Older people's experiences of dignity and nutrition during hospital stays: Secondary data analysis using the Adult Inpatient Survey
Lead Research Organisation:
London School of Economics and Political Science
Department Name: Centre for the Analysis of Social Exclus
Abstract
A number of recent studies, investigations and inquires have examine the treatment of older people in healthcare and have identified shocking evidence of poor treatment:
-The Joint Committee on Human Rights (2007) raised concerns about poor treatment, neglect, abuse, discrimination, lack of support for eating and drinking, and malnutrition and dehydration.
-Age UK (2010) highlighted lack of detection and treatment of malnutrition in hospital as a 'national disgrace' and called on the Government to introduce compulsory monitoring of malnutrition.
-Patients Association (2011) details sixteen accounts of poor hospital care heard by its Helpline focusing on care-communication, access to pain relief, assistance with toileting, and help with eating and drinking.
-The Health Service Ombudsman (2011) investigation into NHS care of older people raised key concerns about lack of assistance with eating and drinking.
-The Care Quality Commission (2011a) dignity and nutrition inspection identified evidence of people not being given assistance to eat, not having their nutritional needs monitored and not being given enough to drink; staff not treating patients in a respectful way; and older people not being sufficiently involved in their care. It concluded that national minimum standards of dignity and nutrition were not being complied with in many casesn and in some cases treatment was so poor that it amounted to a violation of legal rights.
-Further shocking findings were identified in the Equality and Human Rights Commission (2011) inquiry into the treatment of older people requiring or recieving home-based care and support.
The new research will build up a quantitative statistical evidence base in order to produce a national statistical picture on older people's treatment during hosptial stays. We will analyse older people's responses to questiosn about dignity and nutrition using the Adult Inpatient Survey. The Adult Inpatient Survey is a national survey that the Government uses to monitor quality and performance in the NHS. Participants in the survey are adults who have stayed at least one night in an NHS hospital in England. They are asked whether they feel that they were treated with dignity and respect during their hospital stay, and whether they received the help that they need with eating during their hospital stays.
The new research involves evaluating older people's responses to these questions. We will be analysing what older people have said about their treatment during hospital stays over the period 2002-2011 and whether older people are at any greater risk than younger people. The research will focus on trends in how many older people are affected by lack of dignity in treatment and inadequate nutritional support, and on who is at greatest risk. We will also be examining the links between older age and disability, and older age and area deprivation, as pathways to disadvantage and poor treatment.
The research will provide new evidence on older people's treatment during hospital stays and will provide more in-depth evidence in this area than has previously been provided. It will answer important questions such as:
-Has the national proportion of older people reporting not being treated with dignity and respect, or not receiving the support they need with eating, during hospital stays increased or decreased over the period 2002-2011?
-Are older people more or less likely to experience not being treated with dignity and respect, or not receiving the support they need with eating, during hospital stays, compared with other population sub-groups?
-Do other factors such as disability, sex, ethnicity, type of hosptial and area deprivation make a difference to older people's experiences of disadvantage and poor treatment?
-The Joint Committee on Human Rights (2007) raised concerns about poor treatment, neglect, abuse, discrimination, lack of support for eating and drinking, and malnutrition and dehydration.
-Age UK (2010) highlighted lack of detection and treatment of malnutrition in hospital as a 'national disgrace' and called on the Government to introduce compulsory monitoring of malnutrition.
-Patients Association (2011) details sixteen accounts of poor hospital care heard by its Helpline focusing on care-communication, access to pain relief, assistance with toileting, and help with eating and drinking.
-The Health Service Ombudsman (2011) investigation into NHS care of older people raised key concerns about lack of assistance with eating and drinking.
-The Care Quality Commission (2011a) dignity and nutrition inspection identified evidence of people not being given assistance to eat, not having their nutritional needs monitored and not being given enough to drink; staff not treating patients in a respectful way; and older people not being sufficiently involved in their care. It concluded that national minimum standards of dignity and nutrition were not being complied with in many casesn and in some cases treatment was so poor that it amounted to a violation of legal rights.
-Further shocking findings were identified in the Equality and Human Rights Commission (2011) inquiry into the treatment of older people requiring or recieving home-based care and support.
The new research will build up a quantitative statistical evidence base in order to produce a national statistical picture on older people's treatment during hosptial stays. We will analyse older people's responses to questiosn about dignity and nutrition using the Adult Inpatient Survey. The Adult Inpatient Survey is a national survey that the Government uses to monitor quality and performance in the NHS. Participants in the survey are adults who have stayed at least one night in an NHS hospital in England. They are asked whether they feel that they were treated with dignity and respect during their hospital stay, and whether they received the help that they need with eating during their hospital stays.
The new research involves evaluating older people's responses to these questions. We will be analysing what older people have said about their treatment during hospital stays over the period 2002-2011 and whether older people are at any greater risk than younger people. The research will focus on trends in how many older people are affected by lack of dignity in treatment and inadequate nutritional support, and on who is at greatest risk. We will also be examining the links between older age and disability, and older age and area deprivation, as pathways to disadvantage and poor treatment.
