The views expressed by Patrick Duffy of NHS Supplies (Letters, 4 December) are endorsed and, indeed, voiced repeatedly by the state-registered dietitian. The evidence for the positive contribution of nutrition to clinical outcomes is well documented; however, patients still go hungry in hospital.

It beholds all of us (doctors, nurses, catering staff, dietitians and managers) to ensure that the basic needs of our patients are met - this includes provision of food and drink.

Dietitians are only one link in the complex hospital food delivery chain. The weakest link is frequently where the food on the plate fails to enter the patient's mouth. Do we do our utmost to help and encourage our patients to eat?

Provision of normal food is the preferred, and by far the cheapest form of nutrition. All too frequently, and at great expense, this aspect of patient care is sadly neglected.

Jackie Kay,

State registered dietitian,

Bishop Auckland,

Co Durham.

A view from a not-so-'neglected dietitian' is that Patrick Duffy's comments make a lot of sense. Quite simply, there is no excuse for poorly presented, unpalatable food in our hospitals.

Preston Acute Hospitals trust is an excellent example of how to get it right when it comes to nutritional care. This was highlighted in a recent seminar to share best practice with other trusts in the region.

Menus provide choice and balanced nutrition, while the meals themselves are well presented and tasty. The key has been the development and implementation of a trust-wide 'food and health policy', which has been adopted from the chair and chief executive down.

It is the result of a partnership between the dietetics and catering departments, and provides a framework within which standards are set and audited. It covers many aspects of meal provision, right down to the nutrition training of the hostesses who present patients with meals.

Poor nutrition delays recovery, increases the incidence of serious complications and significantly increases treatment costs. Therefore, encouraging the patient to eat well is in all our interests.

Stuart Hayton,

Chief dietitian,

Preston Acute Hospitals trust.

Patrick Duffy asks for dietitians' views about the link between nutrition and clinical outcome.

Good nutrition is instrumental in achieving quick recovery and can be continued after discharge. Sicker patients need more specialist advice from dietitians and flexibility in menus to meet their nutritional needs.

Hospital catering is a complex process and partnership with other health professionals is crucial to ensure it's the best food, given to the right patient, at the right time... and it is eaten.

Ruth James,

Chief dietitian,

Oxford Radcliffe Hospital.

Our trust has had a food health strategy since 1996. Its development and implementation have involved real consultation with patients, the voluntary sector and all levels of staff. Its main objective was agreed to be to make food and nutrition a priority both in patient care and in the workplace.

There is as much indisputable evidence that malnutrition is a major factor in morbidity and mortality as there is that patients still starve unnoticed in British hospitals. Why is this? Malnourished patients have a slower rate of rehabilitation, so cost more.

We have implemented a system to identify malnutrition on admission, with subsequent documentation of nutritional interventions by all involved, and we are working hard to encourage these pockets of good practice to spread to the rest of the hospital.

Successful wards are those that have given it 'clinical' priority. We are also very fortunate in having a commendable catering service, which must save on the drug budget - if only it could be 'clinically' proven.

Stephanie Beaven,

Nutrition and dietetic services manager,

Southmead Health Services trust,

Bristol.

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