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Hospital food: The chef that hopes to improve standards

 
Nurse trying to feed sick child in hospital bed

A new report has criticised government efforts, which involved celebrity chefs, to improve hospital food. But James Martin believes expert chefs can still help raise standards.

You are ill, in hospital and might not feel like eating anything.

Maybe you could stomach chicken soup. But the odds are you won't be served it.

Some hospitals are serving locally sourced, sustainable, nutritious food, and receiving accolades for it, as they are saving money, food waste and jobs.

James Martin makes it better:

Madeira cake

Mend wounds with Madeira cake

Heal with butternut squash and lime soup

Soothe with roast parsnip and rosemary soup

Restore with cauliflower and apple soup

However, according to a report produced by The Campaign for Better Hospital Food, the UK government has wasted more than £54m of taxpayers' money on failed attempts to improve patient meals since 1992.

There have been 21 failed initiatives, it says, many involving celebrity chefs such as Albert Roux, Heston Blumenthal or broadcaster and gastronome Loyd Grossman.

But one chef has recently been working to make a difference.

In the BBC Two series Operation Hospital Food, James Martin went in to the Royal Orthopaedic Hospital in Birmingham to give things a shake-up. Previously he had done similar at Scarborough General Hospital, North Yorkshire.

"Every hospital has its own particular problems," he says. "With only three months to complete the transformation it has seemed like an impossible task."

Sample dinner menu:

James Martin stirring custard
  • Fruit juice
  • Moroccan chicken tagine
  • Tabbouleh with lemon and mint
  • Green beans
  • Chips
  • Madeira cake

Watch Operation Hospital Food at 09:15 on BBC One weekdays starting Monday 25 February

He was shocked to find 40% of food being thrown away, the catering department crippled by a huge overspend and facing the threat of closure, and no system to assess how many people they were cooking for - or what they would like to eat.

"At times I have actually sat at home thinking, 'Is it worth it?', because I simply wasn't getting anywhere," says the chef.

"But I passionately believe that patients deserve the best standard of food available and I'm determined not to fail."

He introduced a new seven-day menu helping the head chef take control of stock management and ordering, and combining the restaurant menu and patient menu to save costs.

His new lunch and dinner menu featured healthy, nutritional classics, including cauliflower cheese with leeks, slow roast shoulder of pork, and a range of soups such as roast parsnip, or carrot and coriander - made with fresh not packet ingredients.

Go behind the scenes

Start Quote

Why wouldn't they be wary of a film crew descending on their hospital and exposing their flaws?”

End Quote Series producer Lucy McLennan on the TV blog

Desserts, which could be swapped for fruit salad, included pancakes with orange sauce, steamed treacle sponge, and baked rice pudding with raspberries.

James Martin is perhaps best known for presenting the weekend food show Saturday Kitchen on BBC One.

So could a Saturday Kitchen-style menu save the day?

"I have tasted some of his dishes like the soup for the starter and they are really good," says Lucy Jones, consultant dietician and co-director of Nutrifit Health Ltd, based in Purley, Surrey.

In fact soups can be both comforting and nutritious and are appealing to those convalescing.

"One of the areas we have fallen down on in the past is that the dishes can be far too rich. Meals should be relatively bland, not too rich and easy to digest, with a soft texture," she says.

James Martin recruited chefs Stephen Terry, Galton Blackiston, Paul Merrett, Lawrence Keogh, James Tanner and Chris Tanner to each work with a hospital in their own area.

Since then, a 92-dish menu he and Stephen Terry created has been adopted by 115 NHS hospitals in Wales.

Small girl being fed by mother in hospital Campaigners want more fresh, organic and locally-sourced fruit and vegetables

Gardening expert Alys Fowler has a partner who has a genetic disease and has two or three hospital stays a year.

"Sick people can be really finicky about what they eat. Depending on how you are feeling, anything challenging can make you nauseous. It's a really contested and difficult thing," she says.

Why is good nutrition important?

Savoy cabbage

Nutrition is critical to the healing process.

A good nutritional intake helps you to recover more quickly, and reduces the risk of complications.

You need to increase the amount of protein you consume in the weeks before as well as the weeks following surgery.

By increasing you protein intake, it will help your body heal itself more quickly and effectively. Protein is included in foods such as chicken, fish, and eggs (try to avoid fried greasy foods). If you are a vegetarian make sure you are meeting your protein needs.

Incorporate dark green leafy vegetables into your meals before and after surgery, such as, cabbage, spinach, broccoli, and asparagus. These contain vitamins and minerals which taken in conjunction with protein and water, will boost your healing rate and will aid in your recovery.

Source: Royal Orthopaedic Hospital

She has sympathy with catering providers, as "although the food system is not ideal, they are working on a budget".

However, "going for the cheapest option all the time is not always good for patients", says Amy Leech, a policy officer with the Soil Association, which campaigns for healthy and sustainable food and farming.

Some hospitals are criticised for preparing processed, non-locally sourced food.

Recently horsemeat has been found in some hospital food served in Northern Ireland, and questions are being asked over the supply chain in England's hospitals.