The research will provide new evidence on older people's treatment during hospital stays and will provide more in-depth evidence in this area than has previously been provided. It will answer important questions such as:
-Has the national proportion of older people reporting not being treated with dignity and respect, or not receiving the support they need with eating, during hospital stays increased or decreased over the period 2002-2011?
-Are older people more or less likely to experience not being treated with dignity and respect, or not receiving the support they need with eating, during hospital stays, compared with other population sub-groups?
-Do other factors such as disability, sex, ethnicity, type of hosptial and area deprivation make a difference to older people's experiences of disadvantage and poor treatment?
Planned Impact
Key stakeholders include the Care Quality Commission, the Department of Health, the Equality and Human Rights Commission (which has a statutory mandate to promote equality and human rights and has recently drawn up a Memorandum of Understanding for working with the Care Quality Commission on shared concerns), Kings Fund, Nuffield Trust and voluntary sector organisations with an interest in health, older people, and equality and human rights, including the Patient's Association, Age UK, the British Institute of Human Rights and the Equality and Diversity Forum. Our identification of key stakeholders builds on our pre-existing networks and relationships. Our discussions during the development of this proposal indicate that these stakeholders will be highly receptive to new set of in-depth quantitative research findings on older people's experiences of respect and nutrition during hospital stays given their own mandates, responsibilities and on-going workstreams in this area. We intend to maximize our impact by working with this group of potential users and beneficiaries in a focussed and targeted way.
The research findings will be of particular use to the Care Quality Commission in the context of monitoring the implementation of essential standards in healthcare; DH in its ongoing work on evaluating and improving NHS quality, performance and productivity; EHRC in its workstream on the treatment of older people in health and social care, as well as in its triennial equality and human rights reporting exercises and in relation to its Memorandum of Understanding with the CQC; and NGOs including Age UK and British Institute of Human Rights. In terms of medial engagement, tecent CQC and EHRC reviews of older people's treatment in health and social care have received significant media attention and generated considerable public and political debate around how to design public policy interventions that will ensure improved quality of health and social care for older people. We therefore anticipate a "receptive audience" and a significant programme of user and practitioner engagement with key stakeholders is planned.
The Picker Institute, CQC and EHRC, ONS and NHS Information Centre for Health and Social Care, Nuffield Trust and Age UK have been involved in the development of this proposal from the earliest stage and their comments have helped to shape our proposed methodology. Picker Institute, CQC, ONS, EHRC, Nuffield Trust and Age UK have already agreed to participate in our Advisory and user-engagement group. Early indications of use of the research findings by these bodies are promising and details of specific potenial uses of the project findings suggested by EHRC are provided in a "Letter of Support" and in our "Pathways to Impact" document and by Age UK in our "Pathways to Impact" document. EHRC have also suggested a training workshop for analysts from EHRC/CQC and other data users, to demonstrate how the new patient population weights can be used with the Adult Inpatients Survey, and have committed to attend such an event. Other non-academic outputs and dissemination activities aiming at maximising impact will include: ensuring free access to findings and outputs on our website and ESRC website; presentation of results to non-academic policy and practitioner audiences and NGO workshops (using user group and our existing network of contacts); non-academic policy briefings and guidance (short and accessible 4 page briefings and guidance that will be specifically tailored to meet the needs of our key potential users and beneficiaries) which could potentially include joint outputs with users and beneficiaries, feeding into and engaging with their broader workstreams; newspaper articles; specialist press (e.g. Patient's Association and CQC newsletters / Health Service Journal); press release; new media (e.g. twitter); LSE Public Policy Blog.
The research findings will be of particular use to the Care Quality Commission in the context of monitoring the implementation of essential standards in healthcare; DH in its ongoing work on evaluating and improving NHS quality, performance and productivity; EHRC in its workstream on the treatment of older people in health and social care, as well as in its triennial equality and human rights reporting exercises and in relation to its Memorandum of Understanding with the CQC; and NGOs including Age UK and British Institute of Human Rights. In terms of medial engagement, tecent CQC and EHRC reviews of older people's treatment in health and social care have received significant media attention and generated considerable public and political debate around how to design public policy interventions that will ensure improved quality of health and social care for older people. We therefore anticipate a "receptive audience" and a significant programme of user and practitioner engagement with key stakeholders is planned.
The Picker Institute, CQC and EHRC, ONS and NHS Information Centre for Health and Social Care, Nuffield Trust and Age UK have been involved in the development of this proposal from the earliest stage and their comments have helped to shape our proposed methodology. Picker Institute, CQC, ONS, EHRC, Nuffield Trust and Age UK have already agreed to participate in our Advisory and user-engagement group. Early indications of use of the research findings by these bodies are promising and details of specific potenial uses of the project findings suggested by EHRC are provided in a "Letter of Support" and in our "Pathways to Impact" document and by Age UK in our "Pathways to Impact" document. EHRC have also suggested a training workshop for analysts from EHRC/CQC and other data users, to demonstrate how the new patient population weights can be used with the Adult Inpatients Survey, and have committed to attend such an event. Other non-academic outputs and dissemination activities aiming at maximising impact will include: ensuring free access to findings and outputs on our website and ESRC website; presentation of results to non-academic policy and practitioner audiences and NGO workshops (using user group and our existing network of contacts); non-academic policy briefings and guidance (short and accessible 4 page briefings and guidance that will be specifically tailored to meet the needs of our key potential users and beneficiaries) which could potentially include joint outputs with users and beneficiaries, feeding into and engaging with their broader workstreams; newspaper articles; specialist press (e.g. Patient's Association and CQC newsletters / Health Service Journal); press release; new media (e.g. twitter); LSE Public Policy Blog.
