In recent years celebrity chef James Martin has led the most determined attempt to get hospitals sourcing, preparing and serving fresh, locally produced food for patients, and for staff.
Unlike many of the expensive gimmicks that had fruitlessly spent up to £50m under New Labour, including attempts by top chefs and by Lloyd Grossman to introduce unrealistic new menus from top down, Martin focused on the basics, reopening or making much better use of what kitchen facilities were available, and working with staff to find viable solutions.
However Martin also worked to debunk some of the false assumptions which made hospital trusts opt for buying in cook-chill food (and sandwiches) rather than preparing any food on site.
High quality, mass produced cook chill ‘ready meals’ are of course popular when sold by Marks and Spencer, Waitrose and by other supermarkets.
However the restricted budget for NHS meals (with amounts spent on food varying between trusts from as little as £2.12 per patient per day to £10.50 in 2015) limited the quality of ingredients, and the way they were actually served to patients, often luke-warm after being wheeled around a large hospital for an hour in a heated trolley, meant that they tasted very different from the dishes management were able to sample straight from the producer’s oven.
And while an individual cook chill meal may appear to be cheaper than a freshly cooked one, they don’t come as individual meals, but as trays of up to eight, which can mean high levels of waste.
With growing awareness of the hazards of single-use plastic and focus on environmental sustainability the large volumes of plastic packaging and additional food miles from production centres are an unnecessary environmental cost. When the Royal Free hospital reverted to home produced food it ended the need for 50,000 disposable plastic containers.
Martin worked with hospital staff to produce three excellent series of ‘Operation Food’, proving that investment into kitchens and locally sourced food could enhance the food for patients and for staff – reduce wastage rates and even generate a modest surplus where there had previously been a cost.
But it was an uphill battle against management who had decided in advance that cook chill, or the replacement of hot meals with sandwiches was the only way to go.
It was also done without any support from government.
When Health Secretary Jeremy Hunt in 2014 refused in advance even to consider bringing in new legislation to enforce minimum food standards in hospitals regardless of the outcome of an inquiry, one government advisor resigned in protest and Martin responded “You should be ashamed.” He denounced the persistent refusal of ministers to take the issue seriously. “I’ve tried five years to speak to someone in government and the response is they’re ‘too busy’.”
The report of the Hospital Food Standards Panel included a cost benefit analysis of some of the changes proposed, and estimated savings would more than cover the limited additional costs to a very modest annual spend of just over £500m a year on hospital meals for patients.
However the Panel argued against legislation to enforce action, and claimed it would be enough to introduce five recommended standards as “legally binding standards in the NHS Standard Contract”.
Alex Jackson of Sustain, who resigned from the inquiry panel on this issue, pointed out that while school meal standards are enforced by law, there is no such legal safeguard for hospital food, and warned that what the Panel was proposing was “tinkering with commissioning contracts and hoping for the best”.
He was right. In 2017 an article in Health Business noted that “negative discourse around hospital food dominates now, more than ever.” It pointed to a review of progress two years after the HFSP’s report which found widespread breaches of what were meant to be mandatory standards:
“For example, 48 per cent of hospitals were found to be non-compliant with the Government Buying Standards, whilst only 55 per cent of hospitals follow the BDA’s Nutrition and Hydration Digest.”
The food standards introduced into the NHS Standard Contract were not comprehensive enough, and because no real regulatory programme had been introduced, the result had been slow adoption of the standards.
Perhaps even more worrying, the Panel had focused on issues which were not central to patients’ concerns. In particular there were “no stipulations in the Government Buying Standards regarding the quality of food procured and served. In fact, this is not touched upon in any of the five standards introduced.”
As a result the Panel missed the crucial point: “Even if meals and ingredients are ethically sourced, kind to the environment and nutritious, if they are badly presented and bad tasting, patients will ultimately be dissatisfied.”
Part of the problem was obvious from the start: the Panel’s 2014 report avoided any reference to the very low average amount available for catering managers to spend per head on NHS food – a point repeatedly stressed by the Hospital Caterers Association, which pointed out that when James Martin’s first BBC ‘Operation Hospital Food’ series was broadcast:
“It clearly highlighted the lack of investment in hospital kitchens and the limited food costs that many caterers are working with. James Martin was quoted as saying that the daily NHS budget allocation per patient was £3.49 for all food and beverages but in fact many caterers are having to work with far less.
“For many Trust Boards, catering is viewed as a low priority and in this period of economic crisis, many are looking for more ways to make cost savings”.
The HCA also followed up after the third series in 2014, arguing that:
“We are aware that we still need to address a range of quality issues and establish uniform standards across the country. The HCA is, therefore, calling for a minimum food spend per patient per day as part of a campaign for the introduction of mandatory national nutritional standards for hospital food.
We also want to stop CIPs (Cost Improvement Programmes) being applied to catering as short term solutions versus more effective long term funding”.
Five years later, with both main political parties apparently calling for catering to be brought back in-house, but with real terms hospital budgets only fractionally higher than they were in 2010, it remains to be seen if we are really much closer to the necessary investment in kitchen facilities and staff that could make this a reality.
- A future article will look at the alternative examples of how catering is done in Wales.