Do degrees mean nurses will not 'dirty' their hands?

VIEWPOINT Dr Helen Allen and Pam Smith Centre for Research in Nursing and Midwifery Education, University of Surrey

Researchers say students feel technical care is valued over bedside care

The training changes that have given students the opportunity of getting a degree in nursing at university have provoked fears that the basic care of patients will suffer.

Two University of Surrey researchers conducted a study that showed the modern student nurse does not always see it as their role to do the 'dirty' things like cleaning up blood and faeces.

Dr Helen Allen, director, and Pam Smith, professor of nursing, say it was not an attack on nurses but on a health system that devalues care.

Our study 'How student nurses' supernumerary status affects the way they think about nursing: a qualitative study' was headlined on some websites as 'clearing up poo will not help me learn - student nurses reject basic care'.

Our fieldwork took place in acute wards where trained nurses told us they faced increased pressures to meet NHS targets Your comments

It illustrated the dilemma faced by students and nurses to provide vital bedside care to patients while remaining at the heart of nursing.

The response to our article, resulted in over 90 comments from students, nurses, health care assistants (HCAs), teachers and mentors demonstrating just how acutely and passionately that dilemma is felt.

'Too posh'

The background to our study arose as a response to the 'too posh to wash' debate following the changes in nurse education that removed student apprentices from the formal workforce, replacing them with HCAs.

Given the current pressures, trained nurses are unable to deliver bedside care

We also wanted to find out who provided the leadership for care in a changing NHS and a system that has uncoupled formal education from practice.

Our fieldwork took place in acute wards where trained nurses told us they faced increased pressures to meet NHS targets.

Although they maintained that bedside nursing is still central to what they do, we found that the pressure from targets led to the work becoming routine and a hierarchy of tasks.

Bedside personal care primarily performed by HCAs has been divided from the technical work performed by trained nurses who administer drugs, dressings and undertake organisational work.

'Routine care'

Making bedside care routine is not new.

It existed in the 1980s when the new nursing challenged routine and hierarchy and sought to personalise care through the nursing process and primary nursing in a spirited attempt to give holistic patient-centred care.

We make very clear that it is the system not the student that is at the heart of the problem - both the way education is de-linked from practice and the hierarchy of technical nursing over personal care

Given the current pressures, trained nurses are unable to deliver bedside care.

This situation reinforces the perception that technical care is valued over and above bedside care as a source of learning for students' future roles leaving them feeling unprepared to be trained nurses.

Our research showed that students conceptualise nursing differently to qualified staff because of an intensification of the division of labour between registered and non-registered staff.

Consequently students often observe HCAs performing bedside care and trained nurses undertaking technical tasks.

The absence of clear role models leads students to sometimes question bedside care as part of their learning to become a qualified nurse and to put greater value on learning technical skills.

'Difficult positions'

Our research does not suggest that students are the problem.

Rather it analyses the system that puts them into difficult positions.

We make very clear that it is the system not the student that is at the heart of the problem - both the way education is de-linked from practice and the hierarchy of technical nursing over personal care.

As one respondent said, 'mentors don't know what to do with students, so they use them as a spare HCA'.

Many of the respondents agree with our findings that trained staff in placements don't always know what to do with students and that students can end their placements in a rush to achieve their learning objectives having spent their time beforehand fitting in and 'not alienating their colleagues'.

Furthermore mentors must organise patient care at the same time as supervising students and receive neither recognition nor rewards for their efforts.

Our research neither attacks students nor devalues care but analyses a system that does.

BBC sold on climate change

The health risks of a big carbon footprint

VIEWPOINT Dr Tony Waterston Consultant paediatrician and chair of the Advocacy Committee, Royal College of Paediatrics and Child Health

It is difficult to open a newspaper or watch a news report without hearing the words 'climate change'.

Doctors have united under the Climate and Health Council

But while the iconic images might be of the polar ice caps melting, paediatrician Dr Tony Waterston warns there will also be a devastating human health cost unless we reduce our carbon footprint.

Have we heard too much about climate change? Are people switching off the subject, particularly as we in the UK go through the coldest, snowiest winter for many years, and the media is full of stories about the climate sceptics?

The Lancet medical journal has had two special editions on the subject during the last year, which show that children, the most vulnerable in any community, are already dying in large numbers in poor countries as a result of a warming world.

To a paediatrician, this would be a devastating response, coming just as health professionals are accepting not only that lives are being lost by global warming, but that the potential health benefits of a low carbon lifestyle would be very, very big.

