Hospital Food

Imagine you’re recovering from an operation in hospital, your appetite is returning and you’re looking forward to nothing more complicated than a bowl of hot, tasty soup. Instead on your tray you find a tired tuna sandwich encased in a plastic container and a bag of crisps, or worse, an unidentifiable plate of lukewarm mush. No wonder more than 80,000 meals are left uneaten every day and two thirds of hospital staff admits that they would not themselves eat what they serve up to patients. You can’t blame either patients or staff: most hospital food is a disgrace.

After a needlessly long, drawn out process of consultation, new recommendations to address this scandal are finally set to come into force in April. Unfortunately none of it amounts to more than a row of over-processed beans.

First of all, the government set up a ‘Hospital Food Standards Panel’ in December 2013 to examine nutrition and health. That was some progress, but then they invited food manufacturers to sit on the panel.  Food manufacturers of course, have, justifiably, one aim only and that is to sell their products. Asking them to advise on a healthy diet is like asking a fox to lock the chicken run. 

The panel’s apparently sensible idea is to have minimum food standards built into NHS catering contracts from April. But have you ever seen a catering contract? Any “standards” (and the panels are hopelessly weak) will be buried in pages of small print that hospital administrators will be too busy to look at once they are signed. They seldom say much about food anyway, concentrating more on pricing, delivery, and who pays for what investment. And without monitoring and enforcement the contracts’ only purpose will be to cover the backs of NHS trusts should they ever need someone to blame for some disaster. 

What a missed opportunity. Wouldn’t it have been great if Jeremy Hunt, instead of effectively ducking the issue, had announced a hospital food revolution to match the school food one of recent years, with standards enshrined in law, and hospitals given the means and incentives to produce good, nourishing food for patients?  

It’s not an easy subject. I’m not for force-feeding “healthy” food down every patient. An elderly woman at no risk of obesity, maybe in hospital with a broken hip, is unlikely to accept a new diet at 85 when her bad old one has served her well. And why should she?

But someone whose problems stem from obesity should obviously not live on chips or the chocolate brought in by well-meaning visitors. Children with cancer need small portions of tempting good-for-them food, including the occasional ice cream or jelly. Diet must be tailored to the individual.

It should be elementary that hospitals’ overall aim should be healthy, nourishing and above all, delicious food. But sadly, despite doctors recognising the links between health and diet, most don’t manage that. Food for patients, arguably the people most in need of good nutrition, is of a worse standard than that permitted for school children, prisoners, the armed forces and Whitehall. Sick children in hospital can be given food that would be banned in their school. Why is that considered acceptable? 

What would it take to improve the meals the sick can expect? And would it be affordable to deliver such improvement and lower the waste rate, which is running at 70% in some hospitals? Ideally, I would eliminate over-packaged, over-processed junk. And which of us wants the dispiriting experience of having to open a package to find sustenance when we’re not well? I’d return to a smaller range of tasty, nutritious options: vegetable soup, fish-cakes with chili chutney, chicken and leek pie, vegetarian curry. You would be able to order a light salad or scrambled egg on toast if you didn’t feel up to a full meal. And I’d make sure everything was freshly cooked in the hospital, with last minute finishing and the making of alternative snacks on the ward in a small secondary kitchen, where staff or patients can make tea and coffee on demand.   

Sadly, under the iniquitous PFI scheme, many hospitals entered into long-term deals with caterers, which they now can’t get out of.  The result is that few hospital kitchens are actually cooking any food. All kitchen staff now do is reheat frozen meals and add the inevitable difficult-to-undo packages: of cutlery; sweaty squares of cheese; cheap biscuits; dabs of marge. The meals themselves are made miles away in a factory from the cheapest available ingredients, delivered frozen, re-generated in the hospital and kept warm in a trolley. No wonder it’s disgusting. 

But you can’t blame the caterers. In return for fifteen-year, sometimes twenty-five-year contracts they may have funded factory units to prepare these horrible meals. Often they have borne the cost of converting hospital basements from old-fashioned kitchens to stations for the regeneration of processed food and the assembly of food trays. The cost of breaking those contracts and compensating the caterers is beyond the hope of most cash-strapped Hospital Trusts. But that is what they need to do.  

The real problem is that patients have no consumer power in hospitals. Where consumers do have power because they are doing the paying, as in restaurants, pubs and even supermarkets, real change is happening: standards of quality, sourcing and sustainability are strict. If they fail, customers can vote with their feet, which patients cannot. It's another story in hospitals:  the NHS is the customer and the patient has to like it or leave it.  About half leave it. 

Hospitals don’t like to admit it, but they have a financial interest in as few people eating meals as possible. Even in schools, the more children who take up school dinners the better, because the school is paid for every meal either by the government under Free School Meals legislation, or directly by the parents. The more meals the school sells the better. In hospitals the more meals served the more it costs. And if the patients won’t order from the menu, and their relatives buy junk from the hospital shop for them instead, the hospital gains twice, once from saving on that hospital meal, once from its share of the profits from the shop. 

Successive governments have wasted more than £50 million of taxpayers’ money on voluntary, often celebrity-led, headline-grabbing initiatives to improve hospital food since 1992. Of course they didn’t work. Dishing out famous chefs’ recipes to untrained kitchen staff in hospitals geared to re-heating food was never going to work. And the Hospital Food Panel’s suggestions aren’t going to work either. 

Sad to say, legislation is the only answer.  We need to set up another, better, and totally independent panel to agree food standards of quality, sustainability and ethical farming practice. We also need a staffed and funded body to support hospitals in achieving the standard. It will take a heap of money to get out of those contracts and equip hospitals for on-site, preferably on-the-ward and cooking-from-fresh. And hospital and catering staff will need to be inspired and re-trained.  

Impossible? No it’s not. We already have shining examples of NHS hospitals that treat their patients like valued customers and know that good food is medicine. The Brompton Hospital in London is one. 

There are some hopeful initiatives too.  The Soil Association’s Food for Life Catering Mark with its Bronze, Silver, and Gold awards for achieving freshly-cooked sustainably sourced and ethically produced food, so successful in schools, is now being sought by hospitals with a conscience.  And they are finding that, though capital investment is a real problem, the actual cost of ingredients and labour is no higher than serving unhealthy, over-processed, reheated food. Sometimes it is cheaper.

Let’s hope the movement grows.  Hundreds of organisations including all the Medical Royal Colleges, patients’ organisations, environmental and sustainability charities, plenty of financial and ethical think tanks, and many, others, support the Campaign for Better Hospital Food. Everyone, it seems, except the Government.