Health and Social Care Bill

Having listened to the debate, there is no doubt in my mind about the strength of feeling on this issue. I cannot emphasise enough that I share noble Lords’ concerns. As the noble Baronesses, Lady Knight and Lady Masham, know, I take this matter very seriously. A great deal of work is currently being carried out on the ground in relation to nutrition and hospital food, as was very well described by the noble Earl and the noble Baroness, Lady Cumberlege. For example, the Government have invested £67 million in care homes to improve the care environment, including dining rooms and support for residents at mealtimes. They are also working closely with the regulators, CSCI and the Healthcare Commission, to make dignity a key part of the inspections, because dignity is also part of this debate. We very much welcome the Healthcare Commission’s decision to inspect 25 acute hospitals to check compliance with dignity and nutritional standards. The department is using a number of different tools to tackle this important issue, including the current core standards, the Nutrition Action Plan programme and the NHS operating framework, as has already been mentioned. However, there is no excuse for people saying that they are too busy to assist at mealtimes. The introduction of protected mealtimes is a key tool in making certain that the right level of attention is given to ensuring that patients who can do so will enjoy their meals, while those who need assistance will receive it without interruption. It is unacceptable that some of our most vulnerable older patients, service users and people with special requirements do not receive the help they need in eating food and that efforts are not made to ensure that they enjoy it. It is an issue with which we are seized. We have proposed a registration requirement to be made under Clause 16, which I hope will help reassure the noble Baronesses, Lady Knight, Lady Masham and Lady Cumberlege, and the noble Earl, Lord Howe, that we can achieve the intention behind Amendments Nos. 48 and 54 without amending the Bill. Our proposed requirement 5 is, "““making sure people get the nourishment they need””." Under that proposed requirement, providers of care would have to: "““Ensure, where meeting nutritional needs is part of the service, that people have access to safe and sufficient nourishment. This includes: the provision of support for eating, drinking or feeding where required; the provision of a sufficient choice of palatable food to meet religious or cultural needs; and the prevention of harm through lack of access to sufficient nutrition and hydration””." This is important. It is out for consultation. The groups that have been mentioned and prayed in aid have the opportunity to comment on it and I encourage them to do so. The Care Quality Commission will be able to act on these issues whereas the Healthcare Commission cannot. So while the requirements are very similar, with nutrition as a requirement for enforcement, the Healthcare Commission can act to ensure that this is followed through. Noble Lords have expressed their concerns that this is not happening at the moment. I hope this comes close to noble Lords’ expectations of the comprehensive, appropriate and rigorous levels of care that service users should be entitled to expect. As ever, the noble Earl and the noble Baronesses made a powerful case for specific standards for the promotion of adequate nutrition and criteria for assessing their compliance. We have acknowledged throughout debates on this Bill that the commission itself will be best placed to set the specific criteria by which providers are assessed for compliance with the registration requirements. We have already talked about the need for the commission to be as independent as possible, and so I still remain unconvinced that it would be appropriate for the Government to issue a code of practice on nutrition or for regulations to determine the criteria by which compliance is assessed. We fully intend that this critical issue should form a part of the new commission’s registration regime, and the Bill already enables this. I say to the noble Baroness, Lady Knight, that we have agreed—despite chopping off heads, as she might say—to look again at regulatory requirements, user involvement, LINks and the CQC, clarifying the role of the CQC in relation to commissioning in Chapter 3 of Part 1, and safeguarding the rights of service users. So we have gone some way to meet concerns. It is not the case that we have not considered everything. We think that the framework proposed in the Bill and the teeth that the Bill has to deal with these issues is sufficient. Therefore, I hope that the noble Earl and the noble Baronesses will feel able to withdraw these amendments.