Eat well, get well

Hurrah! Just when we've been labelled a nation of fatties, a nutritionist has reminded us that sticky toffee pudding or chocolate-chip sponge is often just what the doctor ordered.

Well, for some of us, anyway. Sue Baic, nutritionist for cook-freeze food supplier Apetito, says that hospital caterers should always remember to include high-energy dishes on their menus, because seriously ill or undernourished patients need energy-laden foods to help them recover.

"The perception of hospital food is that it should be healthy, but it is about meeting a range of needs," says Baic. "At one end, you have those who need low-fat or special diets, and at the other, there is a high proportion of people who are undernourished."

Concern over malnourished patients was triggered a few years ago, but the problem hasn't gone away. Figures published last year by BAPEN (British Association of Parenteral and Enteral Nutrition) confirmed that as many as 40% of adults admitted to hospital are malnourished. They don't respond well to treatment and can take much longer to recover. Experts say that if malnutrition was tackled, the NHS would save £226m a year.

Combating malnutrition is one of Baic's crusades. She codes all the dishes that are suitable for undernourished patients. Sausage hotpot or steak and kidney pie, for instance, have 500 calories per portion when served with potato and vegetables. Desserts with custard add 300 calories, so one meal provides 40% of daily requirements. "Traditional healthy-eating requirements do not apply to many hospitalised patients," Baic says.

At the other end of the scale is the much-publicised problem of obesity. Baic reckons that the least caterers can do is give patients the right message about healthy eating, so she has developed low-fat sweet-and-sour chicken and various fish dishes. "You can put [these patients] on a low-fat diet but they really need a lifestyle change," she says.

Her current priority is to create about 25 dishes with 20% less salt, to help prevent heart problems. So far, she has cut salt in dishes such as breaded chicken without affecting taste.

Many of these nutritional developments came from the Better Hospital Food programme, set up in 2000. So, how does Baic reckon it is working?

"Housekeeping services, 24-hour delivery and snack boxes are all really good," she says. "It's important that caterers continue to improve overall service to ensure there is plenty of choice and that the food is tasty, hot, familiar and well-served."

Protected mealtimes
Nutrition isn't just about giving patients the right food, it's about making sure they eat it. No wonder, then, that the move towards protected mealtimes is gathering pace. This is where patients are allotted an hour to eat their meals, safe in the knowledge that they won't be bundled off for an X-ray or have any other medical interruption.

Alison McCree, associate director of estates and facilities for County Durham and Darlington Acute Hospitals NHS Trust, is a staunch supporter of protected mealtimes. She was one of the first caterers to trial it in her eight NHS hospitals, about 12 months ago. Six have so far introduced it, and she believes more hospitals would benefit from adopting the scheme.

So what are the benefits? It's not a scheme that will make caterers rich quick, but it does have huge implications for the patient. Not only do they get time to eat and digest their food properly, thus improving nutritional intake, the fact that they are not being interrupted during meals means less food is wasted.

"I think that protected mealtimes will make a difference," says McCree. "In the past, food often didn't reach patients' mouths for various reasons. This will help - but there is still a long way to go."

Feeding children Mike Pearson, catering services manager at the Royal Cornwall Hospital in Truro, Cornwall, feeds about 70 children a day on a budget similar to that for adults - about £2.30.

He works closely with the hospital dietitians when devising new menus, a relationship that he says has improved immensely since the Better Hospital Food programme was introduced in 2000. "It meant we had to sit down and talk, and since then we have had more regular meetings," he says.

There is also the Nutrition Action Group, comprising former patients, patients, dietitians, nurses and caterers who meet to discuss how catering and service are developing and how they can be constantly improved.

Pearson reckons that one of the most difficult dietary problems to deal with is obesity in children. He is devising menus with less fat, but says that, if children are admitted for only a short time, the best he can do is to educate them about good eating habits. To that end, he has also linked up with local producers and schools.

Such education works both ways. Many patients on children's wards are in fact teenagers and, recognising that 12- to 16-year-olds have different tastes, Pearson has now introduced a young adults' menu. This arrives on a separate trolley, so the older children no longer have to take pot luck after the youngsters are fed.

Not all nutritional solutions are directly related to food, particularly when it comes to dietary requirements. Children with, say, cystic fibrosis need a quick sugar intake, so Pearson has adopted the voucher system to allow them to graze in the canteen. "They have to act in a responsible manner, because they are leaving the ward, but we know who they are when they come down," he says.

Others need help. This is where the Better Hospital Food's ward housekeeper system is crucial. Ward staff are briefed to make sure children eat well and to find out what might tempt those who aren't eating. Pearson's team will then try to accommodate them.

"Children can be very disorientated or scared in hospital, so we need to talk to them," he says. "Equally, sometimes long-stay patients get bored, so they will discuss a new menu."

What next? Top of Pearson's wish list would be the funds to use local organic produce. Unfortunately, a trial week producing just one organic meal for 800 patients a day cost an extra £700.

"We can always improve," he says. "We need to keep revisiting the children's scenario. We could do more, but there are budget, time and staff constraints."

Going private Robert Koppens, general manager for independent caterer Bartlett Mitchell, says it has been hard understanding the role of food in his current job. "I have a catering background, where food is nice," he says, "but here, food is a medicine rather than pleasurable."

That's because he is overseeing the catering at a private clinic in Roehampton, London, which treats people with alcohol, drug and sex addiction as well as eating disorders.

For budgetary and logistical reasons, all his menus have to be based on the needs of the eating-disorder patients. These patients, mostly women, have a highly developed memory for food, so although the menu is on a four-week cycle, all the dishes have to look the same as in the previous month. This means weighing and measuring everything, down to the last baked bean.

"If, four weeks ago, they had roast beef with carrots that were two inches long, and two potatoes, then it must look identical the next time or they won't eat it," explains Koppens.

This throws up countless problems. Not only do all dishes have to be photographed and copied, it also means Koppens can't vary the menu to take advantage of, say, suppliers' cut-price offers. "We need to take 20 extra steps because of the mental approach patients have to food," says Koppens.

Over in the main hospital, he has to tweak the menus slightly to ensure that dishes have high flavour. This is because addicts who are recovering their sense of taste need lots of variation. "We've even got oxtail on the menu - bet there aren't many hospitals that do that," he says.

He can't divulge his budget but, needless to say, it is considerably higher than in an NHS hospital. Variables can make a dent in it, though. For instance, he has to buy in kosher food for Jewish patients. More specifically, as most eating-disorder patients are checked in for a year, he has to keep the same produce throughout the seasons, regardless of price - and that includes strawberries.