Buying cheap processed food "is not a sensible thing to do", says Alex Jackson, from the Campaign for Better Food.

"Local and seasonal food is good for a number of reasons: it creates less food miles, it supports the local economy and local farmers, and can be grown in a natural way," he explains.

"The kind of standards we'd like to see, are environmental and ethical standards. Eggs should be cage-free, hospitals should be buying more cage-free poultry and sustainable fish. It's not only about how healthy it is, but the benefits for all with good provenance."

So how do meals measure up nutritionally?

In Wales, a patient is assessed whether they are nutritionally at risk, healthy or well, says Alex Jackson. The assessment is used to decide what they are fed, a policy not necessarily followed elsewhere.

"Hospital food in Scotland and Wales has to meet nutritional standards, but hospital food in England doesn't," he adds.

Eat well in hospital:

Woman peeling apple in hospital with man in bed

Poor nutrition pre and post operatively may result in:

  • Increased length of stay
  • Headaches
  • Depression
  • Inability to concentrate
  • Increased risk of infection of chest
  • Increased risk of urinary tract infection
  • Increased risk of and wound infection and delayed healing
  • Increased risk of pressure ulcer formation
  • Increased chance of re-admittance to hospital

"If you look at nutritional guidelines on a daily basis, each meal served should contain a third of a patient's daily nutrients and a variety of micronutrients," says Lucy Jones.

"Malnutrition in hospitals is so widespread. It has a massive impact on recovery. It has been a problem in the past. People can end up with pressure sores if not getting enough to sustain them moving around," she explains.

According to the Campaign for Better Hospital Food, some hospital meals served in 2012 were saltier than fast food burgers.

James Martin has tried to ensure his menus are fresh and nutritionally-balanced.

Lucy Jones says variety is important, ensuring menus contain many types of foods.

"Those having cancer treatments may do better on cold, dry things," she says. "And anyone in there for a long time can get food fatigue if always having same things."

Nottingham University Hospitals and North Bristol hospitals serve a variety of fresh, local produce, says Amy Leech.

They follow a catering mark scheme designed to show that food is freshly prepared, free from undesirable additives and better for animal welfare.

"We are helping hospitals try to achieve the mark by serving 75% fresh food, farm-assured meat," she says.

It's a target James Martin has also encouraged hospital catering staff to meet.

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  • rate this
    +2

    Comment number 33.

    The problem is not only with the food. It is often is served at times that suit the hospital routine but not when the patient is ready to eat. During my most recent stay in hospital the evening meal was served at five/five thirty just at the point when those who had been at work were calling in to see me on their way home. Having been given lunch at midday I wasn't that hungry and preferred to talk to my visitors.

  • rate this
    +1

    Comment number 32.

    A bit of imagination from the procurement department (yes, not just cooks) and hospital food could be improved no end. They don't have to buy Supermarket standardised raw ingredients - strange shaped carrots will do and will help farmer by buying their supposed sub-standard produce - and buying cheaper cuts of meat in bulk from quality suppliers works out even cheaper. Who said there had to be meat anyway?

    Common sense and budgetting are needed. It's what the Government keep telling lower income people to keep them healthy, why don't other Government departments, ie NHS, practice what is preached?

    It shouldn't take a celebrity chef to turn this around - no one running a hospital kitchen should be without these skills

  • rate this
    0

    Comment number 31.

    The term 'quality food' is emotive, does it reflect simply its taste and appearance or is it also related to nutritional value. Is menu planning to be a generalised choice or will specific individualised nutritional needs be addressed. Until the NHS places nutrition at the centre of its treatment protocols and until nutritional deficiency is seen as endemic within its patients any alteration is largely tinkering. Research firmly supports nutritional intervention as valid and efficacious, current medical practice largely dismisses its potential and overseas an ever increasing and largely untreatable range of chronic conditions. This is not simply a question of less chips and more cabbage, although that would be a start as would nutrition being placed at the centre of doctors training.

  • rate this
    +1

    Comment number 30.

    During my last hospital stay the only edible food was the salad. Even that was ruined one day when the catering staff put mashed potato and gravy on my salad, just because the server thought it did not look like enough food. Once I was mobile I ate in their restaurant where the food was good. It is prepared by the same company as the ward food. ...why the difference?

  • rate this
    +7

    Comment number 29.

    Hospitals do not need chefs, Celeb or otherwise, they need cooks who can cook and who are allowed to cook.

    I have spent time in hospital on three occasions over the last two years and each time the only cooked meal was in the evening, unless we count the two triangles of toast at breakfast, the rest of the food was wrapped in plastic or cardboard. Breakfast cereals, milk, fruit juice, jam and spread all came in their own wrapping as did the lunchtime sandwiches, ice-cream and fruit cocktail. These things are only cheap when compared to similar items in the shops, they are NOT cheap when compared to freshly made or in large packets, such as cereals. They are also an environmental disaster in their plastic overcoats.

    Unfortunately catering in hospitals is a Cinderella service shoved well out of the way, out of sight and out of mind.

  • rate this
    +3

    Comment number 28.

