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Can the NHS go from Hell’s Kitchen to MasterChef?


In 2000 food expert and star of TV’s Through the Keyhole Loyd Grossman was appointed to lead a £40m drive to improve the quality of hospital food.

A year later “new hospital food” was described as slop by nurses, with one nurse researcher telling the BBC: “The hospital chefs are just given ingredients and they have to make the food. They are not always able to do that.”

I confess to finding this a bit surprising. I’d imagine that if you gave ingredients to chefs they would, by definition, be able to make food. Assuming you gave it to them in or near a kitchen. Maybe there was a clerical error? Maybe we were giving the ingredients to hospital chiefs by mistake? And they really didn’t know what to do with them.

‘Do we want patients to love the food they are given? If so, perhaps we could franchise catering to McDonald’s. Or is the responsibility of hospital food to provide nutrition?’

Anyway in 2003 figures released by the Department of Heath said only 17 per cent of hospitals were producing meals of “good quality”. Many of the others were made to sit on the naughty step or, to put it in the language of the time, were designated “red food hospitals”. Health minister Lord Hunt said food standards would have improved by the end of the year.

In 2005 the British Medical Association’s annual conference approved a motion to ask Jamie Oliver - fresh from his success in revolutionising school meals - to help with hospital food. Their concern was that the low standard of food and nutrition was slowing patient recovery. The DH said standards were improving; patients, on the other hand, felt differently. In 2006 a food watch survey of nearly 2,500 patients showed that a third of them abandoned their food and 40 per cent of them had visitors bring their food in for them. And in 2007 a survey by Which? magazine found a third of patients were unhappy with the standard of food they received.

Last week a new report said that hospital meals contained too much fat and salt. A hospital lasagne, for example, contains over six times more salt than one served in school. The DH expressed concern over the survey’s findings, saying they recognise the importance of nutrition and healthy foods in hospitals.

It may be that the dual drivers of cost and “patient satisfaction” create an unsolvable problem for hospital caterers. Patients do not necessarily measure their satisfaction by the nutritional value of food but instead by its taste and ability to make them feel full or nice. Similarly, whatever measly investment has been tossed at hospital food, it has tended to be spent on marketing rather than ingredients or provision.

Perhaps what we need is some clarity of purpose? Do we want patients to love the food they are given? If so, perhaps we could franchise catering to McDonald’s. Or is the responsibility of hospital food to provide nutrition rather than comfort or pleasure - and if patients don’t like that, so be it?

Whatever we decide, surely we can’t keep confusing pleasing people with helping people can we? Because therein lies the difference between working with customers and working with patients.


Readers' comments (10)

  • I recently had surgery in the Netherlands. After the operation (and being fasted from the day before), my main evening meal and the last meal of the day (served at 4.45 pm with no choice of menu or deviation in timing) was three slices of bread, two thin slices of cheese, and one thin slice of something which resembled ham, served with one pat of butter and a pot of tea. On checking with the staff and other patients I was informed that this was the regular evening meal - day in day out - at the hospital I was being treated in (and paying for via my private health insurance contributions). believe me, things are really not so bad in the NHS - or so wonderful elsewhere that I would choose anything better. Yes, the quality leaves something to be desired at times, but it is generally warm, the patient gets at least a nominal choice, and generally feel that someone has made an effort. Not so in my case. Nutritional standards should of course be improved - nutrition is therapy, but part of the problem is the fact that so little is spent on food for patients and this is the root source of the problem.

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  • Incidentally... looking at the main foyers of most NHS hospitals I have visited or worked in, I was under the impression that the catering in those institutions HAD been contracted out to MacDonalds or KFC! We need proper minimum nutritional standards for patient meals which does not mean that they have to be bland or tasteless. We have come a long way technologically, and in our knowledge of human nutrition since Nightingale advocated arrowroot and nutritious gruel for patients. It is possible for hospital food to be both nutritious, therapeutic and appetising as the many good examples prove. If it isn't, why aren't nurses advocating for their patients and sending it back to the kitchens? I have done so in the past and invariably, a suitable replacement was provided for the patient with the minimum of delay!

