HOS­PI­TAL FOOD: ‘BY AND LARGE IT’S INED­I­BLE’

Hos­pi­tal food is set to im­prove with the an­nounce­ment of new poli­cies on choice and qual­ity. Not a mo­ment too soon, to judge by what pa­tients told ‘The Ir­ish Times’ this week

The Irish Times - Weekend Review - - NEWS REVIEW - Paul Cullen

That sta­ple of med­i­cal de­bate, hos­pi­tal food, is back on the menu af­ter the Min­is­ter for Health this week promised the early in­tro­duc­tion of new poli­cies fea­tur­ing bet­ter menu choice and greater flex­i­bil­ity for pa­tients.

Si­mon Har­ris says the poli­cies will en­sure pa­tients have ac­cess to reg­u­lar, good qual­ity meals and snacks, and get re­place­ment meals when needed. A re­newed em­pha­sis on nutri­tion is in­tended to put an end to the more egre­gious tales of soggy chips, rub­ber eggs and cold din­ners on hos­pi­tal wards.

And not a mo­ment too soon, to judge by the re­sponse from Ir­ish Times read­ers on the is­sue this week ( see panel). Too of­ten still, it seems, pa­tients are be­ing served bland, un­ap­petis­ing food, or they can’t get the food they want be­cause they’ve been out for a test, or have spe­cial di­etary needs that are not catered for.

“The food is by and large ined­i­ble,” says Laura, cur­rently re­cov­er­ing from surgery in an Ir­ish hos­pi­tal. “Din­ner at noon, smell is nau­se­at­ing, has been cooked hours be­fore­hand. Choice of dried fish or chicken with lumpy yet over­cooked veg. Dessert is high-sugar jelly and ice-cream.”

The good news is that change is afoot and, in some hos­pi­tals, im­prove­ments have al­ready been im­ple­mented. In 2014 The Ir­ish Times re­ported Leo Varad­kar, when he was Min­is­ter for Health, “declar­ing war” on bad hos­pi­tal food. This was shortly af­ter the Coombe ma­ter­nity hos­pi­tal was forced to in­tro­duce health­ier op­tions when a pa­tient posted an on­line pic­ture of a par­tic­u­larly sorry meal of sausage rolls and burnt potato wedges.

Di­eti­tian Mar­garet O’Neill was ap­pointed to lead the HSE’s na­tional ef­forts to im­prove stan­dards in the area and her ef­forts over the past four years will shortly bear fruit in the form of na­tional guide­lines on the qual­ity and nu­tri­tive value of hos­pi­tal food.

While some pa­tients may chafe at the qual­ity of food be­ing served at their hos­pi­tal bed, O’Neill says that 30 per cent of pa­tients come into hos­pi­tal in a mal­nour­ished state. “For many peo­ple, hos­pi­tal food will be health­ier than what they are eat­ing at home,” she points out. And it has to be. As a di­eti­tian, O’Neill knows her first task is to en­sure the food served in the 50 or so Ir­ish pub­lic hos­pi­tals is “nu­tri­tion­ally ad­e­quate” as well as be­ing tai­lored to the pa­tient’s spe­cific health needs. “It’s not the same as a restau­rant. Stan­dards have to be met in or­der to keep the pa­tient well fed in hos­pi­tal.”

Good taste

Few of us are likely to choose a restau­rant for a slap-up meal on the ba­sis of “nu­tri­tional ad­e­quacy” but O’Neill is cer­tain “it is pos­si­ble to pro­duce ther­a­peu­tic meals that taste good”.

The ques­tion is why that so of­ten fails to hap­pen. Gal­way chef JP McMa­hon puts fail­ures down to an “ab­sence of imag­i­na­tion and cre­ativ­ity”.

“There’s a mas­sive gap be­tween what they know should be served up and what is be­ing done,” he says, adding that hos­pi­tal food is too of­ten cooked “too high and too much”, caus­ing it to de­grade.

He says he doesn’t “buy” the var­i­ous ar­gu­ments put for­ward in de­fence of medi­ocre hos­pi­tal food – that the num­bers in­volved are large, or the dis­tances from kitchen to bed­side are con­sid­er­able, or the bud­get is lim­ited.

“Cost is be­ing used as a scape­goat for a lack of imag­i­na­tion. Modern kitchen tech­nol­ogy can be used to keep food moist. And cater­ers are used to keep­ing some types of food hot for a num­ber of hours with­out loss in qual­ity.”

