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Feature: Food for thought

With the number of foodbanks distributing essential supplies to people across the UK continuing to grow, how can nurses make sure their patients make the most of this resource?

Just before Christmas a GP tweeted that when a patient in her practice had unexplained symptoms, they were now asked if they could afford to eat. The comment - which was retweeted nearly 4,000 times - will strike a chord with many nurses working in primary care and the community. 

The answer for many of them has been to suggest patients visit a local foodbank. Until recently foodbanks were unheard of in many areas of Britain - something that were associated with the depression of the 1930s - but now they are ubiquitous. Lisa Emmerson, one of a team of family nurses working with teenage parents in Norwich, says: “We have families that have to choose between food and heating. Without support they go hungry and some would have no option but to borrow more money and get into debt.”

Last year it is thought that at least 500,000 people were supported by foodbanks. And the Trussell Trust - one of the biggest operators - has been opening three a week, including many in affluent areas. The organisation runs 400 foodbanks, but there could be as many as 700 across the UK. 

Typically foodbanks will collect non-perishable food and toiletries, donated by the public and sometimes by supermarkets, parcel this up and give it to those in need. Recipients may be in work but on a low income, while others will be unemployed or disabled, or perhaps homeless. Many foodbanks are run by churches though support tends to come from across a community. One recent development has been 'baby banks' to help parents with basics for young children such as nappies and clothing, and some foodbanks also provide pet food. 

People will be assessed as being in need - often by a healthcare professional, such as a nurse, a social worker or even the police - and will be given a voucher. For foodbanks affliated to the Trussell Trust, this normally entitles them to three days worth of food - tailored to their family size - and they can use vouchers on three consecutive occasions. It argues that it acts as an emergency service, helping people who are in crisis and immediate need, and does not encourage welfare dependency. Its volunteers will also try to guide people towards other sources of help such as a debt counselling service if they owe money. 

Other foodbanks may operate to different rules and may offer longer-term support. Some will never turn people away - even if they don't have a voucher - and may offer a hot meal even if they can't give out bags of food. Ms Emmerson, who works for Norfolk Community Health and Care Trust, says nurses sometimes have to talk to foodbank managers when families have exhausted their three vouchers but still need help. A common issue for her clients is long delays in benefit payments. 

Many nurses are in an ideal situation to spot when an individual or a family is not coping. This is particularly true of health visitors and nurses who go into people's homes, and may see the heating turned off to save money and little food in the kitchen. 

School nurses may also come across children who are struggling. “It's children who aren't sleeping well, or looking pale or wolfing down their lunch,” says Sue Anderson, who heads the school nursing team for social enterprise Sirona Care and Health, based in Bath. “We do ask whether there is enough food in the house. It is about gently trying to find out what is happening in their lives.”

And Jane Cook, a health visitor who is now lead nurse with a London homeless charity, says nurses are well placed to identify those in need of help - although they may not always reveal what the issue is straight off. 

“If you are seeing patients who are depressed or are saying they are really stressed, it is being able to unpick that and ask 'how are you coping?' It is being able to ask these questions.”

She says women will often smoke to suppress their own appetite and leave more food for their children. Children who are not getting enough to eat may end up in A&E repeatedly or may be frequent attenders at a surgery. 

Many practices are now getting actively involved with foodbanks. Typically this may involve referring patients to them, acting as a collecting point for donations and publicising foodbanks in the practice newsletter and in waiting rooms. Some GPs have been concerned about assessing whether people are in need of this support and have argued they don't necessarily know about their personal circumstances. 

Patients may be shy or embarrassed to admit they are not coping and need support: Ms Emmerson says in these cases nurses may want to bring up foodbanks as an option. She says more than half of the families she supports have had to use a foodbank at some point. 

While they are very conscious of the need to eat healthily, it is very hard for them to afford a healthy diet. The Institute of Fiscal Studies has shown how families are being forced to turn to cheaper options and reduce the nutritional value of the food they eat. 

Foodbanks try to provide nutritionally balanced packages - although they are dependent on what has been donated and usually only accept dried or packaged food for practical reasons. However, research from the US has shown that policies to exclude 'unhealthy' foods have been controversial and foodbanks are concerned they could affect the total amount donated. 

Not surprisingly, the government has been lukewarm about foodbanks - despite their 'Big Society' nature. JobCentre Plus has 'signposted' some people towards local foodbanks and some ministers have praised them. But others have been more dismissive, suggesting it is the growth in the number of foodbanks driving increased use, rather than increased need. Local authorities - which have taken over the Social Fund, providing support to people in need - are starting to work with foodbanks in some areas. 

Foodbanks seem here to stay: crisis loans for people on low incomes are likely to be reduced and the chancellor has spoken of the need for more cuts in welfare budgets. While the economic situation is improving for many - and unemployment has fallen - for those without a job or on low incomes foodbanks may offer vital support for the foreseeable future.