So last night's Dispatches was an undercover expose of hospital food. *Sigh* Another one.
Tonight, I believe we are to be treated to Heston Blumenthal's treatment of the subject. *Sigh*
Back in 2000 the famous-chef-person was Lloyd Grossman. The exposes found - you'll never believe it - that you wouldn't feed hospital food to your dog.
No doubt back in the 50s, someone tried to enlist Fanny Cradock to improve standards after some clipped-voice BBC reporter got served gruel for a few weeks as an in-patient suffering from rickets or something.
How many exposes do there need to be? Why do we never listen? More to the point, why don't politicians and hospital managers see why it matters?
:Last night's programme pointed out that this was part of wider failings in patient care. The same ward that leaves a patient lying in their own filth for hours on end is unlikely to hold a fork or cup to make sure a patient gets to eat. The same hospital that covers up the failings of an incompetent surgeon is unlikely to care whether or not the custard is hot.
Oh, I remember all too well the "beef crumble" and "grey-gristle pie" (unidentified meat) of the mid 90s! Who's ever eaten beef crumble for goodness sake? Many patient's are elderly and it goes without saying that all are ill - appetites are unlikely to be huge and often patients are too frail to feed themselves. Did you know that it uses calories to be ill too? Infections munch up calories like an hour in the gym and post surgically, a patient can literally need thousands of extra calories just to not lose weight as the body goes into overdrive to heal itself.
But there is hope!! It can change and change very effectively. My hospital, Addenbrookes really embraced the 2000 food revolution. It took a few years, but eventually, the effects filtered onto the wards. The food is now somewhere on the spectrum between good - excellent and this is how they did it :
1) In the 90s, hospital catering was largely outsourced and quality had been endlessly squeezed to make room for profit. What's more, food was often prepared elsewhere and simply re-heated on site. Addenbrookes fired up the dormant kitchens, and bought it back in-house.
2) Real Menus - Every patient gets a glossy menu at the beginning of their stay with 3 or 4 daily choices at each meal. Every morning, the patient chooses what they'd like for the next day, cutting down on waste. The options come up on heated trolleys and there is always room to change your order or even go back for seconds.
3) Quality of ingredients - A "vegetable" had previously only ever been soggy and pre-frozen, now they're the right colour - carrots are buttery with a little parsley, beans crunchy and sprouts fresh. Salads sprang into life and are always available as a side dish. Meat turned into real meat and you could find plenty of it lurking under a crispy puff pastry pie crust or fluffy dumpling. Mashed potato is made from potatoes (a little lumpy, but "real" at least) Deserts are yummy - fluffy sponge puddings and homely apple pie.
There is always a cold option that can't spoil if you need to wait a while to eat it - maybe smoked mackerel or cold meats. My personal favourite is cold poached salmon with a fresh cucumber and coriander salsa.
4) 24 Hour menus - This is the most important innovation of all. If you found yourself a long term in-patient, you used to miss meals all the time. Most days you are wheeled off for a scan or procedure and by the time you get back you've missed lunch and maybe even dinner too. You might have been nil-by-mouth the night before and could very often go 24 hours or more without getting a thing to eat. It's not hard to see how after a week or two of this malnutrition started to beckon.
Now, Addenbrookes always has sandwiches, cheese and biscuits or soup available on the ward out of mealtimes and they introduced a 24 hour menu, always available if a patient feels a bit peckish. You simply ask the nurse and within half an hour or so a hot or cold meal option is sent up from the kitchens.
5) Snacks and encouragement - patients are now offered a little treat with the tea rounds - maybe a muffin or a jam tart. Biscuits are always offered and the staff serving the food are helpful and concerned. They encourage and cajole, they tempt patients to munch on a calorie or two wherever possible. They notice which patients aren't eating and support them as much as they can.
6) Special menus - All special diets are catered for - diabetic, low fibre for bowel disease, low fat for weight loss, high calorie for weight gain. Patient's with special dietary needs get a separate menu that simply goes in with all the other orders.
7) Protected meal times - Lunch and dinner times are now protected. In practise this doesn't always work, but there is at least an attempt to keep doctors rounds or visitors away. Staff are a little more able to find time to help weak patients feed themselves and meals don't congeal uneaten as endless phlebotomists and physios interrupt them.
8) Finally, it must have taken real commitment. Financial, sure, but also at every level of patient care. There must have been excellent training to ensure that all staff realised the importance of nutrition to patient care. From the catering staff to the medical staff to the managers, all must have been brought on board and inspired to change attitudes. That is the part that is hardest to achieve and Addenbrookes appear to have achieved it very successfully. Asking for a cup of tea or a slice of toast no longer feels like you are being demanding - in fact it's encouraged - the most important distinction of all.
The BIG question is, did it cost money? I imagine not. The improvement to patient moral and nutrition would have shortened hospital stays, reduced re-admissions from malnutrition and infection and reduced waste. I've always been convinced that spending a little more on food would save tens of thousands elsewhere. Even if it did cost a few pence more per patient, it was a few pence well spent if the health of patients benefited - surely that's what the NHS is there to do?
This debate is never more relevant than now. "Efficiency savings" will always start with catering and coalition plans to outsource and privatise almost everything in the NHS mean that old profit-demon will start to munch away at quality all over again. It's not too late for hospitals like Addenbrookes to roll out a national scheme using their experiences to get things right - but it will be soon.