Little has been said in the media about climate change and health - usually what we hear about is polar bears, loss of the ice cap, dying species and flood risks.

But much hard data has come out in recent months to show that health is being hit now.

The Lancet medical journal has had two special editions on the subject during the past year, which show that children, the most vulnerable in any community, are already dying in large numbers in poor countries as a result of a warming world.

Women involved in agricultural work are also severely affected.

Disease increase

What will happen?

There will be increases in malnutrition and malaria, with flooding and diarrhoeal disease up next.

Malnutrition is already linked with most deaths in the developing world, and is increasing as a result of the effect of climate change on food crops.

The countries most concerned are those where children are already dying in substantial numbers

According to the World Health Organisation (WHO), climate change is projected to increase the percentage of the population of Mali at risk of hunger from 34% to 64-72% by the 2050s.

Both droughts and flooding will become more common and both interfere with growing seasons especially in countries already prone to such disasters.

And malaria will be more common as the mosquito which carries it moves into countries which were formerly too cold. Dengue, another severe tropical infectious disease also spread by mosquitoes, will similarly increase.

Health benefits

Mothers will also be affected by the same conditions, and if they become ill or die then there will be a knock-on effect on their children.

The countries most concerned are those where children are already dying in substantial numbers: Sub-Saharan Africa, Asia, in particular Bangladesh, and low-lying island states in the Pacific.

A WHO assessment of the burden of disease caused by climate change suggested that the modest warming that has occurred since the 1970s was already causing over 140,000 excess deaths annually by the year 2004.

Just one meat-free day a week could make a difference to health as well as to the climate

So doctors are increasingly determined to do something to prevent global warming, particularly as the health benefits of low carbon living are huge.

Reduced dependence on motor traffic will mean less pollution and reduced road accidents; more walking will lead to less obesity and reduced heart attacks; and less meat eating (since growing animals to eat is a huge contributor to global warming) will mean lower cholesterol and perhaps fewer cancers.

Doctors united

This doesn't mean everyone giving up meat! But just one meat-free day a week could make a difference to health as well as to the climate.

What can doctors do to help their patients and the government understand that low carbon living offers a great future?

Over the years, doctors have taken a lead in setting health priorities, on topics from sewers and drains to immunisation, smoking and alcohol and road traffic accidents.

Now doctors both locally and globally have united under the Climate and Health Council (CHC). Top doctors in the UK are calling on the NHS to reduce its carbon footprint and the government to set higher targets for reduction of carbon emissions to avoid a worsening health crisis worldwide.

And crucially, doctors are curbing their well-known love of travelling by holding video conferences instead, and bringing together medics from India, Africa and Europe for educational meetings without leaving a carbon footprint.

The power of a good example?

He has 19 children according to his office

Jacob Zuma 'deeply regrets pain' over love-child

Jacob Zuma is proud of his Zulu culture

South African President Jacob Zuma has apologised for fathering a child with a woman who was not his wife.

"I deeply regret the pain that I have caused to my family, the ANC (African National Congress), the alliance and South Africans in general," he said.

The daughter of a World Cup chief gave birth to a baby girl last year believed to have been fathered by Mr Zuma.

Mr Zuma, aged 67, is a Zulu, a group which practises polygamy. He has three actual wives and at least 19 children.

Pressure

"I have over the past week taken time to consider and reflect on the issues relating to a relationship I had outside of wedlock," Mr Zuma said in a statement, admitting that it "has been a subject of much public discussion and debate".

ZUMA'S WIVES Thobeka Madiba-Zuma - married, January 2010 Nompumelelo Ntuli - married, January 2008 Sizakele Khumalo - married, 1973 Home Affairs Minister Nkosazana Dlamini-Zuma - divorced, 1998 Kate Mantsho Zuma - died, 2000

"It has put a lot of pressure on my family and my organisation, the African National Congress," the statement said.

Earlier this week, the president confirmed that he was having a relationship with Sonono Khoza - the 39-year-old daughter of World Cup official Irvin Khoza.

He said the matter was "intensely personal" and dismissed as "mischievous" criticism from activists who said his actions had undermined official HIV/Aids campaigns.

Mr Zuma was praised last year when he announced major changes to the country's Aids policy, which included increasing the roll-out of anti-retroviral drugs.

But opposition parties now say his behaviour contradicts the government's stance on HIV prevention - preaching regular condom use and faithfulness to one partner.

South Africa has the highest number of HIV infections in the world - more than five million people.