McMa­hon, who is in the early stage of mak­ing a tele­vi­sion doc­u­men­tary on the is­sue, says he has on oc­ca­sion been forced to drop in food to pa­tients who were averse to the fare served in the lo­cal hos­pi­tals in Gal­way.

Based on the com­ments com­ing to his Twit­ter feed, though, he says some hos­pi­tals are do­ing a bet­ter job than oth­ers – Mayo, and the Ro­tunda and Beau­mont in Dublin, get favourable men­tions.

Per­haps un­sur­pris­ingly, pri­vate hos­pi­tals get con­sis­tently good feed­back from pa­tients. Cathal Ka­vanagh, ex­ec­u­tive chef at the Black­rock Clinic, says the qual­ity of his food is “all about the sys­tem” but also in­volves “a bit of thought”.

In the hos­pi­tal, food is served “a la carte”. “It’s cooked for and served di­rectly to the pa­tients, with al­most no re­heat­ing,” he ex­plains.

It was his fa­ther’s ex­pe­ri­ence of “bland, unimag­i­na­tive” hos­pi­tal food that prompted Ka­vanagh to com­plete a masters in culi­nary nutri­tion and to switch to the hos­pi­tal sec­tor. “Peo­ple should be able to look for­ward to their meals, even in hos­pi­tal when there is so lit­tle else to brighten the day.”

Tim­ing is an­other key el­e­ment in get­ting the right food to the right pa­tient at the right time, he says, and “it is as easy to use fresh pro­duce as frozen”.

A pa­tient’s ex­pe­ri­ence of a hos­pi­tal stay may be de­fined, or at least heav­ily marked, by the qual­ity of food. “The qual­ity of hospi- tal stay is of­ten bench­marked against the food the pa­tient eats,” O’Neill agrees.

And although pub­lic pa­tients, and pa­tients with health in­sur­ance in pub­lic hos­pi­tals, may not be pay­ing di­rectly for their hos­pi­tal stay, this will sel­dom cost (the tax­payer or health in­surer) less than ¤1,000 a night. It does not seem un­rea­son­able to ex­pect some palat­able food to be served dur­ing this time.

There’s a cost too, for the hos­pi­tal, as O’Neill points out – badly nour­ished pa­tients spend longer re­cov­er­ing in hos­pi­tal and there­fore cost more.

The pub­lic hos­pi­tals in the State use a va­ri­ety of ar­range­ments to de­liver food to pa­tient bed­sides. Some use cook/chill meth­ods – sim­i­lar to the hot meals served on an air­plane. This is ef­fec­tive in de­liv­er­ing food hot but en­tails greater waste if a pa­tient misses a meal as the food can­not be re­heated.

Pro­tected meal times

Other hos­pi­tals rely on cook/ fresh, can­teen-style de­liv­ery. Mean­while, some hos­pi­tals do their own cook­ing and food sup­ply while oth­ers de­pend on the ser­vices of large cor­po­rate cater­ers.

The task for O’Neill and her team is to im­pose some uni­for­mity on these di­verse ar­range­ments that sat­is­fies pa­tient tastes and nu­tri­tional needs. They also have to take ac­count for an in­creas­ingly di­verse pop­u­la­tion and the vary­ing re­quire­ments of dif­fer­ent age groups – which could be boiled down sim­plis­ti­cally to meat and two veg for older pa­tients and “health­ier” op­tions for younger groups.

Steer­ing groups have been set up in each hos­pi­tal and im­prove­ments have al­ready been in­tro­duced.

In one hos­pi­tal, for ex­am­ple, it was found that the soup be­ing served as a nu­tri­tious starter at lunchtime was ru­in­ing pa­tients’ ap­petite for the main course. As a re­sult, the soup is now be­ing served ear­lier in the morn­ing.

In Mayo hos­pi­tal, pro­tected meal times have been es­tab­lished so that pa­tients can fo­cus on their eat­ing with­out dis­rup­tion from ward rounds.

Fur­ther work will fo­cus on the nutri­tion needs of two other groups fre­quent­ing hos­pi­tals – the staff and the vis­i­tors.

‘‘ The Coombe ma­ter­nity hos­pi­tal was forced to in­tro­duce health­ier op­tions when a pa­tient posted an on­line pic­ture of a par­tic­u­larly sorry meal of sausage rolls and burnt potato wedges

A pa­tient’s ex­pe­ri­ence of a hos­pi­tal stay may be de­fined, or at least heav­ily marked, by the qual­ity of food. The good news is that change is afoot and, in some hos­pi­tals, im­prove­ments have al­ready been im­ple­mented.

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