Publications
Vizard P
(2021)
Older people's experiences of dignity and support with eating during hospital stays: analytical framework, policies and outcomes
in Ageing and Society
| Description | • There was a widespread and systematic pattern of inconsistent or poor standards of care during hospital stays in England in 2012. Patient experiences of inconsistent or poor standards of dignity and help with eating do not appear to be limited to isolated "outlier" providers. Rather, this appears to be a significant general problem affecting the vast majority of NHS acute hospital trusts. • In 2012, about a quarter of all survey respondents indicated that they needed help with eating during their hospital stay. This is a substantial proportion and points towards support with eating being relevant for significant numbers of inpatients - just under three and a half million each year - rather than being a marginal or specialist issue. • Of those who needed help with eating, more than 1 in 3 (38%) report that they only sometimes received enough help with eating from staff, or did not receive enough help from staff. This is equivalent to around 1.3 million people on an annual basis, of whom about 640,000 are aged 65 or over. • Amongst the population aged over 65, risks of inconsistent and poor standards of care were higher for women than for men, for individuals aged over 80 and amongst those who experience a limiting long-standing illness or disability such as deafness or blindness, a physical condition, a mental health condition or a learning difficulty, or an illness such as heart disease, stroke or cancer. • Levels of inconsistent or poor standards of dignity and help with eating are too high in the vast majority of trusts. There has been remarkably little change in the percentage of individuals reporting inconsistent and poor standards of care over time. • Whilst there has been increasing public policy attention in this area following the Mid-Staffordshire Public Inquiry, ongoing public policy efforts will be required to ensure quality improvement and that the new fundamental standards of care, which cover dignity and respect and help with eating, are implemented and enforced. • The quantity and quality of nursing care, and whether or not there is a choice of food, have a large, statistically significant, effect on the probability of experiencing poor standards of help with eating. These variables stand out as key potential policy levers for improving standards of care relating to meeting individual nutritional needs. • Equality and human rights standards should be fully embedded into the arrangements for monitoring, inspecting and regulating healthcare. There is a need to move away from a "population average" approach, to systematic disaggregation and identification of "at risk" groups (for example, individuals aged 80 or above who experience a disability). • Judgements about the compliance of acute hospital trusts with fundamental standards of care should be based on the evaluation of absolute levels of inconsistent and poor care (a "minimum threshold approach"). A "deviation from average" approach risks under-identification of inconsistent and poor standards of care. |
| Exploitation Route | The findings are of potential use for hospital trusts, NGOs, healthcare commissioners, healthcare regulators and the general public. |
| Sectors | Healthcare |
| Description | Our research and resulting report (Vizard and Burchardt, 2015) has contributed to a growing body of evidence highlighting sub-standard care in English healthcare settings. A number of impact and influencing activities were set out in our impact strategy in order to engage with key stakeholders and to disseminate the findings to relevant audiences in order to increase knowledge and understanding of the nature and scale of this problem, raise media and public awareness, stimulate discussion and ultimately influence processes of improvement and change. The research has received interest from across the public and third sectors, a fuller account of which can be found under "Engagement activities". Within this narrative, we provide details of key impact and influencing activities and highlight where we believe we have begun to achieve impact at the level of public policy, practitioner or public influence. Age UK participated in our Advisory and User Group from the outset of the project. Our work has had a direct impact on Age UK and we have also worked with the Age UK Health Influencing team in order to engage with a broader range of stakeholders in healthcare and policy. On the former, the research has provided a robust evidence based on older people's treatment in healthcare, which Age UK has been using in its own work in this area. "Age UK has been highlighting issues of dignity and nutrition in hospitals over the past few years. Food is a critical part of a patient's hospital experience and our Chairman, Dianne Jeffrey CBE DL has worked tirelessly to bring these issues to the fore, through the Dignity Commission, Hospital Food Standards Panel, and the Malnutrition Task Force. This vital research from LSE allows us to keep this momentum, and continue to raise awareness. We know from this research that hospitals need to redouble their efforts. We are using this research to inform external briefings and reports, to lobby on behalf of older people in hospital." (Age UK, 2015b) Findings from our research report (Vizard and Burchardt, 2015) were highlighted on the Age UK website (Age UK, 2015a) and discussed in an Age UK blog post (Isden, 2015). The contribution of this research to an evidence base highlighting problems of dignity and nutrition in English healthcare settings has also been recognised by the Malnutrition Task Force - an organisation working to tackle avoidable and preventable malnutrition and dehydration in older people. It is