Food standards in care and residential homes are often overlooked. Out of sight, it seems, is out of mind.
But the matter has recently been put under the spotlight by Liberal Democrat MP Paul Burstow. He tabled a private member's bill on 11 January calling on the Government to introduce minimum nutritional standards for all homes and tougher regulation via the Food Standards Agency (FSA).
To support his motion "to tackle the scandal that is elder abuse in our country", Burstow drew on a December 2005 report from food standards pressure group the British Association for Parental and Enteral Nutrition. It found that more than one-fifth of residents over 65 in UK care homes are at medium to high risk of falling victim to malnutrition, which equates to about 65,000 people.
Figures from the Commission for Social Care Inspection (CSCI) give further cause for concern. They show that more than 2,000 care homes out of the 11,000 in England failed to meet minimum standards for meals.
While the figures are shocking, accurately gauging the extent of the problem is difficult. Sue Hawkins, chairman of the National Association of Care Catering (NACC), believes the CSCI inspections, which work on a pass or fail system, are blunt instruments with which to measure a complex issue. Of the 2,000 that "failed", 1,842 were judged to have "almost met" the standards.
Hawkins believes the problem of malnutrition among care home residents can have multiple causes. "Depression due to the recent loss of a partner or the debilitating effects of diseases like cancer can also cause people to lose weight," she says.
Against this ambiguous background, work is being done to improve guidance on the types of foods that should be served. The current CSCI standards, which demand that a diet is "varied, appealing, wholesome and nutritious", have been criticised by Burstow for not giving enough direction on nutrition.
The FSA is developing specific recommendations for the sector, which include example menus to help with food planning, while the NACC is set to launch a special diets plan in the near future.
Earlier this month, Care Services Minister Liam Byrne also announced plans for a scheme to register, train and vet care workers for the first time.
"Registration is about public safety. It will allow us to train care workers to look after our vulnerable people properly," he says.
The inadequacy of the current training available for care home caterers has led some operators, such as Anchor Homes, to take things into their own hands. They believe that issues such as matching food to medication and the special dietary and feeding needs of the elderly mean that specialist catering training is essential.
Anchor, which runs 103 of the UK's 17,000 homes, will launch its Cater Craft programme next month, replacing the generic NVQ in food preparation that its staff currently take.
"It [the current NVQ] does not fully equip our chefs with the specific skills needed for care home catering," says managing director Jane Ashcroft.
Catering for the elderly, says Andrew Isaac, seniors and marketing director at caterer Sodexho Healthcare Services, requires a whole raft of specialist knowledge.
"Swallowing difficulties, dementia and diabetes are just some of the common conditions found among older people that will have an effect on the way food is prepared and served," he says.
Other localised initiatives are helping to address the training problem. Upmarket care home provider Barchester Health Care has had a separate training programme - the Barchester Diploma - in place for a year and is working with TV chef Paul Rankin to devise new menus.
BUPA Healthcare, which runs 299 care homes, says it gives its employees additional training and holds forums where residents discuss the food service with the staff.
Tim Brooke, the company's national hotel services manager, says: "People come out of college with good basic skills, but catering for the elderly is a specialist area, and it is important that they are developed and trained further."
Shaun Hill, former chef-proprietor at the Michelin-starred Merchant House, Ludlow, and a food consultant, warns that guidance on food standards in care homes should not be too prescriptive.
According to Hill, meal times are often the highlight of the day for people in residential care, and to tie them too tightly to bureaucratic procedures ignores the entertainment value of food.
Fish pie, corned beef hash with an egg on top and eggy bread, with fresh fruit, are just some of the types of dishes that should be on the menu, he says
It seems some people are starting to listen to those calling for tougher standards. An Early Day Motion tabled two weeks ago by Burstow to gauge support for the catering element of his bill had the backing of 27 MPs as Caterer went to press.
"There is cross-party support for this issue, and the letters I'm getting from people with relatives in homes underlines that this is a case that requires urgent action from Government," Burstow says.
Time will tell whether this is just more laudable lobbying or the first flickerings of a Jamie Oliver-style revolution.