The results of a survey by the Soil Association show hospitals across the country are routinely letting patients down, with 63% describing food as ‘unappetising’, 35% labelling it ‘unacceptable’, and 53% saying they would not serve the meals to a child.
The findings back up previous reports which have found the bad reputation of hospital catering is, in most cases, richly deserved, with services often seen as an add-on to clinical care and an expensive distraction.
Hospitals seem to give the same priority to the contract for feeding their patients and staff as they do to getting the windows cleaned or the lawns mowed
The Soil Association report, entitled First Aid For Hospital Meals, states: “To most people it will seem self evident that food in hospitals should help people get better, rather than make them sick. But for many of those running hospital trusts, this thought does not seem to have crossed their minds. They seem to give the same priority to the contract for feeding their patients and staff as they do to getting the windows cleaned or the lawns mowed. We all too frequently have food that would be more appropriate to a disease service than a health service.”
The report cites a number of previous surveys and publications which have highlighted problems with catering standards in the NHS, criticising a lack of desire to make improvements. These include official guidelines published by the Government in 1995, which were largely ignored; and a Better Hospital Food initiative launched in May 2001, which resulted in 25% of trusts failing to introduce a single new dish.
In addition, a 2009 report by the Nutrition Action Plan Delivery Board said 239 patients had died in hospital due to malnutrition. And an Age Concern investigation in 2006 found six out of 10 older people were either at risk of becoming malnourished or actually became malnourished while in hospital.
The cost of all these failed attempts to improve NHS catering has landed taxpayers with a £50m over the past decade, according to research by Sustain.
The Soil Association report states: “Rather than treating food as an optional add-on to the service they provide; or worse, an expensive distraction, all hospitals should be aware that good quality food is the cornerstone of good health.
“Hospitals should feed their patients so they get healthier. Hospitals and the health service also have a crucial role to play in setting the standards for public health. If places where doctors and nurses work and care for sick people do not provide healthy and nutritious food, which is a pleasure to eat, the public health campaigns designed to encourage healthy eating have absolutely no chance of success.
“The nation’s health service must lead the way in providing healthy food before public health professionals can expect to have much influence in changing the nation’s diet.”
The report says that one of the most common excuses given by trusts to defend poor quality catering is a lack of funding.
However, it goes on to provide examples of trusts which have made noticeable improvements without breaking the bank.
The hospitals that are doing a brilliant job are not necessarily those spending the most on their food service
“The mantra constantly repeated by those running hospital trusts with unhealthy food is that they cannot afford better quality,” it states. “This ignores the fact that poor nutrition is costing the NHS billions of pounds a year, and the wider economy tens of billions. It also ignores the fact that the hospitals that are doing a brilliant job are not necessarily those spending the most on their food service.
“The best hospitals’ food is good for patients, good for NHS staff, good for British farmers and food businesses - good for Britain. But the majority of hospitals are delivering hospital food that is bad for patients, bad for staff and bad for Britain.”
Examples cited include one hospital that saved £6m a year by cooking with fresh, local ingredients, and another that sources yoghurt from a local supplier for two thirds of the price of the nationally-approved supplier. Others singled out as beacons of best practice, include:
* Northampton-based St Andrew’s Healthcare which sources 40% of its food from within a 50-miles radius of its sites and 20% of ingredients are organic. The trust estimates it has reduced food miles by 96,000 as a result
* Nottingham University Hospitals Trust - holders of a Food for Life Bronze Award - sources all milk for the City Hospital - 1,000 pints a day - from a dairy 11 miles away. In addition 95% of its meat comes from a local processor sourcing from farmers in the East Midlands. The trust’s switch to local suppliers has saved an estimated 150,000 food miles and £6m a year
* North Bristol NHS Trust - also holders of a Food for Life Bronze Award - has introduced winter and summer menus to make the best use of seasonal, local produce. The trust buys local milk and ice cream from a farm near Bath is now free from artificial colours or flavours, but is the same price as the ice-cream the trust used to buy, which came from Belgium via Bolton
A spokesman for the Bristol trust said: “The Food for Life award recognises the use of a high percentage of ethically-produced locally-sourced provisions. This, of course, improves the quality of the food we serve to our patients and works towards reducing the trust’s carbon footprint.