co-sponsored by its founding members which consist of Age UK, apetito, BAPEN, Nutricia and RVS. The Malnutrition Task Force has cited our work online, alongside a report of new NHS England commissioning guidance (Malnutrition Task Force, n.d.) and in a presentation they produced to supplement NHS England guidance (Malnutrition Task Force, 2015). In addition, the Age UK Health Influencing Team has itself made a substantial contribution to our broader impact influencing activities, including activities which aim to promote engagement with key stakeholders and activities aiming to promote more general knowledge and understanding of the issues, through media attention and dissemination to public audiences. Specifically, the research findings were disseminated pre-publication through a practitioner-orientated roundtable discussion organised by Age UK and ourselves in June 2015. At the roundtable, we delivered a presentation of our research findings to professionals from a range of organisations including the Department of Health, NHS Trusts, the British Medical Council, General Medical Council, British Geriatric Society and Patient Concern. Responses were delivered by Age UK and NHS England. The report is cited in the NHS England official publication "Guidance - Commissioning Excellent Nutrition and Hydration 2015 - 2018" as one of "numerous reports which have highlighted the fact that individuals in [English community and healthcare] settings often receive inadequate nutrition and hydration" (NHS England 2015: 6). Noting that these problems remain "poorly recognised", the guidance has been produced to "support commissioners to address these issues and develop strategies to improve the delivery and commissioning of excellent nutrition and hydration care in acute services and the community" (NHS England 2015: 16). We worked with Age UK and the LSE press office to take forward the press and media work relating to the launch of the project, resulting in high profile coverage that disseminated findings to a large public audience. On the day of its publication, coverage included live interview and headlines for part of the morning, BBC 1 breakfast; Today programme, BBC radio 4; BBC London 94.9FM live interviews followed by public phone in on the issue; BBC News 24, BBC Radio 5 Live, BBC Radio 2, and over 30 regional BBC radio stations. Articles discussing the research were published by multiple national newspapers: BBC News (2015), The Guardian (Campbell, 2015), Mirror (Davies, 2015), The Telegraph (Donnelly, 2015), The Sun (Mcdermott, 2015) Daily Mail (Spencer, 2015) and Daily Express (2015). In addition, over 90 regional newspapers reported our research findings from the Press Association (e.g. South West Argus, 2015; The Northern Echo, 2015). Overall, these engagement activities resulted in largescale dissemination of the key research findings to public audiences, in an accessible, timely way. Whilst it is very difficult to measure increases in public awareness resulting from this engagement, we noted significant social media discussion and interaction resulting from the topic, with notable tweets/retweets from individuals and organisations with a high number of followers (over 10,000) such as Carers UK and Friends of the Elderly. This led to further conversation on twitter, including the sharing of individual's experiences of elderly patient's treatment in hospitals. At the level of practitioner influence, NHS Trusts have listed the report within bulletins of the latest healthcare evidence (Royal United Hospitals Bath NHS Foundation Trust, 2015; UHL Clinical Librarian Service, 2015). It is also included within the National Institute for Health and Care Excellence search engine, a "unique index of authoritative, evidence-based information from hundreds of trustworthy and accredited sources" (NICE, n.d.), featured in a news article by Nursing Standard, the UK's best-selling nursing journal (Kleebauer, 2015) and has been highlighted online by several websites with a health/care focus (e.g. Healthcare Alliances, 2015; OnMedica- Torjesen, 2015). Two sources of follow up funding were secured. The first was a small grant from the LSE International Inequalities Institute, to extend and deepen the analysis by evaluating how deprivation interacts with other variables such as age, disability and hospital trust in explaining poor standards of care. This resulted in updating of the work using the 2014 dataset and an extension of the analysis to include the effects of deprivation. A journal article based on the update has also been drafted. The second source of follow-up funding was an LSE HEIF5 award to take forward our impact and influencing work in this field, in partnership with Age UK. This resulted in the organisation of two interactive workshops co-organised with Age UK (May / June 2016, London and Leeds). The interactive workshops were aimed at practitioner engagement including: presentation of research findings, co-production of key policy relevant messages and identification of good practice. The workshops had a specific focus on how to improve care - specifically, dignity and nutrition, for older people, the workshops will provide a unique opportunity for professionals to come together, exchange ideas and understand the pressures on wards, with participants hearing from people leading practical solutions in wards. Attendees included Age UK, NHS England, the Royal College of Nursing and NHS Foundation Trusts, including nursing staff, healthcare assistants, quality improvement staff, dieticians, commissioners, catering staff, carers and others. Plans for co-produced articles in practitioner-oriented journals all resulted from these events. In addition, this award resulted in the development of an online webtool providing public and practitioner access to dignity and nutrition data and a practitioner orientated video