Mention the phrase ‘hospital food’ to most people and the response is likely to be one of displeasure, with the belief that these mass-produced meals are procured at a pretty measly cost per patient per day. I was rather surprised, therefore, to read in a report by Hall (2019), that the Government has called upon the NHS to reduce spending on food and drink, in particular breakfast products, where it is believed that savings could total £420 000 a year on this meal alone. The Government has claimed that hospital trusts could get much better deals on breakfast items without compromising quality and has encouraged hospitals to sign up to a new deal that plans to save hospitals thousands of pounds on catering services. The ‘Breakfast Savings Initiative’ aims to reduce the variation in prices paid by different trusts and currently has 19 trusts participating.
The quality of our hospital food is one of the areas that my Trust has committed to improve, based on feedback both from formal complaints, and via the Care Quality Commission (CQC) inpatient survey. I have recently asked myself whether the view that hospital food is not expected to be of a high quality has become normalised.
The CQC's regulation 14 (2014), which is governed by the Health and Social Care Act 2008, aims to ensure that people who use our services have adequate nutrition and hydration to sustain life and good health, and reduce the risks of malnutrition and dehydration while they receive care and treatment. In order to meet this requirement, the regulation states that we must make sure that people have enough to eat and drink to meet their nutrition and hydration needs. It also stipulates that our patients must receive the support they need to do so. In order to achieve this, we must assess our patient's nutritional needs and ensure that food is provided to meet those needs; this includes patients who are prescribed nutritional supplements and/or parenteral nutrition. In addition, we must also ensure that our patients' preferences, and religious and cultural backgrounds are taken into account when providing food and drink. If we are found in breach of this regulation, the consequences can be serious.
Green (2019) provides a fascinating look back over the history of hospital food, starting in the pre-NHS 1920s, where patients were offered a ‘spleen diet’ —‘pulp scraped from the fibrous part of the spleen, tossed in oatmeal and fried’.
Green reports that, even as early as 1945, complaints about hospital food were being voiced, citing a booklet by The King's Fund in 1945, claiming that it was ‘not surprising’ that, given wartime restrictions on food supplies, ‘the public speak with bitterness of the food’ in some hospitals.
Green also cites the work of Dr Jennifer Crane, who has been studying food in the NHS for the past 3 years. A summary of her findings walks us through a very interesting review of progress, or lack of it.
Overall, Crane reflects that, while hospital cuisine has never been the most nutritious or of the finest quality, people's expectations of NHS food were probably lower in the past than they are today. However, Crane identified that the pressure on the NHS to provide food has always been great, with the average inpatient in the service's early years staying in hospital for weeks at a time rather than days, as is the case now.
Crane's research has found the following:
This has made me reflect that a national approach to the issue of the provision of hospital food is the way forward. If the NHS as a whole can both apply the learning from previous multiple reviews and procure the best quality food at the right price to reduce the variation and improve quality across NHS organisations, then we could improve the overall experience for our patients, and ensure that we meet the required regulatory standards.
I will be advising my colleagues that we sign up to the ‘Breakfast Savings Initiative’ followed, I would hope, by the lunch and tea initiative!