Diane Spalding

Background There is continuing concern over the lack of attention to the nutritional needs of older people in hospitals. A 2-year audit project was undertaken to examine the nutritional care of inpatients in Leicestershire Community Hospitals. Method The methods used included analysis of menu cycles; observation of meal and drink provision, wastage, supplement usageand portion sizes; and patient satisfaction questionnaire examination. Results Patient menus were nutritionally inadequate for energy, fibre and vitamin D, and protein levels were variable. The percentage of meal wastage and inadequate portion sizes were of concern. Patient satisfaction results were overall positive. Conclusion Patient energy intakes are a major concern with low calorie provision from menus exacerbated by a deficit in recommended portion sizes and a high percentage of meal wastage. Routine audits need to be implemented to monitor both portion size and meal wastage, and to address patient satisfaction issues to improve the overall intakes of patients. Multidisciplinary team input is required to address the above issues and additional recommendations to promote nutrition as a key component in clinical care.

Local food and health policies were initiated in the UK in the early 1980s, andthis paper traces developments in Leicestershire, England. The first policy waslaunched in 1987, which promoted the nutrition education messages of that time(less fat, more fibre and less sugar), primarily within the National Health Service.As a result of the publication of the Health of the Nation Green Paper in 1991, a local health plan was developed for Leicestershire, in which nutrition formed an integral part. Wider perspectives on nutrition have evolved reflecting the multidisciplinary approach to developing the Food and Nutrition Policy. In addition, updating of the nutrition messages in the local Food and Nutrition Policy has occurred to reflect the shift in emphasis towards nutritional adequacy and balance. The scope for implementation is now much wider, involving several key settings in the community, and there is an increased emphasis on monitoring and evaluation.