with key policy relevant messages (co-produced with Age UK). Both can be accessed via the project website http://sticerd.lse.ac.uk/case/_new/research/equality/age_dignity_and_nutrition/default.asp. Looking forward, continuing and further substantial impact is anticipated through these future engagement activities. References • Age UK (2015a) Poor or inconsistent standards of dignity and nutrition for older people shown to be widespread in English hospitals by new in-depth analysis. [Online] 15th July. Available from: http://www.ageuk.org.uk/latest-press/poor-dignity-and-nutrition-standards-in-english-hospitals/ [accessed 26/11/2015] • Age UK (2015b) Statement provided in private e-mail correspondence. • BBC News (2015) Many NHS hospital patients complain of 'lack of dignity'. [Online] 15th July. Available from: http://www.bbc.co.uk/news/health-33532483 [accessed 27/11/2015] • Campbell, D. (2015) NHS care of elderly patients often poor and lacking dignity, report says. The Guardian [Online] 15th July. Available from: http://www.theguardian.com/society/2015/jul/15/nhs-care-of-elderly-patients-often-poor-and-lacking-dignity-report-says [accessed 27/11/2015] • Daily Express (2015) Hungry plight of 1m older patients. [Online and print] 15th July, p.18. Available from: http://www.express.co.uk/news/uk/591151/Hospitals-rob-elderly-dignity-NHS-crisis [accessed 27/11/2015] • Davies, J. (2015) Hundreds of thousands of elderly patients go hungry because of poor hospital care. Mirror [Online] 15th July. Available from: http://www.mirror.co.uk/news/uk-news/hundreds-thousands-elderly-patients-go-6067949 [accessed 27/11/2015] • Donnelly, L. (2015) A third of elderly patients go hungry. The Daily Telegraph [Online and print]), 15th July p.2., Available from: http://www.telegraph.co.uk/news/health/news/11738980/vulnerable-hospital-patients-go-hungry.html [accessed 27/11/2015] • Healthcare Alliances (2015) Older people's experiences of dignity and nutrition in hospital. [Online] Available from: http://www.healthcarealliances.co.uk/Public/infoservices_news_detail.asp?NewsID=7215 [accessed 27/11/2015] • Isden, R. (n.d.) Nutritional standards still a "significant problem" in hospitals. Malnutrition Task Force [Online] available from: http://www.malnutritiontaskforce.org.uk/nutritional-standards-still-a-significant-problem-in-hospitals/ [accessed 27/11/2015] • Isden, R. (2015) Dignity standards still lacking in hospitals. Age UK [Online]. Available from: http://ageukblog.org.uk/2015/07/16/dignity-standards-still-lacking-in-hospitals/ [accessed 26/11/2015] • Kleebauer, A. (2015) Mealtime support and standards of dignity patchy, but improving. Nursing Standard. 29 (47) 8-8 [Online and print] Available from: http://journals.rcni.com/doi/abs/10.7748/ns.29.47.8.s4 [accessed 04/12/2015] • Malnutrition Task Force (n.d.) NHS England launch new Guidance: Commissioning Excellent Nutrition and Hydration. [Online] Available from: http://www.malnutritiontaskforce.org.uk/nhs-england-launch-new-guidance-commissioning-excellent-nutrition-and-hydration/ [accessed 27/11/2015] • Mcdermott, N. (2015) 1.3m left to starve in NHS hospitals. The Sun [Online and print] 15th July, p.6. Available from: http://www.thesun.co.uk/sol/homepage/news/6544342/13m-sick-Brits-left-to-starve-in-NHS-hospitals.html [accessed 27/11/2015] • NHS England (2015) Guidance - Commissioning Excellent Nutrition and Hydration 2015 - 2018. [Online] Available from: https://www.england.nhs.uk/wp-content/uploads/2015/10/nut-hyd-guid.pdf [accessed 26/11/2015] • Royal United Bath NHS Foundation Trust (2015) Nutrition and Hydration Current Awareness Bulletin. [Online] Available from: http://www.ruh.nhs.uk/Training/support/library/documents/current_awareness/Nutrition_Current_Awareness_Bulletin_2015_09.pdf [accessed 26/11/2015] • South West Argus (2015) Elderly patients experience poor hospital care. [Online] 15th July. Available from:http://www.southwalesargus.co.uk/news/national/news/13418817.Elderly_patients__experience_poor_hospital_care_/ [accessed 27/11/2015] • Spencer, B. (2015) Exposed, hospitals' neglect of the elderly. The Daily Mail [Online and print] 15th July, p.24. Available from: http://www.dailymail.co.uk/news/article-3161690/Exposed-hospitals-neglect-elderly-one-million-65-patients-treated-without-respect-experts-warn.html [accessed 16/11/2015] • The National Institute for Health and Care Excellence (n.d.) Evidence Services. [Online] Available from: http://www.evidence.nhs.uk/ [accessed 16/11/2015] • The Northern Echo (2015) Elderly Patients experience poor hospital care. [Online] 15th July. Available from: http://www.thenorthernecho.co.uk/news/national/13418817.Elderly_patients__experience_poor_hospital_care_/ [accessed 27/11/2015] • Torjesen, I. (2015) Large numbers of older patients experience lack of dignity in hospital [online]. OnMedica 15th July. Available from: http://www.onmedica.com/newsArticle.aspx?id=dd0ea49d-0d5f-480d-b17b-7f6cbf282737 [accessed 26/11/2015] • UHL Clinical Librarian Service (2015) Older People Evidence Update July 2015. [Online] Available from: http://www.uhl-library.nhs.uk/cl/pdfs/evidenceupdates/2015/olderpeople_jul2015.pdf [accessed 26/11/2015] • Vizard, P. and Burchardt, T. (2015) Older people's experiences of dignity and nutrition during hospital stays: Secondary data analysis using the Adult Inpatient Survey. [Online] Available from: http://sticerd.lse.ac.uk/dps/case/cr/casereport91.pdf [accessed 26/11/2015] |
| First Year Of Impact | 2015 |
| Sector | Healthcare,Other |
| Impact Types | Societal,Policy & public services |
| Description | 5) Citation in Age UK submission to United Nations Universal Periodic Review of the United Kingdom (3rd Cycle) September 2016 |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Citation in other policy documents |
