Medical drama

A study into hospital catering which resulted in a report criticising hospital food had 16 working party members, none of whom was a hospital caterer. That, says Hospital Caterers Association (HCA) national secretary Sandra Roberts, is wrong.

"How can they understand the practicality of catering issues if they haven't talked to us?" she says. "This is a report by clinicians and academics, and while it makes some good points, wouldn't it have been better to have had a working hospital caterer on the study group? That way, they could have got answers to some of the questions they raised before writing the report. Why didn't they work with us in this study?"

Hospital Food As Treatment (Caterer, 17 June, page 6) looked at areas such as cooking and food delivery systems, food serving and menu writing as well as nutrition. It was produced by the British Association for Parenteral and Enteral Nutrition (BAPEN), a clinical nutrition study group.

While the report does say it is not intended to be a criticism of hospital caterers, it has some sharp arrows. It says that up to 50% of hospital food is wasted, 40% of patients are malnourished on admission and most continue losing weight while in hospital, and many patients are not getting the recommended minimum nutritional intake.

Roberts says these are sweeping, headline statements that paint a far darker picture than exists in healthcare feeding. "Hospital catering has progressed enormously in the past two years with the introduction of the Patients' Charter," she says. "It's almost as if they were looking at the hospital catering of five years ago. Changes called for in the report are now in widespread practice."

Editor of the report, Dr Simon Allison, a consultant at Queen's Medical Centre, Nottingham, says caterers were represented on the working party by Professor John Edwards from Bournemouth University, who is a professor of catering management. Edwards told Caterer that although he was now an academic, he had a catering background. "I was 25 years in the Army Catering Corps. I know about catering."

Allison adds that while having a working hospital caterer in the study group might have been helpful, that caterer could only represent his or her own hospital. "This was a working party from a clinical society," he says. Roberts stands by her belief that the report would have benefited from direct input by somebody from the HCA.

Having gone through the report line by line, Roberts points out examples of where it is out of step with the majority of today's hospital catering and offers answers to some of the questions raised.

One of the most damning points in the report is the claim that there is up to 50% food wastage in hospital catering. Bulk service at ward level, where food is portioned out from serving dishes, can be wasteful, admits Roberts, but that is part of giving the patient a better choice. She points out that at North Staffordshire Hospital, where she is catering manager, bulk service is operated on a lot of wards and patients choose their meal at the point of delivery.

"If you are going to deliver that level of service you are bound to have a higher level of food waste than a plated service," she says. "But we are as low as 5% waste on plated meals. Managing food waste is now a key issue for hospital caterers. I would guess most have got it down in the past two years."

Roberts is bemused at the report's claim of poor menu description, not accounting for language difficulties or cultural needs. "Most hospitals would have some information that meets cultural needs where necessary," she says. "If you get only a few patients from a different cultural background it doesn't make sense to print menus in foreign languages, but hospitals with high ethnic communities offer food and language the patients understand. What we do here at North Staffordshire is offer both options, talking to patients when they are admitted to find out the type of food they want."

Equally puzzling to her is the claim that patients who prefer to graze rather than have full meals are not always accommodated and that patients sometimes have to go 12 hours between their evening meal and breakfast. "Most hospitals do offer snacks," she says. "There's always tea and biscuits available, and hospitals offer a hot drink and biscuits at bedtime. It's a matter of communication."

Malnutrition in new patients is one area where Roberts is at one with the report. "It is a problem and it isn't always visible, although a number of trusts are nutritionally assessing patients," she says. "I'd like to see every patient nutritionally screened by medical staff on admittance so we can provide the correct meals as needed. But that would cost a lot of money."

As half the report's working group came from a clinical dietetics background, it is hardly surprising that one of the recommendations is that the chief hospital dietician should have executive control over the catering department. No more surprising is that, wearing her HCA hat, Roberts thinks partnership between the catering and dietetics department is the more sensible option.

Co-operation is Roberts's final thought. "Reports like this are useful, but nothing can be better than the day-to-day co-operation between catering, dietetic and nursing staff," she says. "We should be working with each other, not just in day-to-day operations but when one of us decides to report on an area that involves us all."