This is not the first time that the president's sex life has been under the spotlight.

In 2006, while being acquitted of rape, Mr Zuma admitted that he had made a mistake by having unprotected sex with a woman he knew to be HIV-positive.

Like Ms Khoza, the woman was also the daughter of a family friend.

Mr Zuma has been married five times in all, most recently in January, and is also engaged to another woman.

He has 19 children according to his office, but it is not clear if that includes the baby born last October.

Green fuels cause more harm than fossil fuels,

March 1, 2010

Green fuels cause more harm than fossil fuels, according to report

Ben Webster, Environment Editor

The expansion of plantations has pushed the orang-utan to the brink of extinction in Sumatra, where it takes 840 years for a palm oil plantation to soak up the carbon emitted when rainforest is burnt

Using fossil fuel in vehicles is better for the environment than so-called green fuels made from crops, according to a government study seen by The Times.

The findings show that the Department for Transport’s target for raising the level of biofuel in all fuel sold in Britain will result in millions of acres of forest being logged or burnt down and converted to plantations. The study, likely to force a review of the target, concludes that some of the most commonly-used biofuel crops fail to meet the minimum sustainability standard set by the European Commission.

Under the standard, each litre of biofuel should reduce emissions by at least 35 per cent compared with burning a litre of fossil fuel. Yet the study shows that palm oil increases emissions by 31 per cent because of the carbon released when forest and grassland is turned into plantations. Rape seed and soy also fail to meet the standard.

The Renewable Transport Fuels Obligation this year requires 3¼ per cent of all fuel sold to come from crops. The proportion is due to increase each year and by 2020 is required to be 13 per cent. The DfT commissioned E4tech, a consultancy, to investigate the overall impact of its biofuel target on forests and other undeveloped land.

The EC has conducted its own research, but is refusing to publish the results. A leaked internal memo from the EC’s agriculture directorate reveals its concern that Europe’s entire biofuels industry, which receives almost £3 billion a year in subsidies, would be jeopardised if indirect changes in land use were included in sustainability standards. A senior official added to the memo in handwriting: “An unguided use of ILUC [indirect land use change] would kill biofuels in the EU.”

The EC hopes to protect its biofuel target by issuing revised standards that would give palm plantations the same status as natural forests. Officials appear to have accepted arguments put forward by the palm oil industry that palms are just another type of tree.

A draft of the new rules, obtained by The Times, states that palm oil should be declared sustainable if it comes from a “continuously forested area”, which it defines as areas where trees can reach at least heights of 5m, making up crown cover of more than 30 per cent. “This means, for example, that a change from forest to oil palm plantation would not per se constitute a breach of the criterion,” it adds.

Clearing rainforest for biofuel plantations releases carbon stored in trees and soil. It takes up to 840 years for a palm oil plantation to soak up the carbon emitted when the rainforest it replaced was burnt. The expansion of the palm oil industry in Indonesia has turned it into the third-largest CO2 emitter, after China and the US. Indonesia loses an area of forest the size of Wales every year and the orang-utan is on the brink of extinction in Sumatra.

Last year, 127 million litres of palm oil was added to diesel sold to motorists in Britain, including 64 million litres from Malaysia and 27 million litres from Indonesia. Kenneth Richter, biofuels campaigner for Friends of the Earth, said: “The billions of subsidy for biofuels would be better spent on greener cars and improved public transport.”

the spectator sport China DOESN'T want you to see

Animals torn to pieces by lions in front of baying crowds: the spectator sport China DOESN'T want you to see

By DANNY PENMAN

Last updated at 20:57 05 January 2008

The smiling children giggled as they patted the young goat on its head and tickled it behind the ears.

Some of the more boisterous ones tried to clamber onto the animal's back but were soon shaken off with a quick wiggle of its bottom.

It could have been a happy scene from a family zoo anywhere in the world but for what happened next.

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Children feed goats before the 'show' starts. One that has been 'bought' by a visitor is carried off

A man hoisted up the goat and nonchalantly threw it over a wall into a pit full of hungry lions. The poor goat tried to run for its life, but it didn't stand a chance. The lions quickly surrounded it and started tearing at its flesh.

"Oohs" and "aahs" filled the air as the children watched the goat being ripped limb from limb. Some started to clap silently with a look of wonder in their eyes.

The scenes witnessed at Badaltearing Safari Park in China are rapidly becoming a normal day out for many Chinese families.

