This week’s letters include a call for a change in attitudes to mental health and responses to HSJ’s exclusive interview with Sir David Nicholson, as well as making the case for the use of nutritional supplements in care homes

Changing our approach mental health

Claims last week by the health secretary Jeremy Hunt that doctors are refusing to check for dementia because they think it is pointless while there is no “cure” for the condition will have horrified anyone who works with the condition.

If this is indeed the case, this kind of attitude is not only callous but flies in the face of new advances in treating dementia. To give just one example, Westminster city council will next month open a dementia centre which has been built around new ways of understanding dementia.

‘Mr Hunt is absolutely right to highlight dementia as an issue for all of society’

The centre is custom designed based on advice from Stirling University’s specialist dementia design team, and includes features designed to make the user feel at home, rather than being in a clinic or hospital.

Clinical specialists at the centre are there to give as early a diagnosis as possible and we can then help users, as well as their families, to live as full a life as possible and access the support they need.

Mr Hunt is absolutely right to highlight dementia as an issue for all of society. The health service, social services and communities have got to play their part in offering a bridge to a better life for those living with this troubling condition.

Rachael Robathan, cabinet member for adult services at Westminster city council


Nicholson’s “command and control”

We read with interest of Sir David Nicholson’s plans to use the NHS Commissioning Board’s responsibility for specialist commissioning to “reshape England’s largest teaching and specialist hospitals in an attempt to control the ‘commanding heights of the health economy’” (, January 14).

The views attributed to Sir David seem unfortunate as they are reminiscent of the “command and control” battles of the past.

‘A spirit of mutual respect and partnership lies at the heart of all successful commissioner/provider relationships’

We can all agree on the importance and benefit of the board bringing much needed coherence to specialist commissioning. This will, inevitably, lead to significant reshaping of the acute sector.

But this work will succeed to best effect if it is undertaken in the spirit of mutual respect and partnership that lies at the heart of all successful commissioner/provider relationships.

The board will also need to have careful regard to its statutory duty to promote local autonomy. It will also need to recognise that the decisions it takes on smaller acute trusts undertaking specialist work could have a major impact on those trusts’ continuing viability.

Taking this approach, all of us in the provider sector would stand ready to fully support Sir David and the board’s vital work in this area.

Peter Griffiths, chair, and Chris Hopson, chief executive, at the Foundation Trust Network


Supplements can work

The problem of malnutrition in care homes is widespread and persistent, as Paul Dinsdale’s article,‘Good nutritioncan replace costly supplements in care homes’ (HSJ, 17 January), correctly identifies and we welcome the efforts by the Food First programme to improve the quality of food available in care homes.

The British Association for Parenteral and Enteral Nutrition has estimatedthat malnutrition costs the NHS £13 billion a year. Improving nutritional care for individuals who are malnourished or at risk of malnutrition in care homes could therefore have considerable cost saving implications.

Dietitians have a vital role to play in making sure food for older people is nutritionally balanced and appetising so they can have as normal a diet as possible. The needs of patients will vary while and older people’s health can deteriorate very quickly without the right food and hydration.

For some patients there are times when food alone, however nutritious, will not be sufficient to meet their needs, eg: because of a period of illness or because they are recovering from an operation. Malnutrition at these times can delay wound healing, lead to pressure sores, cause muscle wastage, weaken immune responseand have a lasting effect on someone’s quality of life.

‘In tackling malnutrition, the choice is not an either/or between meals and nutritional supplements’

Oral nutritional supplements should never be seen as an acceptable short-cut for a care home to avoid making enjoyable and nutritious meals. However, when  prescribed appropriately, oral nutritional supplements which are specially designed and formulated to meet the nutritional needs of patients can make an important contribution to helping people recover from ill health and disease-related malnutrition.

The recently published Managing Adult Malnutrition in the Community guidance sets out clearly how malnutrition can be identified and managed and the role for supplements alongside high-quality food.

What is critical is that care homes are responsivetothe changing nutritional needs of the people they lookafter and that GPs have up to date and accurate information from their staff so that they can prescribe supplements when needed.

Both cost and health benefits can be realised if patients are prescribed supplements as soon as they need nutritional support. This has been recognised by NICE in its guidanceon Nutrition support in adults and its quality standard.

In tackling malnutrition, the choice is not an either/or between normal meals and oral nutritional supplements. Both have an important place in improving the quality o flife and health of older people.

Roger Clarke, director general the British Specialist Nutrition Association