    Nutritionists and dieticians work in hospitals so why do they not enforce patient food requirements are met? Sufficient staff should be around at meal times to ensure people are able to feed themselves and, if not, give assistance. It's not rocket science!

    Also, and I know this may be controversial, but why can't NHS trusts form partnerships with FE colleges and offer placements to catering students which would be beneficial both ways - a paid placement to learn proper kitchen management and lower staff costs as it is a placement?

  • rate this
    +7

    Comment number 27.

    All very well getting advice from passing TV chefs, what hospitals need to do is to hire decent chefs to work in their kitchens. They ought to talk to the local FE college, most of which teach BTEC Catering courses, discuss their specialist requirements, contribute to the courses and get young eager chefs excited to work in the NHS.

  • rate this
    +6

    Comment number 26.

    I have to attend hospital once a year due to a long standing condition. My gratitude for the NHS in having saved my life twice is limitless but the food is so bad i take my own. It's not about 'celebrity' chefs, it's about spending the money where it's needed i.e not executive salaries.

  • rate this
    +8

    Comment number 25.

    I worked in 2 different hospitals in the 60s and 70s and they both had in-house chefs. Everything was "home made" and the food for both staff and patients was exactly the same stuff and delicious. In one of the hospitals they had a menu card on which patients ticked what they wanted to eat the next day and it was delivered on their own tray in a heated huge trolley thing. Hiving off catering, cleaning etc to the private sector has led to the current situation of starving patients and the rise of MRSA. Bring back matrons who used to do rounds of the wards and kept an eagle eye on everything that was happening in their hospital instead of silly managers who know nothing other than number crunching.

  • rate this
    +9

    Comment number 24.

    I thought hospitals appointed dieticians. I thought good nourishment was central to patient care. But then I also thought that hospitals were clean and staff were caring.
    I shall have to re-think, won't I?

  • rate this
    +1

    Comment number 23.

    Yet another £54m wasted, but as usual no-one will answer for their gross incompetence? This solution is simple really - MP's repeatedly alude to the fact that they don't get any special treatment, so on this basis, send all the parliamentary caterers from Westminster to the hospitals, using the same budget structure to CARE for the countries unwell? Gravadlax & Moet on the menu tomorrow, gran!

  • rate this
    +2

    Comment number 22.

    9. Little_Old_Me


    Please....




    stop........




    typing all your.....




    comments......





    like.....





    this.......





    It takes up screen space, and means we all have to scroll more than we would otherwise do to get the next ones. Thank you.

  • rate this
    +6

    Comment number 21.

    NHS hospital food is Dreadful. Only the toast is vaguely edible.

    Do any hospitals employ high quality chefs and decent kitchen staff like any good hotel?

    No they do not, they employ somebody with a lacklustre qualification from a non-descript catering college and hire some labourers to work steaming equipment.

    Everybody knows NHS hospital food is disgusting.

  • rate this
    +5

    Comment number 20.

    All very well celebrity chefs prancing about in hospital kitchens but once they leave its back to the same old slop. My father reckoned the food was better in Stalagluft IVB even without the Red Cross parcels.

  • rate this
    +3

    Comment number 19.

    And waste even more money on some pompous prat. AS number 18 says stop letting the NHS being ripped off, especially as the grub is absolute slop. It can hardly be called food. What about the nurses who just leave it to get cold too and God knows what else?

  • rate this
    +10

    Comment number 18.

    They have the same issues in other countries. Government organisations are charged tens or hundreds times as much as others for exactly the same product. Because it's tax payers money, nobody questions it. Get rid of these greedy profiteering cartels and then start talking about cuts and fancy (expensive) food.

  • rate this
    +3

    Comment number 17.

    First rate food needs first rate nursing to go with it. It's pointless leaving a meal with a patient who cannot sit up to eat it. It's wasteful to expect a patient to consume a full meal if they can barely manage a slice of toast. Nurses say they don't have the time for 'individual' care. Perhaps we should take the millions wasted and reinvest them in increased salaries and training and stop doing things on the cheap.

  • rate this
    +8

    Comment number 16.

    The NHS already employs people who are experts in food nutrition - they're called dieticians!!!! They've spent years at university studying but of course they aren't celebrities so they don't attract the attention.

    The fact remains the NHS sources their food from the cheapest providers - as it does with all it's services - so don't expect highly nutritious, appetising or healthy food - you get what you pay for!!!!

  • rate this
    +9

    Comment number 15.

    I'm all for improving standards but if you buy services via a reverse auction where the aim is to buy as cheaply as possible then quality and standards are going to suffer. If anyone has ever seen a reverse auction in operation then they will know what i mean and i know for a fact that services within the nhs are bought using this method, not everything to be fair but i've seen enough.

  • rate this
    -1

    Comment number 14.

    "Mend wounds with Madeira cake"

    Is this serious? I use honey as an antiseptic and saw the recent article about using granulated sugar to aid healing, but this does sound like an interesting new direction.

    Does the cake need to be a dry one to absorb moisture and aid clotting? Do I put the candied fruit on the wound first to place vitamins directly where needed?

 

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