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Once the goat is carried from its pen, it is swiftly thrown into the lion enclosure

Baying crowds now gather in zoos across the country to watch animals being torn to pieces by lions and tigers.

Just an hour's drive from the main Olympic attractions in Beijing, Badaling is in many ways a typical Chinese zoo.

Next to the main slaughter arena is a restaurant where families can dine on braised dog while watching cows and goats being disembowelled by lions.

The zoo also encourages visitors to "fish" for lions using live chickens as bait. For just £2, giggling visitors tie terrified chickens onto bamboo rods and dangle them in front of the lions, just as a cat owner might tease their pet with a toy.

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The ravenous big cats quickly attack the goat and start to tear it limb from limb, all in the name of 'entertainment' for the Badaling zoo visitors

During one visit, a woman managed to taunt the big cats with a petrified chicken for five minutes before a lion managed to grab the bird in its jaws.

The crowd then applauded as the bird flapped its wings pathetically in a futile bid to escape. The lion eventually grew bored and crushed the terrified creature to death.

The tourists were then herded onto buses and driven through the lions' compound to watch an equally cruel spectacle. The buses have specially designed chutes down which you can push live chickens and watch as they are torn to shreds.

Once again, children are encouraged to take part in the slaughter.

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The lions tear the goat to pieces within seconds of landing in the enclosure

"It's almost a form of child abuse," says Carol McKenna of the OneVoice animal welfare group. "The cruelty of Chinese zoos is disgusting, but think of the impact on the children watching it. What kind of future is there for China if its children think this kind of cruelty is normal?

"In China, if you love animals you want to kill yourself every day out of despair."

But the cruelty of Badaling doesn't stop with animals apart. For those who can still stomach it, the zoo has numerous traumatised animals to gawp at.

A pair of endangered moon bears with rusting steel nose rings are chained up in cages so small that they cannot even turn around.

One has clearly gone mad and spends most of its time shaking its head and bashing into the walls of its prison.

There are numerous other creatures, including tigers, which also appear to have been driven insane by captivity. Predictably, they are kept in cramped, filthy conditions.

!Zoos like this make me want to boycott everything Chinese," says Emma Milne, star of the BBC's Vets In Practice.

"I'd like to rip out everything in my house that's made in China. I have big problems with their culture.

"If you enjoy watching an animal die then that's a sad and disgusting reflection on you.

"Perhaps we shouldn't be surprised by their behaviour towards animals, as the value of human life is so low in China."

East of Badaling lies the equally horrific Qingdao zoo. Here, visitors can take part in China's latest craze ? tortoise baiting.

Simply put, Chinese families now gather in zoos to hurl coins at tortoises.

Legend has it that if you hit a tortoise on the head with a coin and make a wish, then your heart's desire will come true. It's the Chinese equivalent of a village wishing well.

To feed this craze, tortoises are kept in barbaric conditions inside small bare rooms.

When giggling tourists begin hurling coins at them, they desperately try to protect themselves by withdrawing into their shells.

But Chinese zoo keepers have discovered a way round this: they wrap elastic bands around the animals' necks to stop them retracting their heads.

"Tortoises aren't exactly fleet of foot and can't run away," says Carol McKenna.

"It's monstrous that people hurl coins at the tortoises, but strapping their heads down with elastic bands so they can't hide is even more disgusting.

"Because tortoises can't scream, people assume they don't suffer. But they do. I can't bear to think what it must be like to live in a tiny cell and have people hurl coins at you all day long."

Even worse is in store for the animals of Xiongsen Bear and Tiger Mountain Village near Guilin in south-east China.

Here, live cows are fed to tigers to amuse cheering crowds. During a recent visit, I watched in horror as a young cow was stalked and caught. Its screams and cries filled the air as it struggled to escape.

A wild tiger would dispatch its prey within moments, but these beasts' natural killing skills have been blunted by years of living in tiny cages.

The tiger tried to kill ? tearing and biting at the cow's body in a pathetic looking frenzy ? but it simply didn't know how.

Eventually, the keepers broke up the contest and slaughtered the cow themselves, much to the disappointment of the crowd.

Although the live killing exhibition was undoubtedly depressing, an equally disturbing sight lay around the corner: the "animal parade".

Judging by the rest of the operation, the unseen training methods are unlikely to be humane, but what visitors view is bad enough.

Tigers, bears and monkeys perform in a degrading "entertainment". Bears wear dresses, balance on balls and not only ride bicycles but mount horses too.

The showpiece is a bear riding a bike on a high wire above a parade of tigers, monkeys and trumpet-playing bears.

