Starving to death in hospital

Dr Grumble was at a meeting the other day at which he was urged to recognise the problem of malnutrition in his patients. The allegation was that doctors often fail to spot the problem. The recommended solution was loads of supplements and, if necessary, feeding the patients with tubes either poked through their noses into their stomachs or plunged more directly into their stomachs through their abdominal walls. For some reason, like so many things these days, it's doctors that are to blame.


But Dr Grumble has another explanation. He thinks it's the nurses that are to blame. Nurses have become very good at paperwork and very good at doing work (though not the chores) that used to be done by doctors but they have become very bad at basic nursing care. And what could be more important than getting patients to eat and drink? From their voluminous paperwork nurses frequently tell Dr Grumble that patients are not eating enough. Dr Grumble asks why. Often the explanation is that the patient just won't eat. Around the bed of such patients invariably you will find a wonderful collection of expensive nutritional supplements of one sort or another. They cost more than a decent meal. Yet often they are untouched by the patient and more often than not they are just out of the patient's reach. After Dr Grumble has been told this, he will select the most appetizing supplement, usually a pot of yogurt, and pass it to the patient. Not infrequently the patient will snatch the pot from Dr Grumble and consume the contents ravenously. These patients are indeed starving. They are starving not because the hospital food is bad (ours is quite good). They are starving because the nurses don't even ensure the food is within reach of the patient. They certainly don't spend enough time feeding patients unable to feed themseves. Some patients need to be fed like a baby needs to be fed. It needs time. It needs patience. It needs kindness. It needs attention to basic needs. It needs nurses - good old-fashioned nurses. These nurses need to be supervised by senior nurses, proper ward sisters, not managers, who need to have pride in their work and be rewarded. These nurses need to be rewarded for nursing not for becoming quasi doctors. Running a busy ward is a great responsibility. It's not easy. Why is that never recognised?

The solution to hospital starvation lies not in criticising doctors for not appreciating the problem of malnutrition and being reluctant to assault their patients with tubes. Nor are the nurses themselves to blame. We should criticise the rotten systems we have created for training nurses. We used to have vocational nurses, people who had a calling to nurse, who trained in an apprenticeship based around caring for patient. But now we have too-posh-to-wash nurses with degrees who think that basic nursing care is beneath them. We should be spending money on nurses not to become pseudo-doctors or managers but to do, yes, nursing - basic nursing. And instead of those expensive but not always appetising supplements we should spend money on better hospital food and round the clock availability. There was a time when a nurse could rustle up an omelette in the ward kitchen. If this is no longer allowed we need decent alternatives. Who knows? It might even be cost effective.

Far too little attention has been paid to these issues. It was some years ago now that Dr Grumble noticed that those plastic teacher beakers with a spout that were used to water patients had disappeared from the wards. Young doctors have never even seen them. Before then nurses used to feed patients from enamel containers with a spout. All these things have gone and the only substitutes have been the doctors' tubes. Reluctant to resort to these, doctors are now having to do the watering rounds.

British nursing used to be the envy of the world. It's very sad to see the way it has gone.

This post was first published on 20th October 2007. It has been republished now in response to this.