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How Missing Out on Good Nutrition Would be Criminal! - An Open Letter to David Behan, CQC Chief Executive

We have grave concerns that the basic role of food and nutrition may once again be overlooked in this latest review of how the CQC will regulate, inspect and rate care homes.

I am the Head of Nutrition for - a nutrition consultancy working with Vulnerable Communities [Early Years, Adults with Learning Difficulties and the Elderly] advising on their nutrition policies and implementation.

The Care Quality Commission is asking people who use and run health and adult social care services and the public at large for views on its plans for inspecting and rating care services.

So we are writing - here in Huffington Post - an open letter to David Behan, CQC Chief Executive asking him to ensure that our most vulnerable citizens have the best opportunity to maintain their health and wellbeing through good food.

Dear Mr Behan,

We have grave concerns that the basic role of food and nutrition may once again be overlooked in this latest review of how the CQC will regulate, inspect and rate care homes.

We have all been horrified by the recent exposure of abuse, neglect and even physical violence against residents in care. Of course, immediate action is needed to prevent any further suffering by some of the most frail and vulnerable people in our communities. In this respect the CQC review is welcomed. Our concern is that it must not be a knee jerk reaction to quiet a media storm. This is an opportunity to make wide reaching changes to the way we inspect and rate care services, and as experts in nutrition we are acutely aware that good food is currently woefully neglected by the CQC inspectorate.

The horror and impact of headline making stories are important in raising the profile of the quality of care. However they can also detract from some of more day to day aspects of care. While their issues may be less "sexy" to the media they have a greater impact on more people than the criminal actions of a minority care providers.

Our passion and belief is that good nutrition is the foundation for good health and wellbeing. This is true at any stage in the life cycle.

And yet the care sector is getting it wrong on a massive scale. At any given time, more than three million people in the UK are either malnourished or at risk of malnutrition

• 1 in 10 people over 65 are malnourished or at risk (1)

• The population of people over 75 is at highest risk of malnutrition

• 37% of older people who have recently moved into care homes are already malnourished or at risk of malnourishment (1)

• The incidence of malnutrition increased by 10% between 2007 and 2011 (2)

The current CQC outcome focusing on nutrition looks closely at food hygiene, the eating environment and the assistance staff provide for people who need help with eating (3). These are all very important points. However, there is very little guidance about the nutritional value or composition of meals and snacks. This is where we urge you to make changes.

Feeding older people good food needs specialist knowledge and training, but it's not rocket science.

• Older people are at risk of inadequate nutrition.

• Nutritional requirements remain high, while appetite and physiological triggers to eat and drink reduce.

• Food is the mechanism for delivering essential nutrients to keep people well

• As people age, the less nutrients they take in, the weaker and more prone to infection they become

Good nutrition for older people requires simple principles, these are already happening in care homes that the CQC inspects. You just don't look all for the right things. We would like the CQC to set standards and rate these areas:

• Nutritional composition meals and snacks

• Planned menus

• Appropriateness of meals

• Nutrition training provided for staff- chefs, carers & managers

• Availability of specialist eating and drinking equipment

• Protected time for meals, snacks and drinks

• Adequate staffing to support residents

• Screening for those at risk using the "MUST" nutritional screening tool.

• Access to specialist support when necessary

Care providers who already do all of these things simply because they believe "it's the right thing to do" are surely where we should start to see how excellent standards can become the default standards. These providers live and breathe the issues which are at the very heart of care. Compassion, respect and providing what people need to optimise their potential wellbeing. Some might say that these principles are common sense. In our experience, common sense is only common when it's shared.

If further evidence was required for the need for more stringent standards, you need look no further than your own research. In 2012 the Dignity and Nutrition Inspections reported worrying trends in care homes.

Of the 500 care homes inspected:

• Over 1/3rd failed to meet existing standards

• One in six people were not supported to eat or drink enough

• "Tasks before people" described as common culture of care

• Limited food choices

• 14% care homes had insufficient staff to support residents at mealtimes

• Homes caring for dementia sufferers more likely NOT to meet standards.

While these findings may be less impactful than the cruelty and violent acts which prompt media headlines, are they any less neglectful? We think not. Neither do other observers and the call of action is growing momentum.

"Access to nutrition and hydration are fundamental rights, yet too many older and disabled people and their families are left without the support they need to meet basic nutritional needs." Baroness Greengross OBE, Chief Executive of ILC-UK and EHRC Commissioner

"Food suitable for the sick is not just a hotel function- it is treatment" Simon Allison BAPEN

"The perception of malnutrition is limited to third world countries when the sad truth tells a very different story. Malnutrition is a major issue on our very own doorstep. "Andy Burman, CEO British Dietetic Association

Good nutrition is more complex than just food and feeding. We echo the words of these prominent campaigners for better food standards in care and implore the CQC to take this opportunity to take action.

Join our plea by voting on line at: - .

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