Astonishingly, the zoo also sells tiger meat and wine produced from big cats kept in battery-style cages.

Tiger meat is eaten widely in China and the wine, made from the crushed bones of the animals, is a popular drink.

Although it is illegal, the zoo is quite open about its activities. In fact, it boasts of having 140 dead tigers in freezers ready for the plate.

In the restaurant, visitors can dine on strips of stir-fried tiger with ginger and Chinese vegetables. Also on the menu are tiger soup and a spicy red curry made with tenderised strips of big cat.

And if all that isn't enough, you can dine on lion steaks, bear's paw, crocodile and several different species of snake.

"Discerning" visitors can wash it all down with a glass or two of vintage wine made from the bones of Siberian tigers.

The wine is made from the 1,300 or so tigers reared on the premises. The restaurant is a favourite with Chinese Communist Party officials who often pop down from Beijing for the weekend.

China's zoos claim to be centres for education and conservation. Without them, they say, many species would become extinct.

This is clearly a fig leaf and some would call it a simple lie. Many are no better than "freak shows" from the middle ages and some are no different to the bloody tournaments of ancient Rome.

"It's farcical to claim that these zoos are educational," says Emma Milne.

"How can you learn anything about wild animals by watching them pace up and down inside a cage? You could learn far more from a David Attenborough documentary."

However pitiful the conditions might be in China's zoos, there are a few glimmers of hope.

It is now becoming fashionable to own pets in China. The hope is that a love for pets will translate into a desire to help animals in general. This does appear to be happening, albeit slowly.

One recent MORI opinion poll discovered that 90 per cent of Chinese people thought they had "a moral duty to minimise animal suffering". Around 75 per cent felt that the law should be changed to minimise animal suffering as much as possible.

In 2004, Beijing proposed animal welfare legislation which stipulated that "no one should harass, mistreat or hurt animals". It would also have banned animal fights and live feeding shows.

The laws would have been a huge step forward. But the proposals were scrapped following stiff opposition from vested interests and those who felt China had more pressing concerns.

And this is the central problem for animal welfare in China: its ruling elite is brutally repressive and cares little for animals.

Centuries of rule by tyrannical emperors and bloody dictators have all but eradicated the Buddhist and Confucian respect for life and nature.

As a result, welfare groups are urging people not to go to Chinese zoos if they should visit the Olympics, as virtually every single one inflicts terrible suffering on its animals

"They should tell the Chinese Embassy why they are refusing to visit these zoos,' says Carol McKenna of OneVoice.

"If a nation is great enough to host the Olympic Games then it is great enough to be able to protect its animals.

Read more: http://www.dailymail.co.uk/news/article-506153/Animals-torn-pieces-lions-baying-crowds-spectator-sport-China-DOESNT-want-see.html#ixzz0gqufnBmw

BBC 'to cut stations and halve websites'

BBC 'to cut stations and halve websites' report claims

Mad Men is one of the US imports said to be under threat Read The Times article 'Leaked' review - at a glance

The BBC is to close two radio stations and scale back its web presence to make £600m in savings, according to a report in the Times newspaper.

BBC Asian Network and 6 Music will be closed under the proposals, it says.

The Times claims the measures are part of a plan, due to be made public next month, to reduce the BBC's services and focus on quality over quantity.

A statement from the BBC called press speculation "premature" but acknowledged the existence of a review.

The National Union of Journalists, however, said it had "received a detailed briefing" from the BBC this morning "confirming media reports as largely correct".

The Union warned of strikes if cuts went ahead.

Strategic review

The Times claims the proposals are currently being considered by the BBC Trust, the corporation's governing body.

They allegedly involve a wide-ranging series of cuts that will make £600m available for higher quality programming.

Savings will reportedly be made by limiting spending on rights to sporting events and reducing the money spent on imported TV shows.

The BBC Switch and Blast! websites are also to be closed as part of a larger reduction in the BBC's web presence, the newspaper alleges.

INSIDER'S VIEW Torin Douglas, Media correspondent The Times report is very detailed so the paper has clearly been shown a BBC document. Whether these will be the final decisions remains to be seen. The report is to be considered by the governing body, the BBC Trust, and The Times quotes "BBC Trust sources" as saying they would like the Director general to impose even greater cuts to budget for imported programmes. There could also be last-minute lobbying on behalf of the two radio stations said to be due for closure. A campaign to save BBC 6 Music has been running on Facebook for some time.

