Want to improve patient care? Let me propose toast

IT used to be a safe bet that when confined to a hospital bed, a patient could always rely on hot, buttered toast as – given the circumstances – manna from heaven. Not any more. That tiny, delicious privilege was prepared by nurses who saw it as part of their caring vocation. Now it has been snatched away by Health and Safety, which has banned the presence of electric toasters on wards.

Instead today’s toast, if you are foolish enough to request it on the menu card, comes from what can only be called a central depot outwith the actual building but responsible for all ward food inside it. The result is toast so tough you could tile a roof with it; toast which is utterly inedible even when dunked dispiritedly in a cup of tea.

Of course, to hospital managements this toast intolerance is a pesky consequence of the gourmet palate now residing within us all; something too fussy by half for a modern hospital which is, in effect, a conveyor belt factory. But the declining texture of hospital toast can be seen as symptomatic of everything that’s awful about food catering for the sick. It’s not just cancer patients who feel a tide of nausea rising inside them as the meal trolley trundles around the wards, its contents bussed in from God knows how many miles away.

One day, emboldened by steroids, I ordered mince and tatties, a mistake. The dish looked as if it had been cooked by someone who had heard of mince and tatties but never actually eaten any, the meat so glutinous it stuck to the fork, and the potato more lumpy than mashed. Some patients, as they do in Italy, rely on thoughtful family and friends to bring in flasks of soup, interesting salads, yoghurts and cake. But what of those single folk with no access to such nourishing kindness, the ones too weak or too wired up to bedside machines for any slippered shuffle towards the hospital’s franchised coffee shops?

Last week Sustain, the alliance of 89 organisations which lobbies for improved British food and farming, published its report, Campaign for Better Hospital Food. Although its research was trained on England, the general findings are not

Fresh, locally produced, nutritious food is essential for patients’ health

without relevance for anyone recently an in-patient in a major NHS hospital here. Among the most telling revelations: 67%of hospital staff gag at the very notion of eating the meals prepared for patients.

In fact, down south more than 82,000 hospital meals are rejected by patients every day and consigned to the bin. The report also shows that since 1992 there have been 21 national initiatives – many proposed by celebrity chefs – to improve the quality and presentation of hospital meals, and all, according to Sustain, have failed, hampered largely by a lack of political will at a cost of £54m to taxpayers. Yet even the most recalcitrant hospital manager must surely see that serving fresh, locally produced, nutritious food is essential for improving patients’ health, their morale and that of their families and staff. Any extra expense incurred would be offset by their speedier recovery and hospital release.

On the other hand, poorly presented, unappealing food only intensifies the lonely terror that grave illness dumps on sufferers. So, is it really asking too much to bring back the electric toaster, or reinstall efficient kitchens on site? The Orwellian grimness of the central depot kitchen might suit management numbercrunchers, but would they sit down and eat such industrially- produced slops and fodder?

Set against the NHS’s budget troubles, these trials might seem piffling, but they reflect the malaise afflicting care-provision nationwide. Patients, on the front-line of pain, spend hours observing how the cuts are falling most heavily on the likes of hospital porters, auxiliaries and medical secretaries, the very nuts and bolts in any hospital’s infrastructure. And while most patients have nothing but life-long gratitude for the medical skills and nursing attention they receive, they still can’t shift the suspicion that, for management, a patient’s messy complications – and a simple craving for hot buttered toast – have no business in our hospitals at all.