| Impact | Age UK recommends that the UK Government should take an active role in UN level discussions about proposals for a human rights convention for older people. Age UK reported to the UN that serious concerns persist in relation to dignity in the care of older people in social and health care settings. In 2015, the London School of Economics (LSE) found that around a million older people reported 'poor or inconsistent standards of dignity and respect' when in hospital. Around 640,000 older people reported not getting enough help to eat. As lower levels of staffing are linked with poor performance in delivering basic care, it is a growing concern that there are increasing numbers of hospitals under 'special measures,' due in part due to not having safe staffing levels. A recommendation was made to the UN current drives towards quality in hospitals and care homes must be maintained, and hospitals must do more to recognise those with high needs as soon as they are admitted, and to support them after discharge. |
| URL | https://www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/consultation-respons... |
| Description | Citation in House of Lords debate on human rights and care for older persons |
| Geographic Reach | National |
| Policy Influence Type | Citation in other policy documents |
| URL | https://hansard.parliament.uk/Lords/2017-11-16/debates/EBDFE2BC-C410-459D-B77E-2A69792588AD/OlderPer... |
| Description | Citation on the Age Action Alliance website - Dignity and Nutrition for Older People in Hospital |
| Geographic Reach | National |
| Policy Influence Type | Influenced training of practitioners or researchers |
| URL | http://ageactionalliance.org/malnutrition-taskforce/ |
| Description | Citation on the Malnutrition Taskforce website:Interactive workshops for improving dignity and nutrition in hospitals |
| Geographic Reach | National |
| Policy Influence Type | Influenced training of practitioners or researchers |
| URL | http://www.malnutritiontaskforce.org.uk/interactive-workshops-for-improving-dignity-and-nutrition-in... |
| Description | Contributing to a body of evidence on poor and inconsistent standards of dignity and respect, and help with eating if needed, in English acute hospitals |
| Geographic Reach | National |
| Policy Influence Type | Citation in other policy documents |
| URL | https://www.england.nhs.uk/wp-content/uploads/2015/10/nut-hyd-guid.pdf |
| Description | HEFCE/LSE HEIF5 Bid Fund |
| Amount | £64,090 (GBP) |
| Organisation | Higher Education Funding Council for England |
| Sector | Public |
| Country | United Kingdom |
| Start | 10/2015 |
| End | 06/2016 |
| Description | Research award |
| Amount | £8,323 (GBP) |
| Organisation | London School of Economics and Political Science (University of London) |
| Department | International Inequalities Institute |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 11/2015 |
| End | 05/2016 |
| Description | Collaboration with Age UK |
| Organisation | Age UK |
| Country | United Kingdom |
| Sector | Charity/Non Profit |
| PI Contribution | Our original research proposal was discussed at the planning stage with Age UK and Age UK participated in our Advisory and User Group from the outset of the project. We met frequently with the Health Influencing Team including Ruthe Isden (Director of the Health Influencing Team) and Nadia Kalam from Age UK throughout the research project to discuss findings and the policy / practitioner implications from the research and impact strategy. We have worked extensively with the Health Influencing Team, the media team and other Age UK teams on co-planned LSE/CASE/Age UK media engagement and co-produced impact activities. |
| Collaborator Contribution | Findings from our research report were highlighted on the Age UK website (Age UK, 2015a) and discussed in an Age UK blog post (Isden, 2015). Our work has provided a robust evidence based on older people's treatment in healthcare, which Age UK has been using in its own work in this area. "Age UK has been highlighting issues of dignity and nutrition in hospitals over the past few years. Food is a critical part of a patient's hospital experience and our Chairman, Dianne Jeffrey CBE DL has worked tirelessly to bring these issues to the fore, through the Dignity Commission, Hospital Food Standards Panel, and the Malnutrition Task Force. This vital research from LSE allows us to keep this momentum, and continue to raise awareness. We know from this research that hospitals need to redouble their efforts. We are using this research to inform external briefings and reports, to lobby on behalf of older people in hospital." (Age UK, 2015b) The Age UK Health Influencing Team has made a substantial contribution to our impact influencing activities, including activities which aim to promote engagement with key stakeholders, and activities aiming to promote more general knowledge and understanding of the issues through identification of relevant outcomes, media attention and dissemination to public audiences. In particular, our research findings were disseminated pre-publication through a practitioner-orientated roundtable discussion organised by Age UK and ourselves in June 2015. In 2016, two practitioner-orientated interactive workshops were co-organised with Age UK, one in Leeds and one in London. Age UK took the lead on identifying and inviting participants, circulating details within practitioner-orientated newsletters, as well as identifying additional relevant speakers to respond to the research findings and identify/develop policy and practitioner-orientated messages. The workshops were aimed at professionals working on healthcare wards, with a focus on how to improve care, specifically, dignity and nutrition, for older people. They provided an opportunity for professionals to come together, exchange ideas and understand the pressures on wards - with participants hearing from people leading practical