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Practice comment

I’m lovin’ it: would McDonald’s food encourage hospital patients to eat?


Fast food companies service millions of meals to satisifed customers every day. The NHS should tap into their expertise and take a new approach to catering, Susan Holmes

The problems of hospital food and malnutrition have been known since Florence Nightingale first stated that hundreds of patients were “annually starved in the midst of plenty” for “want of a good diet”.

How little has changed. Patients consistently complain about their food, I know of one hospital where 6,500 meals are thrown away each year. However, evidence suggests that even if patients eat all the food provided, nutrient intake remains inadequate. Little wonder then that under-nutrition persists. It should not be difficult to draw links between these factors.

I and others like me have been drawing attention to this situation for over 25 years and yet it remains an intractable problem.  Perhaps it reflects the low importance placed on food, which often seems to seen as an opportunity for trusts to make savings.  Perhaps the significance of adequate nutrition remains unrecognised in practice and the savings that this could achieve are not acknowledged. Or is it that the NHS as a whole has failed to explore what has gone wrong and what could be done? 

In referring to the differences between patients and customers and between pleasing people and helping them, Mark Radcliffe makes an important point. He questions whether we wantpatients “to love the food they are given”.  Surely they should at least like the food if we want them to eat at all? He also asks whether it is the responsibility of hospital food to provide nutrition. What else should it do? There is no good reason why hospital food should not both please and help patients - or customers - at the same time. This surely is not beyond the wit of hospital managers and caterers.

That patients should need good food to promote recovery and prevent malnutrition is beyond doubt. That they eat something – even a burger - is surely better than nothing? Food that is not eaten has no nutritional value.  The patient population has changed over recent years and many stay only a few hours or days - a few stay for longer. Does it really matter that the lasagne they are served is high in fat and salt?Short-term consumption of an “unhealthy” diet will do little harm and may even meet their needs more effectively than so-called “healthy diets”. It is the overall dietary balance that is important, not a short-term aberration.

Applying conventional approaches to solving the problem has clearly failed. What is needed is new and radical thinking if a different solution to food problems in hospitals is to be found. In practice, this may have been compromised by nutritionists or dieticians attempting to impose long-term dietary considerations on to a largely short-term problem. Misguided attempts by TV chefs to impose haute cuisine were unhelpful and taken up by less than 25% of hospitals nationally – patients did not recognise the food they were offered. Good home cooking and familiar, comforting foods are needed, rather than fancy restaurant meals.

Mr Radcliffe ironically suggested that we could franchise catering to McDonald’s - but is that such a bad idea?  I can hear the shouts of horror from here. I am not advocating that patients should be fed on burgers and chips, nor that a McDonald’s McFlurry dessert is suitably nutritious, although the occasional treat will do no harm.

What I am suggesting is that we look to companies such as these for a new approach to hospital catering. They successfully serve millions of palatable meals at any time of day or night, to happy, satisfied customers. They provide food of a consistent standard and a known nutritional content - exactly what is needed formost short stay patients. Of course, the menus would need adjusting to appropriate nutritional and quality standards suitable for patients and their conditions. 

To meet these needs we need the knowledge, skills and expertise of those who make their living by producing food to given nutritional standards that daily supply millions of people.  McDonald’s and the like are good examples of such skills and they may have much to teach the NHS. So, why not suggest they are given an NHS contract?

SUSAN HOLMES,BSc nutrition, PhD, SRN, CMS, FRSPH, is director of research and development, Faculty of Health and Social Care, Canterbury Christ Church University, Canterbury


Readers' comments (18)

  • The argument for a consistent satisfactory standard or nutritious and palatable meals is obvious and sound. But surely the School Food Trust is a far better example of supplying nutritional recommendations for 100,000s of high energy, low saturated fat, low salt meals every day at reasonable cost? Supported, as it is by legislation.

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  • Macdonalds is fine served with a healthy salad for some patients if this is to their taste in hospital and providing the beef is of the highest quality, cooked in little fat and the buns are of whole meal bread otherwise they may not be nutritious enough and too rich in carbohydrates and fats.

