Healthy obsessions
When delegates arrive in Brighton next week for the annual Hospital Caterers Association (HCA) conference, there will be many catering issues on their minds - such as how to move the Better Hospital Food programme forward, the question of whether patients should pay for their food, and the logistics of implementing a protected mealtimes policy.
These issues will be thrashed out over the two-day conference, during which time delegates will doubtless have the opportunity to discuss other issues, such as catering in the new Private Finance Initiative (PFI) hospitals.
Under PFI, of course, the NHS trusts look after all medical services, while everything else, from portering and maintenance to catering, is looked after either by a consortium of companies or by a facilities management firm. As well as easing the trust's maintenance worries, these operators have the chance, in the new hospitals, to rethink space and include increasingly profitable retail outlets.
However, not everyone likes the idea that some PFI hospitals are clawing back space by doing away with kitchens, relying instead on chilled meals being shipped in and regenerated.
John Hughes, catering manager at Nottingham City Hospital, is grateful for his £850,000, state-of-the-art kitchen, and argues that those who work in most new PFI hospitals will not have the flexibility of a caterer with a big kitchen.
"They will put in a delivered meal service," he says. "It's a trend, but it is capital-focused, not patient-focused. If there are no kitchens, you can't give Mrs Jones beans on toast if she wants it. There are better ways to feed people, and we need to get that side right."
Not everyone agrees. Iain Anderson, managing director of Sodexho Healthcare, says that cook-chill is exactly the way hospital catering should go. Budgets vary across trusts from £2.70 to £3.80 per patient per day, including labour, and Anderson estimates that, under the delivered-meals system, food purchasing might be more expensive but labour will be cheaper.
"The benefits for the hospital are that clinical space is freed," Anderson says, "and the benefits for us are that we will be able to provide consistent quality and standards of service. The way we see it, we will have a lot of control."
One area of control is maintenance. Anderson points out that, in old hospital kitchens, the equipment can be 30 years old or more, and needs constant attention. New-build PFI hospitals present an opportunity for today's multi-service contractors to get involved in design and materials. "It's important to get good floor coverings, for instance, with a 30-year contract," Anderson says.
One other issue on Anderson's mind will be the question of whether patients should pay for their meals. He will be involved in the debate on this, but fears that caterers will have little influence over the Government's decision.
"It's a loose question, as we don't know what it covers," he says. "It might be extremely complicated to administrate. Our response, as a contractor, is to ensure quality of food. My personal view is that patients shouldn't have to pay - it's more about national insurance."
What Anderson would like to see is an all-round improvement in non-clinical patient care. "I would like to see the ambience around patients change," he says. "Not just food, but also cutlery and crockery and enhanced service."
He acknowledges that the pressure on hospital caterers is increasing. For instance, NHS trust directors now want to deal with just one contractor, which means that caterers are not merely competing against each other, but against builders or facility management companies. Sodexho regularly offers as many as 10 different services in a hospital, ranging from catering to grounds maintenance.
The solution has been for Sodexho to work more closely with trusts. At North Devon Trust, for instance, it has set up a joint board partnership, which Anderson describes as a major step forward in monitoring the contract and agreeing changes and ways to work together. "Clients are looking for innovation," he says. "They want something different."
The hotel
Where: Nottingham City Hospital
What: 50-bed hotel
Caterer: in-house
John Hughes, catering manager at the 1,000-bed Nottingham City Hospital, has been running a 50-bedroom hotel with a 40-seat licensed restaurant on the top floor of the maternity wing for the past four years. While it isn't new, it is still unique, though Hughes reckons it's a growing trend.
"There are not many in the country," he says. "It was always a far-reaching concept, and we are only just getting to grips with it. We will see more in hospital sites. It makes commercial sense."
He has no plans, however, to increase the number of rooms at his hotel. He's content with an average occupancy of 75% and income for the NHS trust of about £300,000 a year. Rooms sell at £49 a night, and a two-course meal is about £5.60 without wine.
Guests include people who have travelled to visit sick relatives, or chemotherapy patients who need somewhere to recuperate after treatment but are not ill enough to need a clinical bed.
The financial benefits are thus twofold. First, of course, the hotel and restaurant bring in revenue. Second, the hotel can make savings by offering an alternative to convalescents other than a hospital bed.
On the other hand, concedes Hughes, profitability is reduced by the fact the receptionists have to be qualified nurses, who are on duty 24 hours a day.
Palmtop ordering
Where: Darlington Memorial Hospital
What: hand-held computer ordering system
Number of hospital beds: 440
Caterer: in-house
The catering team at Darlington Memorial Hospital is on the brink of introducing a palmtop menu ordering system, thought to be the country's first.
