017