Plans for the day were altered when I had to collect Iona from her house after she had worked the morning, in order to take her to Darenth Valley Hospital A & E. On the way over to Iona I called in at the Centre for just a few minutes at half past twelve to see Isobel, as it was possible I would be tied up for the rest of the day and not be able to come in and feed her tea as usual.

When I arrived Isobel was asleep. She had eaten breakfast and drunk well early in the morning. I had only been there for a minute when Claire, the speech and language therapist, arrived. She had arranged this call apparently at short notice and had asked the Centre staff to try and contact me, but they had not succeeded in doing so. I explained why I had only dropped in for a few minutes and could not extend my stay. I gave Claire a brief account of how Isobel had managed food and drink with me for the past week and expressed the view that feeding had become more difficult in the past couple of days. Claire said that she had particularly wanted to see the Centre staff feeding Isobel. At this point. At this moment a staff member I had not seen before arrived with Isobel's lunch. At the same time a nurse wheeled up the medicine trolley. After a brief conversation with Claire, the nurse replaced the lunch bearer (who was apparently agency staff) with one of the regular feeders. Claire pointed out that the meal just delivered included ice cream for dessert! I confirmed this was not expected, had not happened since her previous call as far as I knew and was contrary to the feeding rules stuck on the wall. Isobel had not been having either ice cream or jelly; her usual dessert was yogurt or plain custard. I arranged to get the results of today's observation from Claire by 'phone either later this afternoon or tomorrow. Isobel was asleep throughout this brief ten minute visit.

I spent five hours with Iona in A & E; she has a problem with the ligaments at the front of the pelvic girdle but it is not serious, just very painful. I did not get back to the Centre on Tuesday.