“Working through the initiative has enabled us to move away from some national contracts where goods are shipped a considerable distance and driven us to seek local suppliers whose businesses we have helped to develop, gaining them additional work, but also getting a better product for ourselves.”
Rather than treating food as an optional add-on to the service they provide; or worse, an expensive distraction, all hospitals should be aware that good quality food is the cornerstone of good health
The report states: “A recent national review by Deloitte found that local and seasonal food did not generally cost more, and can cost less. Hospitals spending half as much as the highest spenders were often able to provide better quality food than those spending more.
“The successful hospitals in this report are doing what any decent health service should do – leading by example. Their experience shows that giving hospital food the priority it deserves need not cost more, it benefits patients, improves health outcomes, benefits the local communities the hospitals serve, and provides vital support for British farming.”
The report goes on to make a series of recommendations for measures than can be taken by trusts, patients and the Government to deal with the problem once and for all.
It advises NHS organisations to:
* Improve transparency and patient accountability by publishing information about the quality of food provided in their hospitals. This information should include measures of patient satisfaction, the food budget per patient per day, and any independent verification of standards. In addition, hospitals could benchmark their food provision against the forthcoming Government BuyingStandards for Food
* Visit one of the successful hospitals set outin the case studies in the report to see what those inthe same position have achieved
* Agree to improve the food served to patients,staff and visitors by concentrating on sourcinggood-quality, seasonal, local, and where possibleorganic, food; providing well-cooked simple mealswith an emphasis on ensuring that the mealsarrive in good condition
* Ensure that all catering serves the NHS’s mission to improve the healthof the nation, by serving healthy, good-qualityand freshly-prepared food for patients, staffand visitors alike.
It also advises hospitals to sign up to the Soil Association’s Food for Life Catering Mark; a voluntary award scheme that offers a pragmatic step-by-step framework for transforming food provision.
The scheme was developed and piloted in hospitals with support from the Department of Health and has already been awarded to caterers serving more than 250,000 meals a day in schools, hospitals, care homes, nurseries, sports venues, and restaurants in the UK.
The report states: “A key benefit for hospitals in adopting the standard is the transparency and trust that an independently-audited award provides. What the hospital is achieving is clear, and any claims the hospital makes about its food are independently verified.”
The document also calls on the Government to do more to promote patient choice and accountability by making measures of food quality in every hospital publicly available on the NHS Choices website and encouraging all trusts to publish this information on their own websites.
If places where doctors and nurses work and care for sick people do not provide healthy and nutritious food, which is a pleasure to eat, the public health campaigns designed to encourage healthy eating have absolutely no chance of success
Patients can play their part by reporting any negative experiences to trusts, or, where standards are high, praising the organisation.
The report states: “There is growing evidence that good nutrition not only helps patients recover faster, but can also relieve the symptoms of some diseases, and improve the effectiveness of some medication. For example, there are links between diet and depression, schizophrenia and Alzheimer’s Disease.”
It concludes: “The story of the failure to provide decent, tasty, healthy food in British hospitals is a result of an indefensible failure by those in charge of hospitals. If there is anyone in our society who should know better, it is those in charge of our health service.
There is growing evidence that good nutrition not only helps patients recover faster, but can also relieve the symptoms of some diseases, and improve the effectiveness of some medication
“The story of the inability to change what has been repeatedly recognised as indefensibly-bad levels of food service is the result of lack of leadership, lack of commitment, and lack of skill. This has little or nothing to do with money. It has everything to do with determination to give reasonable priority to providing patients and staff with good food, while recognising the crucial importance of the quality of the raw ingredients and the skill and commitment of catering staff.
“In contrast, successful hospitals are doing what any decent health service should do - leading by example. No one thought people could be encouraged to stop smoking until doctors themselves stopped smoking. Why should anyone expect the nation to move to healthier, more environmentally-sustainable diets until our NHS starts to lead the way?
“Those still lagging behind should be ashamed of themselves. It is to the leaders of those hospital trusts that this report is aimed. What this report shows is that the solution is in their hands.”