As a result of concerns raised from the Liverpool Care Pathway regarding nutrition at end of life (The Independent, 2012), and the existence of cachexia in palliative patients (Holmes, 2009; Radbruch et al. 2010) St Johns Hospice commissioned an internal review of food and nutrition for patients.

Food is an important part of love, life and family (Furman, 2008).

The audit found that there was good quality food prepared at all times, with fresh produce used from the Hospice’s allotment where possible. However there were issues which needed to be resolved to make patient food much more accessible, individualised and tasty. These included: poor kitchen staff knowledge about special diets and nutritional value; more time being spent on staff food than patients’; staff having more meal choice than patients; food being cooked ahead for patients supper thereby reducing nutritional content and taste; little flexibility between meal times; no formal nutritional assessment of patients.

Over the last year changes have included making sure choice for patients has improved to include smoothies at breakfast, three main meal choices for lunch plus individual requirements as needed, and a finger buffet supper which has had great appeal for the patients. Also food outside mealtimes has been more accepted; the role of Nutritional Support Worker has been introduced with a grant from the Foundation of Nursing Studies and these will complete simple nutritional assessments and link with an agreed dietetic service for complex patient needs.

Kitchen staff will attend a local course for care home cooks, increasing knowledge and presentation skills, and dietetic training about special diets.

Food is now integral in the nursing role and its increased importance has improved the patient experience in recent surveys.