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  • I would like to address the above comments. Firstly, I do not deny that the Schools Food Trust is a good organisation with entirely laudable aims (to transform school food and food skills, promote the education and health of children and young people and improve the quality of food) they do not, themselves produce food so their purpose is a different one. They do, however, provide guidance and recommendations so something similar for the NHS would be an excellent idea.

    Second, if you return to the text above, you will note that I did NOT advocate that patients should be fed on burgers and chips - in fact I specifically stated that they should not! BUT what I did suggest that we used the skills of a company such as MacDonalds to help and guide the NHS in HOW to produce food of an APPROPRIATE nutritional and quality standards suitable for patients and their conditions.

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  • to Susan Holmes | 21-Nov-2010 9:59 pm

    from Anonymous | 21-Nov-2010 3:06 pm

    so what is wrong with hamburgers served as I suggested above, for those who enjoy them? served in the way I suggested I would have thought this is a nutritious and palatable, simple and inexpensive meal which many do enjoy, and I for one. As an alternative to a bun, hamburgers can also be served with other accompanyments too and I am sure nutritious potatos can be cooked as chips in a small amount of unsaturated healthy vegetable oils. I would not recommend serving chips as well as buns as this may have too many carbohydrates and calories but I do advocate whole meal bread.

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  • I cannot BELIEVE it is being seriously suggested that the NHS would benefit from getting into bed with a globalised juggernaut of a corporation like McDonald's. Quite apart from the well documented lack of anything approaching nutrition in their so called food, what kind of message would that send to the public in these times of sharply increasing obesity levels? It says 'we approve of McDonalds, we are endorsing their products, in fact we positively advise you to eat their food. Companies like McDonald's exist TO MAKE MONEY, not to improve the health of the nation. I understand the point about taking their business practices on board, but surely this can be done in a more appropriate way and without advertising the wares of a monster multinational company who, frankly, don't need any help with their advertising. We might as well sell fags in the hospital shop as well.

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  • My view is that Susan has fallen into the same trap she criticised the TV chefs for doing. i.e. focusing only on the food! Food and food quality is important but as every member of the ward staff will testify it is only half the story. Getting the right meal to the right patient at the right time; providing patients with an encouraging environment and the help and assistance they need to choose and eat their food is at least the other half. Hospitality goes hand in hand with good food and in my experience it is the hospitality we fail to achieve in our hospitals.

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  • I can see the logic in approaching McDonalds for input on how to produce food to a set nutritional standard. But surely the way McDonalds work is by producing a limited choice of food in very large quantities. This is not how food is produced for the NHS. Ths choice offered on the standard menu at our trust is quite large and this is not including all the special dietry needs aswell.

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  • size of portions, consistence, colours and presentation are also vitally important. there is nothing less apetising than an overloaded plate when you are lying in bed with little appetite where dainty portions of well presented food may act as a stimulant. a thorough understanding of the nutritional needs of every age group is essential. Appetite stimulants and a small glass of red wine, if not contraindicated, work a treat for the elderly.

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  • most hospital food is rubbish. It is cheap and of poor quality..usually high in fat and salt.

    It is also mostly unpalatable..that is why so much goes to waste. Mcdonalds may be high in fat but it will certainly be palatable to many (if not more so than the usual hospital dog food they are served up).

    malnutrition is an issue for patient's while in hospital and many patients are discharged in a worse state nutrition wise than when they were admitted.

    A daily dose of fast food whilst not nutritious would certainly stave off malnutrition for many. in the short term high fat foods are not particularly harmfull (if at all).

    Hospitals only have a small budget for food and as a consequence it is horrible and goes to waste........something needs to be done to address this situation.

    As one chap in leeds put it (on the front cover of the local newspaper) when he stayed at St James....."i wouldn't feed it to my dog"!

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  • providing poor food to patients is NOT holistic care which is the responsibility of the hospital, its staff and the NHS. Prioritising and distributing funds to the correct sources is not an optional extra. So what is the excuse this time?

    One my patients had a live cockroach in her spinach. A colleague quietly put it in a plastic bag and returned it to the kitchen staff!

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