The Times states the BBC's budget for foreign acquisitions, which currently stands at £100m, will be cut by a quarter.

This could mean the end of such US TV shows as Heroes, Mad Men and The Wire on BBC channels.

The BBC's website budget, which currently stands at £112m, will also be cut by 25 per cent.

The Times says this will be achieved by halving the number of web pages and reducing its staff by a quarter.

BBC Worldwide will be ordered to divest itself of its British magazine publishing arm, the newspaper continues.

If approved, this could see the Radio Times, Top Gear magazine and other publications put out to tender.

In a statement, the BBC said: "Last summer, the BBC Trust challenged the BBC to develop a new strategy to meet the opportunities and the threats of the rapidly changing media landscape.

"Although the details have yet to be agreed... the BBC expects to present its proposals to the BBC Trust in the near future."

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6 Music is the only reason I have a digital radio. As far as I'm concerned they can cut back anything else

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The corporation did not comment on the specific details of the leaked report, but said it was "fully committed to online and to digital television and radio".

'Not rampant'

Speaking to 5 Live, Guardian media columnist Steve Hewlett said the plans, if verified, could be politically motivated.

The BBC has drawn criticism of late amid speculation that an incoming Tory government would seek to freeze the licence fee in 2013 and replace the BBC Trust with another body.

"The BBC needs to create the impression that it's not rampant in terms of its expansion," said Hewlett.

"It needs politically to look like it's going back into its shell a bit," he continued.

The NUJ said the plans "smack of an attempt to appease political and commercial interests".

"Hard-working staff shouldn't be used as a political football and we will fight any compulsory redundancies," said general secretary Jeremy Dear.

Last year Mark Thompson gave a speech at the Voice of the Listener and Viewer Conference in London in which he said changes would take place after the digital switchover is completed in 2012.

THE BBC'S FUTURE Expect to see reductions in some kinds of programmes and content [and] a look at the current scope of our website Mark Thompson last year Full text of speech

"Expect to see reductions in some kinds of programmes and content - a look at the current scope of our website - and a close examination of the future of our service portfolios once switchover has been achieved," he said in November.

Earlier this month a BBC Trust review appeared to allay fears that 6 Music would be closed in a report which praised its "distinctive approach".

The review added that the digital station "needed to grow its audience base without losing its unique selling point".

Fans have already set up a campaign protesting changes to the station, rallying support on Facebook and Twitter.

Among them is musician David Bowie, who issued a statement saying: "6 Music keeps the spirit of broadcasters like John Peel alive and for new artists to lose this station would be a great shame."

Hospital malnutrition warning

By Adam Brimelow BBC News health correspondent

Malnutrition can lead to a longer hospital stay

The government is being urged to promote the concept of a "healthy weight" to help guard against malnutrition as well as obesity.

A report by an independent panel of advisors says more needs to be done to make sure patients who are malnourished get help eating.

It says official figures significantly understate the extent of the problem.

The health charity, Bapen, says about 3 million people in the UK either have or are at risk of malnutrition.

They are more likely to die or have a prolonged stay if they go into hospital.

We know that malnutrition predisposes to disease, it delays recovery from illness and it increases mortality Report authors

The report by the Nutrition Action Plan Delivery Board says official figures are likely to be an underestimate. In 2007, 239 people were reported to have died because of malnutrition in English hospitals.

The advisors suggest the number dying from other causes but with malnutrition is 200 times higher. That would bring the total to nearly 50,000.

The report concludes that healthy eating should not just be about promoting weight loss.

The authors said: "We know that malnutrition predisposes to disease, it delays recovery from illness and it increases mortality.

"It follows that the effect of malnutrition on mortality rates is substantially greater than the number reported to have died because of malnutrition."

Complex statistics

Michelle Mitchell, charity director for Age Concern and Help the Aged, said they launched a campaign over three years ago to demand action from the government.

She said: "We know one million older people in the community are malnourished, yet there is still no evidence of any real progress on this problem."

The report was delivered to the government in August 2009 but has only just been released.

Conservative shadow health minister Stephen O'Brien said: "It is horrific that so many patients are dying with malnutrition.

"We have raised this issue many times but Labour ministers have dragged their feet and are doing very little about it."

But Care Service Minister Phil Hope said the Conservatives had failed to properly describe complex statistics and were presenting totally inaccurate figures.

He said: "It completely misleads the public to compare the number of patients dying as a result of malnutrition, which is 239, with the number of people who have some degree of malnourishment, often as a result of ill health."