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Hospital food needs mandatory standards, urges campaigner

The government’s approach to hospital food is not working and legally binding standards must be brought in, a campaigner has said.

Writing online in the British Medical Journal (BMJ), Katharine Jenner, chairwoman of the Campaign for Better Hospital Food, said a voluntary approach for hospitals to improve food did not go far enough.

She pointed to previous evidence that suggests many hospital meals contain more salt than a Big Mac.

“Several nutritional and environmental standards apply to food served in government departments and prisons,” she added. “So why are there no mandatory standards in English hospitals?

“I am not asking for standards that you would find only in a Michelin-starred restaurant; rather, healthier and more nutritious food with less salt and saturated fat that is sustainable, with higher animal welfare standards, and fair trade.”

Government figures suggest as many as 50,000 people a year could be dying with malnutrition in NHS hospitals in England, Ms Jenner went on.

In some hospitals, food is less environmentally friendly than food served at McDonald’s, food served to children in hospitals is “so unhealthy it couldn’t legally be offered in schools”, and “prison food is served fresher and warmer than hospital food”.

A survey by the Campaign for Better Hospital Food found that three out of every four hospital meals would qualify for a red light for fat under the Food Standards Agency’s traffic light system, while 15 out of 25 meals examined contained more salt than a Big Mac.

Ms Jenner said government support had not been forthcoming for the Hospital Food Bill introduced into the House of Lords, which would require the government to convene a body of experts to draft legally binding food standards for hospitals.

She said the government had created a “hospital food standards panel” to review how standards can be more stringently applied to patients’ meals “without making them legally binding”.



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Readers' comments (40)

  • If we had endless pots of money this would be a priority - we don't so it isn't. Generally, people aren't in hospital for the whole of their life, so a few days of crappy food isn't going to kill them or give them a coronary or raise their blood pressure, is it?

    We've had too much of this nonsense: can anyone remember Chicken al la king care of Lloyd Grossman? I also note some other 'celeb chef' from the BBC pouncing around in a hospital kitchen on TV more recently.

    Most people who are ill fancy a bit of 'stodge' not a Brie and pecan salad!

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  • given the choice of a fry-up or a slice of brown bread and a bowl of cereal for breakfast what do you think most patients would choose?
    i think hospital food is pretty good, it's free, you get three meals a day plus snacks inbetween.
    god, can we ever get anything right or be thanked for what we do?

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  • food needs to be nutritious, promote healing, adapted to individual needs and taste of each patient, palatable, well presented and served in suitable quantities for each individual. a reasonable budget to enable this must follow, it is all part of healthcare. if hospitals can't afford it there should be a compulsory nominal charge for all equivalent to and no more than what patients on a modest income would expect to pay at home and with financial support for those who are too poor to eat adequately at home.

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  • Comment removed.

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  • Removed due to personally offensive nature. Please refer to terms and conditions:

  • always an issue... I have come from chef to nurse, and although I sympathise with food choices available, it is more often presentation that puts patients off food, i encourage vistors to bring in food, better something than nothing

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  • Anonymous | 22-Dec-2013 8:32 pm


    when I visited a friend of mine her blood sugar was measured at 14 - all her friends were bring her in cream cakes!

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  • Anonymous | 22-Dec-2013 5:35 pm

    do you seriously believe a registered and experienced nurse wrote the comment?

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  • Anonymous | 22-Dec-2013 8:58 pm


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  • Anonymous | 22-Dec-2013 5:35 pm

    What a potty mouth you are. Your father lost weight because he was septic: burning more calories and all that. He should've been given a fortified, high calorie diet, but people who are unwell often don't feel like eating big meals or anything at all.

    So I'm presuming you brought your father in home cooked food or sweets, biscuits and snacks to help sustain him or took him to the hospital canteen where there may have been more options? No of course you didn't.

    It wasn't the options on the menu that led to all those patients suffering at Mid Staffs, now was it? Of course nutrition is very important, but bearing in mind that most hospital stays are relatively short, does it really matter if people are offered airline-style pre-cooked meals that are often fortified with nutrients? As long as those who are deemed 'at risk' are given an appropriate menu, I don't see the problem.

    If we really want to make a difference in the populations health, should we not concentrate on what people are eating when they're not in hospital?