solutions in wards. For details, see 'interactive workshops' under other outputs. We have also co-produce a practitioner-orientated video with Age UK, drawing out key policy and practitioner relevant key messages from the research. Age UK were interviewed for the video and set out key policy and practitioner-orientated messages. For details and a weblink, see 'practitioner-orientated video' under 'other outputs'. References • Age UK (2015a) Poor or inconsistent standards of dignity and nutrition for older people shown to be widespread in English hospitals by new in-depth analysis. [Online] 15th July. Available from: http://www.ageuk.org.uk/latest-press/poor-dignity-and-nutrition-standards-in-english-hospitals/ [accessed 26/11/2015] • Age UK (2015b) Statement provided in private e-mail correspondence. • Isden, R. (2015) Dignity standards still lacking in hospitals. Age UK [Online]. Available from: http://ageukblog.org.uk/2015/07/16/dignity-standards-still-lacking-in-hospitals/ [accessed 27/11/2015] |
| Impact | • Age UK produced press release (also on LSE website) and associated extensive media coverage of research findings - June 2015 • Age UK blog post on Age UK website (Isden, 2015) • Practitioner-oriented interactive workshops (London and Leeds, 2016) • Practitioner-orientated video (for weblink, see 'other outputs') |
| Start Year | 2014 |
| Description | Blog post by Age UK |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Blog written to mark the launch of the report by Ruthe Isden, Health Influencing Programme Director at Age UK. |
| Year(s) Of Engagement Activity | 2015 |
| URL | https://ageukblog.org.uk/2015/07/16/dignity-standards-still-lacking-in-hospitals/#more-4420 |
| Description | CASE Social Exclusion Seminar |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Other academic audiences (collaborators, peers etc.) |
| Results and Impact | Questions and discussion Not aware of any impact |
| Year(s) Of Engagement Activity | 2009 |
| Description | Film: Older people's experience of nutrition in hospital and best practice advice for healthcare professionals. New findings from the Adult Inpatient Survey |
| Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | There have been 437 views of the video so far |
| Year(s) Of Engagement Activity | 2017 |
| URL | https://www.youtube.com/watch?v=WHYUWYwXc2M |
| Description | International seminar at Hitotsubashi university Tokyo |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Other audiences |
| Results and Impact | Presentation delivered at International seminar at Hitotsubashi university Tokyo Institute of economic research. |
| Year(s) Of Engagement Activity | 2015 |
| Description | LSE International Inequalities Institute Seminar "Older peoples' experiences of dignity and nutritional support during hospital stays" |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Other audiences |
| Results and Impact | Academic seminar with online video for international public access, available at http://media.rawvoice.com/lse_inequalitiesinstitute/richmedia.lse.ac.uk/inequalitiesinstitute/20170308_olderPeoplesExperiencesOfDignityAndNutrition.mp4 |
| Year(s) Of Engagement Activity | 2017 |
| URL | http://www.lse.ac.uk/InternationalInequalities/Home.aspx |
| Description | Media engagement |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Media (as a channel to the public) |
| Results and Impact | We worked with Age UK and the LSE Press Office to take forward the press and media work relating to the launch of the project, resulting in high profile coverage that disseminated findings to a large public audience. Prior to the publication of the research report, we worked closely with Age UK to produce a joint press release, which was picked up by multiple media sources. The press release was used by over 90 regional newspapers who reported our research findings from the Press Association (e.g. South West Argus, 2015; The Northern Echo, 2015). On the day of the publication of our report, coverage included live interview and headlines for part of the morning, BBC 1 breakfast; Today programme, BBC radio 4; BBC London 94.9FM live interviews followed by public phone in on the issue; BBC News 24, BBC Radio 5 Live, BBC Radio 2, and over 30 regional BBC radio stations. Articles discussing the research were published by multiple national newspapers: BBC News (2015), The Guardian (Campbell, 2015), Mirror (Davies, 2015), The Telegraph (Donnelly, 2015), The Sun (Mcdermott, 2015) Daily Mail (Spencer, 2015) and Daily Express (2015). In addition, following an interview, our research featured in a news article by Nursing Standard, the UK's best-selling nursing journal (Kleebauer, 2015), disseminating findings to a practitioner audience. Overall, these engagement activities resulted in largescale dissemination of the key research findings to public and practitioner audiences, in an accessible, timely way. Whilst it is very difficult to measure increases in public awareness resulting from this engagement, we noted significant social media discussion and interaction resulting from the topic, with notable tweets/retweets from individuals and organisations with a high number of followers (over 10,000) such as Carers UK and Friends of the Elderly. This led to further conversation on twitter, including the sharing of individual's experiences of elderly patient's treatment in hospitals. References: • BBC News (2015) Many NHS hospital patients complain of 'lack of dignity'. [Online] 15th July. Available from: http://www.bbc.co.uk/news/health-33532483 [accessed 27/11/2015] • Campbell, D. (2015) NHS care of elderly patients often poor and lacking dignity, report says. The Guardian [Online] 15th July. Available from: http://www.theguardian.com/society/2015/jul/15/nhs-care-of-elderly-patients-often-poor-and-lacking-dignity-report-says [accessed 27/11/2015] • Daily Express (2015) Hungry plight of 1m older patients. [Online and print] 15th July, p.18. Available from: http://www.express.co.uk/news/uk/591151/Hospitals-rob-elderly-dignity-NHS-crisis [accessed 27/11/2015] • Davies, J. (2015) Hundreds of thousands of elderly patients go hungry because of poor hospital care. Mirror [Online] 15th July. Available from: http://www.mirror.co.uk/news/uk-news/hundreds-thousands-elderly-patients-go-6067949 [accessed 27/11/2015] • Donnelly, L. (2015) A third of elderly patients go hungry. The Daily Telegraph [Online and print]), 15th July p.2., Available from: http://www.telegraph.co.uk/news/health/news/11738980/vulnerable-hospital-patients-go-hungry.html [accessed 27/11/2015] • Kleebauer, A. (2015) Mealtime support and standards of dignity patchy, but improving. Nursing Standard. 