Do hospitals cater for patients with special diets?
Criticising hospital food is a British pastime. But what if you have a special dietary need, which is a necessity rather than a choice? Does hospital food cater for you?
Kathleen, 74, who lives in the Midlands, has had coeliac disease since she was about four years old. This means she cannot eat anything containing gluten, such as bread, cereals, pasta and cake. Even things like soups, sauces and sausages can be off limits.
When she was in hospital a few years ago, she was shocked by the food she was served.
"I was offered toast, but I can't eat that. I need gluten-free bread. They didn't have the porridge oats which I can eat, so I ended up with a boiled egg."
And the subsequent meals did not improve either, despite the fact Kathleen had confirmed she was coeliac when she was first admitted.
"Lunch was fish fingers, which I couldn't eat because of the breadcrumbs. They asked me why I couldn't just pick them off.
"At dinner time they put gravy on my dinner and a Yorkshire pudding on the plate too. Because of the contamination risk, I couldn't eat any of it."
Kathleen is not just being fussy. She, like one in 100 people in the UK, cannot take gluten because it causes damage to the gut lining and triggers a reaction that makes the body's immune system attack its own tissues. This can lead to abdominal pain, chronic diarrhoea and nausea, although the symptoms can vary from person to person.
Even one breadcrumb can be enough to contaminate a whole plate of food.
"It was frustrating. In hospital I was supposed to be in a place full of medical experts - and yet there was this ignorance."
Across the country, hospitals' catering systems can differ significantly and the quality of the caterers can too. This means there is no standard approach to dealing with particular dietary needs.
Staff on the wards cannot be presumed to have heard of gluten-free diets and intolerances, or understand the consequences of eating the "wrong" things.
Even some hospital dieticians may not have the knowledge required to deal with particular diets.
Eileen Steinbock, from the British Dietetic Association's Food Counts group, which has looked at improving nutrition in hospitals, says what matters most is communication between caterers, dieticians and staff on the wards.
"It's like a golden triangle. If it's not working well, then they can't advise each other on what to cook, what food is suitable and what to serve."
The process should start when the patient is admitted, she says.
"There should be a protocol of what to do when someone on a special diet comes in. And when menus are planned, those diets should be thought about."
When a patient who is coeliac has a planned hospital admission, then it is easier to deal with their food needs than a patient who is admitted in an emergency. Often, their access to gluten-free food relies on the hospital caterers having a range of appropriate foods stored in a cupboard or freezer.
Ms Steinbock encourages patients to communicate their needs too.
"If a patient doesn't feel they are getting what they should be, they can always ask to see a dietician and speak to the caterers. They will be happy to come and talk to them."
Hospitals do not have a dietician on every ward all the time, so getting the message through can take a bit of perseverance.
To try to improve the situation, the charity Coeliac UK has recently launched some training courses for caterers to help those working in kitchens in hospitals, care homes and big companies understand the dietary needs of a coeliac.
Sarah Sleet, chief executive of Coeliac UK, says hospital caterers became worried about labelling their food gluten-free after stricter criteria were introduced in January.
In turn, this led to more complaints from coeliac patients that they could not access gluten-free food. She says this is being solved thanks to a new policy that is now in place.
"All coeliacs have a right to have a gluten-free meal provided - it's a core part of your health. Not providing it is equivalent to denying someone their drugs - it's not a choice to be coeliac."
Ms Sleet does recognise, however, that catering for all special dietary needs is a complex problem to address. As a result, the charity has worked with the Hospital Caterers Association to come up with advice and guidance.
While some hospital caterers provide excellent catering for patients with particular diets, some still have a way to go before patients like Kathleen can rest easy in their hospital beds.
"Going into hospital is a stressful experience anyway," says Ms Sleet.
"It's even more worrying if the food in front of you is damaging - and not eating is not good for anyone's recovery."