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  • Anonymous | 23-Dec-2013 2:28 pm

    Another ignorant comment based poor assumption and lack of knowledge. But hey, why let ignorance of facts get in the way of a supposedy smart *rse post?! Of course you don't see a problem. That's problem number one.

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  • Anonymous | 22-Dec-2013 5:35 pm

    Unfortunately, your story is all too common and met with a pretty neglectful attitude by those charged with the care of patients.

    IN NHS England:

    6 out of 10 patients rely on their families to provide food

    3 out of every 4 meals served in hospitals would be given a red traffic light for saturated fat

    Hospital food served to children has been found to be so unhealthly that it could not legally be served to children in school

    2/3 of hospital staff would be unhappy to eat the food that they are serving to patients

    How can this be acceptable?

    Health and Social Care (Amendment) (Food Standards) Bill [HL] 2013-14 received its third reading in early December 2013. This Bill is sponsored by Lady Cumberlege with the purpose of setting mandatory quality standards for all hospital patient meals including standards on nutrition and minimum standards of production. Remarkably, these standards exist for schools and prisons, but not hospitals. Apparently the shrub at 23-Dec-2013 2:28 pm doesn't think any of this is important. This individual is also unaware of the significant numbers of long term NHS patients and those who have frequent admissions of up to several weeks a time for chronic, ongoing conditions. Obviously, he/she is not clinically trained in any way. Hence the comment made without accurate knowledge of the circumstances of your father's illness and/or co-morbidities, if any. Stunning to suggest that 'home cooked food' should be brought in. My NHS trust, (in common with any other NHS trust), must comply with the Food Safety Act 1990 and associated legislation relating to the composition, labelling, safety, handling, control and hygiene of food (but not nutritional content!!). This precludes bringing in food from outside which requires refrigeration or heating, cooked meat and poultry, pre-wrapped sandwiches, etc.

    Obviously, there is a long way to go to change the attitude of some.

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  • Anonymous | 23-Dec-2013 2:28 pm
    pretty shabby comment.
    i spent 9 days in hospital following a car accident. i am otherwise fit and healthy and young. the staff were terrific and most of the care i received was first class. however, the hospital food was deplorable. at no time did i have an elevated temperature or a depressed appetite. my family brought plenty of fruit, snacks, etc. but a decent meal was barely had during my entire admission. nutrition, important in the healing process was just impossible to adequately obtain from the food provided by the hospital. i lost 4kg in weight during my admission, which i could ill-afford. apart from the fact that i was hungry and ready to eat a decent meal, few of these appeared. regardless, i ate what was put in front of me. nutritional issues aside, in the monotony of a hospital stay, meals are important breaks in the monotony of a patient's day and should be something to look forward to.
    suggesting that a family member should feed a sick patient by supplying them with "sweets" and "biscuits" which are of little or no nutritional value or that the family should be cooking for the patient under the care of the hospital is stunningly neglectful and the very reason why an act of parliament is deemed necessary to protect patients from incompetent idiots who think that it is acceptable.
    read the francis report. key amongst the problems highlighted were the fact that nutrition was not treated as a priority and the refusal to take the concerns of patients and their families seriously. the very attitude displayed by you.

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  • Hospital food has always been an issue. But I remember when it was prepared and cooked in hospitals, before the current sub-airline garbage we are expected to serve now.

    I never thought that I would hark back to those days! Everything came to the ward in heated food trolleys and the staff were in charge of portion control, presentation and monitoring of patients nutritional intake. The food might have been unexciting at times but it was nutritious, served in appropriate portion sizes and at the correct temperature. The focus has definitely gone off nutrition. Bringing the preparation and cooking of food back to properly trained hospital kitchen staff would actually save money as well as lives. Put in the resources and you will see the results. It should be a priority. Mandatory standards have existed in Scotland since 2008 and in Wales since 2011.

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  • if substandard food is sent to the ward it is your duty to refuse to serve it and send it straight back demanding an immediate replacement suited to your patients' needs. any excuses are feeble and unacceptable. anything short of this is not carrying out your duty of patient advocacy according to the NMC code of nursing ethics and conduct - the whole code should be enshrined in law if nurses are not capable of understanding and following it and should be a strict criteria of registration and continuing registration. attempting to feed patients substandard meals you would not eat yourselves, which endanger patients and do not promote healing is criminal!