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  • How I agree with Stephen O'Connor above. As both a nurse and a nutritionist I have been writing about - and advocating for - good nutrition in hospitals for more than 25 years. We know about the incidence of malnutrition in hospitals, and we know that patients report food is often inedible - is it really beyond the wit of man (or at least hospital managers, practitioners and the DH) to draw links between these two facts and do something about them? Obviously yes!

    Secondly, Mark, you seem to have forgotten the important fact that it is crucial that patients eat - and food that is not eaten is of the lowest nutritional value. Short term consumption of a diet that is high in fat and/or salt will do little harm while failure to eat will inevitably inhibit recovery. Perhaps McDonalds should be given the franchise since they regularly produce - at all times of the day and night - highly palatable food of a standard nutritional value which is superior to many meals produced in hospitals!

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  • I find it incomprehensible that there is little or no fresh veg on hospital menus. We bang on about eating fresh fruit and veg, then don't serve any of it.
    Also, if a patient is showing signs of malnutrition, we bleep the dietitian and they recommend supplements! These are bound to cost more an both the short and long term.
    Would it not make more sense to feed patients tasty nutritious meals that will make them feel satisfied and well fed, at the same time as meeting their nutritional needs and aiding healing! (Incidentally, this would mean patients may be discharged sooner, again saving money and that seems to be the main focus of the NHS these days!)

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  • I nursed abroad and had a cesaerian section there. Food wasn't much better, even on the private floor. On night duty once we received a message to defrost the patients fridge freezer were food was stored for them. Once it was thoroughly defrosted my colleague immediately switched it on again. I asked her what could we clean the mould out with before we restocked it. She looked at me in horror and shook her head at me saying we were only told to defrost it, nothing about cleaning it and seeing as we were nurses not domestics she had no intention of cleaning it.

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  • I am also a nurse and nutritionist, can't quite agree with Susan that we should be handing it over to MacDonalds - although i understand her irony. My personal experience of hospital food, albeit 4 years ago was that it was awful and at times unidentifiable. This food was shipped in to the hospital, not evens chefs struggling with ingredients. Food is very important to recovery and should not be overlooked. There is one question that has to be answered - what on earth are the dieticians doing?

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  • Sara talks about her experiences of 'awful' and 'unidentifiable' food and yet questions my 'ironic' statement about McDonalds. Patients need food, they need nutrients and they need something to stimulate their appetite - MacDonalds seems to fit the bill!

    However, how much better it would be if hospitals were to take their role in nutrition more seriously. It is surely up to us as professionals and patient advocates to play our role in this aspect of care and campaigning for appropriate food for our patients?

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  • The message with giving out a MacDonalds is so wrong and really it shouldn't come to that. MacDonalds on a cardiac unit? Paediatric unit? Minced up or tube fed.... Apologies Susan, I really did think you were being ironic.

    But I agree, hospitals should take this role much more seriously than they clearly are, and nursing appears to be the most vocal profession.

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  • Phil Dup

    It wouldnt matter how 'nice' food was to me - if I was sat eating a meal whilst all around me on a ward there were people being incontinent , vomiting , wandering around with catheter bags and stinking of cigarrete smoke and the like then I just couldnt eat it anyway. I'd be getting my sons to physically help me out to a car then drive me straight to the nearest McDonalds drive in for a proper protein and calory packed hot meal.
    Sod the NHS.

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  • In leeds for example the food is shipped in (frozen) from a company in wales and reheated. The local paper very recently ran a front page news story on the food in the hospitals and how unedible it was.

    it's cheap (it has to be as there is a paltry budget for it). As a consequence it is unpalatable and quite frankly (as the newspaper stated) not fit for a dog!

    There is no way to improve this other than increasing the money available for it...and that's just not going to happen.

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