29 (47) 8-8 [Online and print] Available from: http://journals.rcni.com/doi/abs/10.7748/ns.29.47.8.s4 [accessed 04/12/2015] • Mcdermott, N. (2015) 1.3m left to starve in NHS hospitals. The Sun [Online and print] 15th July, p.6. Available from: http://www.thesun.co.uk/sol/homepage/news/6544342/13m-sick-Brits-left-to-starve-in-NHS-hospitals.html [accessed 27/11/2015] • South West Argus (2015) Elderly patients experience poor hospital care. [Online] 15th July. Available from: http://www.southwalesargus.co.uk/news/national/news/13418817.Elderly_patients__experience_poor_hospital_care_/ [accessed 27/11/2015] • Spencer, B. (2015) Exposed, hospitals' neglect of the elderly. The Daily Mail [Online and print] 15th July, p.24. Available from: http://www.dailymail.co.uk/wires/pa/article-3161577/Elderly-patients-experience-poor-hospital-care.html?ITO=1490&ns_mchannel=rss&ns_campaign=1490 [accessed 16/11/2015] • The Northern Echo (2015) Elderly Patients experience poor hospital care. [Online] 15th July. Available from: http://www.thenorthernecho.co.uk/news/national/13418817.Elderly_patients__experience_poor_hospital_care_/ [accessed 27/11/2015] |
| Year(s) Of Engagement Activity | 2015 |
| Description | Participation in and presentation of key project messages at "Achieving Excellence in Nutrition and Hydration Roundtable" organised by Malnutrition Task Force / Age UK (Wednesday 2nd November 2016) |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | The "Achieving Excellence in Nutrition and Hydration Roundtable" organised by Malnutrition Task Force / Age UK was a roundtable which brought together strategic partners from across sectors and settings to agree to a consensus of ideas based on the expert knowledge around the table. The aim was to identify key themes that would make the most impact to challenge the malnutrition agenda and identify priorities that will help achieve this. The roundtable brought together strategic partners from across sectors and settings to agree to a consensus of ideas based on the expert knowledge around the table. The meeting resulted in a list of priorities and a creation of a new virtual expert group to be a sounding-board for The Malnutrition Task Force and to provide expertise in your particular fields to help the Malnutrition Task Force move forward with this agenda. |
| Year(s) Of Engagement Activity | 2016 |
| URL | https://twitter.com/MalnutritionTF/status/793853529584705536/photo/1 |
| Description | Presentation at Health Survey Users Conference July 2014 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Type Of Presentation | paper presentation |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Questions Not aware of any impact |
| Year(s) Of Engagement Activity | 2014 |
| Description | Presentation at Human Development and Capability Association Annual Conference 2014 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Type Of Presentation | paper presentation |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Questions, discussion, including useful interchange with Japanese academics also working on inpatient surveys Emerging plan for collaborative work on health with Japanese academics |
| Year(s) Of Engagement Activity | 2008,2014 |
| Description | Presentation at Social Policy Association Conference July 2014 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Type Of Presentation | paper presentation |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Questions and discussion Not aware of any impact |
| Year(s) Of Engagement Activity | 2014 |
| Description | Roundtable discussion |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | The user-orientated roundtable discussion, organised in collaboration with Age UK, brought together professionals from a range of relevant organisations including the Department of Health, NHS Trusts, the British Medical Council, General Medical Council, British Geriatric Society and Patient Concern. We delivered a presentation of our research findings to this audience, which led to discussion. Contributions were delivered by Age UK and NHS England. Following on from the roundtable, a series of meetings were set up with NHS England and the Care Quality Commission, alongside on-going collaborative work with Age UK. |
| Year(s) Of Engagement Activity | 2015 |
| Description | Twitter post by the Malnutrition Taskforce |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | Twitter interactions about the event on 2nd November 2016 Malnutrition Taskforce and NHS England looking at achieving excellent nutrition & hydration in the UK |
| Year(s) Of Engagement Activity | 2016 |
| URL | https://twitter.com/MalnutritionTF/status/793853529584705536/photo/1 |
| Description | Twitter post by the Malnutrition Taskforce |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | Twitter interactions about the event on 2nd November 2016 Malnutrition Taskforce and NHS England looking at achieving excellent nutrition & hydration in the UK |
| Year(s) Of Engagement Activity | 2016 |
| URL | https://twitter.com/MalnutritionTF/status/793855021603520512 |