It's the brainchild of Ron McKenzie, head of catering and housekeeping for County Durham and Darlington Acute Hospital Trust, who approached software company Support Services Solution with his idea. "Other companies have looked at it, but we are the only ones who have got this far ahead," says McKenzie.
Before every meal, a ward hostess visits each patient, discusses the menu and taps the order into the hand-held device. The information is held on a flash memory card, taken to the kitchens and downloaded to a computer. This means that all meals can be cooked to order.
With the old point-of-service method, a trolley was wheeled around with a limited choice of regenerated dishes. If everyone wanted the same dish, there was a problem.
The other benefit is customer satisfaction. It might take time for hostesses to talk to all 30 patients on a ward, but McKenzie reckons that patients make a more successful choice if they have the menu explained.
As soon as staff have been trained, the system will be used to take orders from all 440 patients. Budget per patient is about £2.25 for three meals, seven beverages and snacks.
The Foodcourt
Where: Royal Liverpool University Hospital
What: 140-seat foodcourt and coffee bar
Retail catering contractor: Sodexho Healthcare
With the move towards shorter hospital stays and day-patients, there is a need in hospitals for alternatives to the overburdened staff restaurant, which traditionally catered for visitors.
More to the point, hospitals are tuning in to the fact that they can generate income by clawing back space for additional retail outlets. Space in existing hospitals, however, is predominantly earmarked for clinical use.
So, when an opportunity came up to redevelop the entrance to the Royal Liverpool University Hospital last year, the hospital saw it as an opportunity to get third-party income as well as providing better service to the 6,000 patients, staff and visitors who pass through every day.
Sodexho Healthcare won the job and invested £250,000 to open the 140-seat foodcourt and coffee bar. It has introduced its Strollers sandwich brand and Spitfires fast-food operation. The forecast turnover is £600,000 a year, feeding about 800 people a day, seven days a week.
"You need a critical mass of people to make a big foodcourt viable," says Jeremy Dicks, retail director at Sodexho Healthcare. "You need to look at the number of beds, the size of outpatients clinic, and the accident and emergency unit."
So how lucrative is it for the caterer? Dicks says that the deal is that Sodexho pays the hospital a base rent or percentage of turnover, whichever is the greater over the course of the year. "We take a risk on the long-term lease," he adds. "There's a shed-load of risk [for us], and the NHS trust has none. We do it for the return on investment and to get a presence on the site." He points out that Sodexho doesn't do the patient feeding at the hospital.
Retailing in hospitals is not new - it has been happening for the past eight years - but it is evolving. As Dicks says: "Competition [to run facilities in hospitals] is fierce and ranges from newsagents such as Forbuoys to the voluntary services. It is risk transfer and it generates a profit."
The party venue
Where: Preston Royal Infirmary
What: 280-seat Charters restaurant and function room
Caterer: in-house
Looking for a more unusual venue? At Preston Royal Infirmary, you can book a wedding, bar mitzvah or business meeting - you name it, and the catering team will sort it out.
The commercial arm of the business, Award Catering, was started 10 years ago by Ahmed Jama, food and services manager for Lancashire Teaching Hospitals. When he arrived, the hospitals in the trust were strapped for cash but needed to upgrade their restaurant facilities. Jama suggested they borrow money and generate enough income to pay the loan back. That was the birth of the 280-seat Charters restaurant.
Today, the fully licensed restaurant generates an income of £600,000 a year and, when it isn't booked for a function, opens for lunch and dinner. Dishes on the table d'h"te menu cost £4.50-£7.50 and there is a section that provides waitress service. Jama has also tapped into the large Asian market by recruiting an Indian chef.
If that isn't enough, the income from the restaurant is augmented by a sandwich factory, which Jama started nine years ago. Some 6,000 sandwiches a day are made at the Royal Preston, raking in revenue of £700,000 a year.
There is also a Strollers sandwich bar on site that turns over £700-£800 a day, and the visitor and staff caf‚, which does the core catering on site and brings in £2,300 a day.
All this revenue has helped fund the more expensive Better Hospital Food programme menus. Jama also points out that his chefs are on a profit-sharing scheme, which helps retain talent. Altogether, he has 230-240 catering staff, 1,500 patients and 7,000 medical staff across the three hospitals he oversees.
So, what next? Jama says that the trust has considered opening a hotel for relatives of patients, but decided against competing too much in the commercial arena. "We are working at full capacity," Jama says. "We never stand still, but we want to hold on to what we have got."