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  • ...and no, it is not up to visitors to bring in food and special diets to feed the patients with. anything they bring in should be an extra bonus but should be checked with staff that it complies with their diet suited to their condition and health and safety - eg unwashed and raw fruit, etc.

    if it must be, get the NHS to bring in charges for all patients for daily subsistence which they would have to pay at home anyway but don't need whilst in hospital, such as food, laundering, etc. it only needs to be a very modest charge and is common practice in other hc systems or get everybody to contribute an extra penny in the pound through general taxation which will not break anybodies piggy bank judging by all the shoppers in the sales and prechristmas!

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  • Having spent a fait amount of time as an in-patient, the food can be okay, but it can be horrible - there are a few edible meals if you chose properly from the menu, but the quality and nature of the food is what you'll get if you did all your shopping at Iceland. I would say that each meal looks like it'll cost not much more than £1 to come up with, given economy of scale and all that. And if one doesn't have food supplemented by family and visitors, if you retain a normal appetite, you're not in a good state after a week or two. There aren't enough calories and nutrition in what they give you. There is more than enough research to support the need for mandatory standards, although they will mean nothing without the will and funding to ensure that hospitals can meet the standards. Reading through the comments here, the question seems to be whether or not you consider it acceptable for patients to have poor nutrition in hospital? Worryingly, some (or hopefully just the same person making several comments) think that it is okay. It isn't .

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  • Anonymous | 28-Dec-2013 12:07 pm
    Anonymous | 28-Dec-2013 12:14 pm

    I agree in large part with your posts.

    Nurses in this country fail to behave as patient advocates and don't care enough about what is being done to their patients in any other respect to take action. As you can see by some of the comments, some don't even recognise that hospital nutrition is a problem requiring any action on their part. Criminal indeed.

    However, the problem is much more complex and should be addressed long before the food reaches the ward or patient area. Nurses should be the final link in the chain. They don't control the budgets, or buy, prepare, cook or transport the food. Charging patients for food is not necessary. (It would also require another layer of bureacracy for administration). There is plenty of research which provides evidence that spending more money doesn't necessarily lead to better food. There is a £12 per patient per day difference in the highest and lowest spenders in NHS England, but quality is often worse where more is spent. Good, varied, nutritional food is not expensive when the raw ingredients are bought locally and prepared and cooked by properly trained NHS staff. When profit is being syphoned off to a contracted middle man, money which should be spent on patient food is being given to shareholders.

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  • it is not acceptable to offer substandard meals in hospital and that which patients do not even enjoy. under any circumstances and especially with all the modern technology and means at our disposal, I wrote the comment above about making a small charge. but even if this is not made the taxpaying public are still paying to ensure all patients receive decent and nutritious meals.

    I suppose nurses don't bother to weigh their patients or check their fluids to ensure they are being adequately nourished.

    In my public 1000-bedded hospital in the 80s and 90s food was always quality, suited to each patient in terms of diet and quantity and well presented to make it look appetizing. their names were on their trys to ensure they got the right meal according to choice and diet.

    when we had the customer as king lark from some USA management model, probably responsible for raising expectations beyond what could be delivered and followed by services full of broken promises, the hospital even indulged in table napkins for each and every tray to get this message across bearing a picture of a frog wearing a crown! It was also at this time that complaints about poor service were positively encouraged and various measures to officially encourage them were brought in. Patient-led services became the keyword. However, the patient satisfaction questionnaires were subsequently dropped possibly when management discovered it required more resources to process and deal with them and with increased patient rights to bring their cases to litigation which became very uncomfortable for some! This was followed by a serious financial crisis with all its consequences by which time patients were increasing their demands for more and better personalized services led by these previous messages of encouragement to make their demands known in the times of plenty when we had enough staff to cater for their every whim!

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  • of course us nurses know the importance of good nutrition for the sick and healthy... unfortunately it is not in our power to deliver it. i think it should be public resonsibilty to demand this just like they demand waiting times, and our responsibility to educate them on what they need to get better. nurtition is as important as safety in healthcare, and patients need the right provision to collaboate in their care plan. bearing in mind not all patients have family and friends that can bring in good food, there should be a food safeguarding alert system for these and extra provision accounted for to protect them from malutrition

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  • not much point in educating patients if you can't even feed them properly in hospital. it seems more likely that it is the nurses who need educating by the patients and the public!

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