Ever since I sat in the sunny garden of No 10 with our ebullient Prime Minister in June, I have been inundated with emails, posts and letters about the state of hospital food.
The complaints I have received since becoming an adviser to the government review into hospital food last month follow a familiar pattern.
No toast for breakfast, or toast the texture of pipe lagging; food and drinks put out of the reach of patients; no food at all if you miss lunch because you were having an X-ray; flavourless food; cold food; disgusting-looking food; food that comes in ‘prison trays’; food that’s wrapped up and hard to unwrap; food totally unfit for your diet or even dangerous to your health; food that doesn’t accord with your religion; food you simply don’t like.
Ever since I sat in the sunny garden of No 10 with our ebullient Prime Minister in June, I have been inundated with emails, posts and letters about the state of hospital food, writes PRUE LEITH
And that’s not counting the patients who wrote to tell me they were advised by kindly nurses to get their relatives to feed them.
One patient, a diabetic, spent the day in A&E, followed by X-ray, with no food at all, despite telling everyone he might collapse.
At 9pm, he was admitted to a ward and told he had missed supper, but then a nurse arrived bearing a cold tray of food.
‘You’re in luck,’ she said. ‘Someone in the next ward just died — you can have his supper.’
NHS night-staff complain of vending machines full of junk, with nothing hot or healthy. Visitors complain of poor-quality restaurants and only chocolate bars, biscuits and overpriced sandwiches in the foyers.
Of course, I hasten to add that there have also been stout defenders of our hospital food.
One of my former Leiths directors, who knows a thing or two about catering, spent a week in Chelsea and Westminster Hospital in London and was impressed with the fresh fruit and vegetables, nicely cooked familiar dishes and smiling staff.
But sadly, overall, the messages of praise were wildly outnumbered by the complaints.
What impressed me the most, however, were the offers of help, mostly from experienced people with lots to give.
Not just chefs, food teachers and nutritionists, but NHS employees who can see what the problems are in their own hospitals and would like to suggest solutions, yet are met by the deaf ear of management.
There are caterers who are doing a good job with satisfied customers, doctors who believe that food can be medicine, change-management experts who think the culture in the NHS needs a turnaround, catering consultants pointing us to best practice elsewhere.
Could, for example, a system used in a hospital in Ede, in the Netherlands, work for us?
Prime Minister Boris Johnson recently confirmed a £1.8 billion NHS cash injection to improve patient care. Let’s hope hospital food gets a really big chunk of that. After all, it’s in the interest of the Government to get it right. Above: Boris Johnson serves a meal to a patient during a visit to a Devon hospital
There, every patient is offered a short, but varied, menu that is tailored to his or her dietary needs and personal taste, so no chance of being confronted with a gluten-heavy pudding if you have coeliac disease, or meat pie and chips for a heart attack victim.
The kitchen is on site and you can order anything you like, at any time of the day or night, and it comes within 45 minutes.
We might not be able to offer such luxury service, but, who knows, we ought at least to find a way to provide finishing kitchens on each floor.
That way, staff could make fresh toast, rustle up soup and a sandwich for someone who has missed a meal, or boiled eggs and soldiers for a patient finally awake and hungry after a heavy anaesthetic and the prolonged sleep that follows it, or simply provide a cuppa and biscuit for a worried patient who cannot sleep.
After all, kindness can be a huge comfort.
The government review panel into the state of our hospital food was announced in June, but is yet to have its first meeting, so we don’t have any answers just yet.
But we will get them, I hope, by the end of January. And I am confident that we mean business.
Phil Shelley, former chair of the Hospital Caterers Association, is busy recruiting his team. So far, besides me, he has Henry Dimbleby, who is the chair of Michael Gove’s National Food Strategy.
Henry is doing wonders with his charity Chefs In Schools, whose goal is to place restaurant-trained chefs in 100 schools; as well as an impressive number of doctors and administrators who have been trying — and sometimes succeeding — to improve food in their hospitals.
They are all committed and determined to move mountains.
More importantly, so is the Government. In 50-something years of campaigning for good school food, for the teaching of cooking, for healthier food in prisons, hospitals and care homes, I have never before felt that ‘them up there’ wanted more than a photoshoot with a celebrity chef and a bit of good news with which to woo the public.
But this time, Matt Hancock, the Health Secretary, personally wants to see real change and realises that words are not enough.
