The changing shape of hospital food

The image of hospitals with large kitchens and brigades of chefs cooking the food for the day from basic ingredients may no longer be the case for many of hospitals. But in today’s NHS, caterers have to provide for a complex range of dietary requirements and tastes as well as meet demands for a more cost effective service.

What we eat
The way that people now eat has changed significantly over the last 20 years. The issue of food has also risen to the top of the political agenda over the last few years as unhealthy lifestyles increasingly cause ill-health.
    
Last August, Age Concern published a report - entitled Hungry in Hospital - raising concerns about hospital and care home food services as well as associated problems to the NHS. Since then the Department of Health has taken up the challenge of improving services as part of the Dignity and Respect Agenda.
    
Data from a 2006 in-patients survey of older people by the Healthcare Commission showed that while care has improved when compared to 2005, there is still a long way to go. As many as one in eight elderly patients still say that hospital food is poor and more than one in five 75-84 year olds said that they did not get sufficient help and assistance with eating and drinking.

10 key characteristics
Recently, the Council of Europe Alliance (UK) launched its 10 Key Characteristics of Good Nutritional Care – a distillation of over 100 recommendations made in a 2003 EU Resolution. The Council of Europe Alliance was established by the British Dietetic Association (BDA) and the Hospital Caterers Association to implement the recommendations on food and nutritional care made by the Council of Europe.
    
The 10 Key Characteristics aim to communicate what good care looks like to all professions at the bedside and in the boardroom. It stresses the importance of nutritional screening on admission to hospital.
    
Other recommendations include the implementation of protected mealtimes, to ensure patients get the assistance they need to eat and enjoy their food, nutritional care plans that identify patients’ individual needs and the inclusion of specific guidance on food services in hospitals’ Clinical Governance arrangements.
    
Nutritional care is important because patients’ basic need for nourishing food and water must be met. All hospital treatments are less effective for patients who are malnourished or dehydrated; furthermore, such patients will have a reduced immunity to hospital acquired infection.
    
Dietitians have an important role to play. They are the experts in applying nutritional science to the care situation and can help ensure that food and beverage services are ‘fit for purpose’ and are capable of delivering adequate nutrition and hydration.

Catering for all walks of life
A major challenge facing today’s hospital caterers is the wide range of different people that hospital menus now need to please. Centralisation of hospital services to large sites covering wide geographical areas; an increase in the number of different nationalities that have now settled within the UK; and the increasing age of the population have significantly changed the demographics. This has meant that the population any one hospital has to serve now contains a complex range of people of differing ages, social and ethnic backgrounds, and hence nutritional and food needs.
    
These factors make knowledge of the population to be served extremely important. Menu planning needs to involve a whole range of disciplines including caterers, dietitians, nurses, members of the public and religious leaders. One of the core roles of a registered dietitian is the ability to understand these nutritional and cultural needs and help catering colleagues in the menu planning process.

Special dietary needs
This is also complicated by the need for a wide range of therapeutic diets.
    
A number of conditions and diseases require dietary manipulation as a core part of treatment. These ‘special’ diets need to be available within hospitals and also be able to meet the same wide range of age and cultural needs.
    
There are a wide variety of different ways that these diets are produced. This depends upon the catering system within the hospital and the patient group/range of special diets required. To help, menus have simple dietary codes so patients can make appropriate choices from the main menu for common diets or there may be separate menus available for more complex diets e.g. gluten free, renal or modified consistency menus.
    
Catering staff need to be supported in understanding the complexities of continually changing dietary treatments and the translation of new regimes into practical food choices. Dietitians are able to provide this expertise and it is therefore essential that these two professions work closely together in the process of menu planning.

Catering logistics
A range of pressures such as the need for clinical space, the costs of refurbishment and maintenance of large kitchens has also led many hospitals to look outside to providers of prepared food. Additionally, new hospitals have purpose built catering facilities for receipt and regeneration of prepared food. This generally means that food is reheated close to the ward service points, in trolleys or static ovens within ward kitchens to make sure food is served at the right temperature.
    
Some trusts offer central production units, from which they are able to supply their own and sometimes other hospitals. This food is most frequently prepared in advance, up to five days ahead of consumption, then held and distributed at chilled temperatures to the point of regeneration.
    
Chilled food can also be purchased from outside manufacturers ready for the caterers in the hospital to regenerate and serve to patients. For all chilled food production is to a schedule, generally to accommodate seven days of food within five days of production.

Complete meals
Frozen food is also supplied to many hospitals in the form of complete meals. This has the advantage of retaining nutrients during rapid freezing and frozen storage. Menu planners are less restricted using frozen food as the complete range would be available at all times so that local needs can be met, and if necessary some menu variations within a trust can be created to meet the needs of older patients or maternity wards which could be very different.
    
Trusts need to consider their own requirements when contracting for the supply of prepared foods, their own facilities and the needs of the very different patients that attend hospital care. Dietitians need to be involved in the contracting process as they will be part of the menu planning team and will need to be able to provide for both special diets and the needs of all the local population from the food purchased.

For more information
Web: www.bda.uk.com