We will need real money to change the culture, so that the NHS comes to believe that good food can be a positive thing and not just a drain on assets.
It will also take cash to install proper kitchens in hospitals and to train everyone in new and better ways. We are under no illusion about the size of the challenge.
Among the complaints which PRUE LEITH has been inundated with are: food and drinks put out of the reach of patients; no food at all if you miss lunch because you were having an X-ray; flavourless food; cold food; disgusting-looking food and food that comes in ‘prison trays’
I once heard the head of a catering company for hospitals talking at a conference, where he said: ‘How would you like to work somewhere where you must feed 1,000 or more customers with 50 different diets, religious taboos, cultural cuisines and preferences, where they must all be served at the same time, where half of them are too ill to eat or don’t have any appetite, where 60 per cent of them are between the ages of 65 and 90, and not one of them wants to be there in the first place?’
All the more reason why food should be tailored to the individual patient.
Next, there is the problem of kitchens. Many large hospitals ripped them out under the disastrous private finance initiative, when hospitals were contracted out to the private sector, which paid for their construction or overhaul.
In turn, those companies signed long-term contracts, awarded not on quality, but on price, with caterers who agreed to cough up the investment for replacing cooking facilities with regeneration units (warming-up ovens) and providing central production units miles away.
So now, we are in a position where minced, dehydrated pellets of chicken, lamb or beef are imported from the cheapest suppliers and moulded into portions in a factory, to be called up by the hospital and ‘regenerated’ in some cheap sauce. This is not proper food.
An alarming 55 per cent of the 140 million meals served to patients every year are trucked in from elsewhere.
My ninetysomething mother, in the Royal Free Hospital in Hampstead, North London, after a fall, received such a meal one day.
As she lifted the cloche, a watery, grey mass threatened to overflow the plate. She quickly replaced it and pushed aside the tray.
We now need to break those catering contracts and bring the cooking — using fresh ingredients and trained chefs — closer to the patient.
Personnel is another issue. Of course, in a massive, complicated business such as catering in the NHS, you are not going to get starry chefs in the kitchens worrying about micro-leaf garnish, parmesan crisps and yuzu drizzle.
But, with the years of assembling pre-made, often pre-wrapped, items, real cooks are a thing of the past in many hospitals, and new ones will need to be recruited and trained.
We must also acknowledge the fact that, although dietitians, present in every hospital, are experts in their field, cooking and flavour are not part of their remit.
As Dr Martin Scurr argued on Tuesday in this paper, dietitians need to work with hospital kitchens in order to provide nutritional support matched to patients’ needs.
One of the stark realities of the current crisis is that food is considered a low priority. Hospital administrators see feeding the patient as a regrettable expense, while the morale of the caterers, doing their best in an impossible situation, is at rock bottom.
I personally believe that the unintended consequence of a hospital or trust not receiving a fixed amount of money for every patient fed is that it would much rather not feed anyone.
If, as in schools, they were compensated for every meal served, they would put more effort into doing it well.
The scale of the problem is immense, but there is no doubt it can be fixed.
If the North Bristol NHS Trust — the only one serving meals with the prestigious Silver ‘Food For Life’ Catering Mark accreditation from the Soil Association — and The Robert Jones And Agnes Hunt Orthopaedic Hospital in Shropshire, recently voted by patients as producing the best hospital food in the country, can cook fresh food on site and please their patients, obviously others could.
I am not suggesting that one size fits all, and different approaches may be necessary, but we should start with fresh food, prepared with skill and care.
My hope is that this review will work with conviction and energy to propose a really good plan that the NHS sees the point of and for which the Government will find the money.
As yet, we have little idea how much money that will be. Nor how it will be paid.
It has been suggested that patients who can afford it should pay some contribution — say, for the cost of ingredients, for which they would be paying if they were at home.
Perhaps — but I would argue we’d need the food to be delicious before we proposed that.
Prime Minister Boris Johnson recently confirmed a £1.8 billion NHS cash injection to improve patient care.
Let’s hope hospital food gets a really big chunk of that. After all, it’s in the interest of the Government to get it right.
First of all, it will cheer up patients and make them happier with the beloved NHS.
Second, patients will recover faster and vacate those much-needed beds sooner if they are eating well.
And it will remove what is currently a national disgrace: horrible food in hospital.