Patients rewarded

Cook-Chill, call-order, traditional banqueting and special diet catering are just a few of the varied demands made on the new £4m kitchens at Guy's Hospital in London.

They produce about one million meals a year, and the fact that they are working effectively is a tribute to the planners, because the entire installation was put on ice for five years.

Since 1993 the hospital has been part of the Guy's and St Thomas' Hospital NHS Trust - the largest trust in the UK. Currently the Guy's site has about 660 beds.

Patient facilities are based on a cook-chill unit and chilled storage with capacity for up to 5,000 meals per day, mainly using bought-in main courses and puddings. There is also a bulk liquid production area and a diet kitchen for producing small quantities of specialist meals.

For staff and visitors there is a 150-seat restaurant and 40-seat coffee lounge with their own finishing kitchen and a range of call-order equipment. And there is a dedicated banquet kitchen to supply Guy's banqueting suite.

The huge kitchen complex opened last summer, but was actually installed in 1992-93; problems with Thomas Guy House, the new building that houses it, forced the hospital to delay the opening.

Trust status change

When the kitchen was first conceived, the hospital was part of the Lewisham Health Authority and the change to trust status had a significant impact on a plan to offer branded recipes, developed with the aid of members of the Guild of Food Writers. Mel Rankine, the trust's deputy facilities director, explains: "The original concept was for an outside company to provide a brand of cook-chill meals (called Good Food at Guy's) which we could also sell to other hospitals in the authority.

"But with the changes in the NHS the idea became less attractive to outside companies because we could no longer give them the volumes they needed."

However, Anglia Crown, which now supplies cook-chill meals for the hospital, has incorporated 17 of the Good Food at Guy's recipes into its menu cycle.

The new kitchens - designed and installed by Berkeley Food Equipment - have meant not only new equipment, but also a change in working practices for head chef Ettore Eligio and the 200-plus catering team.

At the heart of the cook-chill unit is a chilled plating area with a Grundy conveyor. Here it takes a team of nine or 10 staff about an hour to plate up 600 meals.

Anglia Crown entrées come in multi-portion packs, which are divided on to plates, along with vegetables cooked and chilled at the hospital. Desserts and other items such as salads (also prepared on site) are added to the tray, according to the patient's order.

The trays for each ward are then loaded on to Grundy ambient trolleys, which have slots that match up with the shelves on Grundy Calorique regeneration ovens. Each ward has its own regeneration oven and catering assistants transfer individual dishes from the trays for heating.

Catering manager Steve Dempsey says: "One catering assistant can service three wards. They unload the elements that need to be heated, leave them in the oven, then go to the other wards while the dishes are regenerated."

The regeneration ovens pulse heat from their electric elements, which stops food burning. And all the plated meals are regenerated with lids on to retain moisture.

Puréed meals for patients who find it difficult to swallow pose a particular problem because regeneration can cause the purées to collapse and spread over the plate. To overcome this, a metal bowl cover is put under the plates, which slows down the heating process.

Among the foods prepared on site, rather than being bought in, are liquids. Rankine says: "It's clearly daft to get a supplier to open a pack of gravy mix, add water, cook it, chill it and send it to you."

One area of the kitchen was, therefore, designed specially for bulk production of liquids such as gravy and custard. It contains two Cattabriga ice-cream makers. Designed to pasteurise and chill ice-cream mixes, they produce gravy just as well.

However, Eligio says they are not yet heavily used because the quantities needed are often smaller than the capacity of the pasteurisers.

Steve Dempsey has also sourced a cold-mix custard powder which eliminates the need for cooking the mixture. Supplied by Zeelandia, the custard is simply mixed with cold water and put into patients' bowls with a sponge or other pudding on top. The heat from the regeneration ovens is all that is needed to finish the process.

The diet preparation kitchen is used to prepare fairly small quantities, which are then frozen in a small Foster blast freezer.

Prep equipment here includes a Hobart mixer and two Robot Coupe food processors which are heavily used for soups and purées. For cooking there is a six-burner Falcon Chieftain range, a Falcon Steakhouse grill and a Bartlett pressure steamer.

The banquet kitchen serves the banqueting suite which does about £400,000-worth of business annually, catering for anything from medical conferences to weddings. This kitchen is also used to cook vegetables for patient meals.

A Falcon Chieftain fryer is used to fry chips and other potato products which are then chilled and regenerated for the children's menu. "The chips aren't crispy when they're regenerated, but they're perfectly edible," says Dempsey.

"We introduced them because children weren't eating mashed potato and parents were bringing in burgers and chips from outside." There is also a Falcon six-burner range, an Elro pressure kettle, Hobart mixer and Convotherm combi-oven.

Dempsey says there is a huge demand for soft food from patients. "The biggest comment we got from patient questionnaires was ‘could the vegetables be softer'."

As a result, the pressure kettle is used for boiling potatoes because it produces softer, wetter results. Dempsey says it is especially important for vegetables to be well boiled for renal patients because cooking removes potassium and iodine.

Dietary concerns

Frozen vegetables are blanched in the combi-oven then chilled. "Even peas need to be blanched," comments Dempsey. "We've had to take as middle a road as we can because obviously the dieticians are keen that we don't cook vegetables too much and lose all the vitamins."

In front of the Foster blast chillers attached to the banqueting kitchen is a pre-chilling area where the temperature is about 9ºC. This means that food can start to cool if the chillers are already full. The aim is to chill all food within 90minutes.

There is also a cold preparation area kept at about 10ºC where salads and sandwiches are made. Equipment here includes a Winterhalter salad washer, which washes the salad in a water bath then spins it.

In the finishing kitchen for the staff and visitor restaurant, equipment includes two Convotherm combi-ovens, an Elro pressure kettle, an Elro pressurised bratt pan, two Falcon Chieftain fryers and a Steakhouse grill.

As with the other kitchens, the equipment is served by flexible connections to services hidden by trunking from Systems Partnership. Says Dempsey: "It makes it very versatile because we can move the connections to reposition equipment if we want."

Call-order equipment in the restaurant itself is from Falcon's Series 350 - including a range, chargrill, griddle and fryer. Dirty dishes from the restaurant are taken by Cidelcem conveyors to the dishwash area. Incorporated into the conveyor is an electromagnetic unit which picks up cutlery, and Dempsey says this works well.

At the heart of the dishwash area are two Hobart flight dishwashers, each with three chambers, which Dempsey says also work efficiently. Additionally, there is a Hobart potwash machine.

With the delay in opening the kitchens there have been some teething troubles. "It's like leaving a car - if you don't turn the engine over every day, things start to stick," says Walker.

One of the worst problems was in a walk-in freezer, which got stuck on a defrost program overnight before the kitchens opened. It will have to be completely rebuilt because the heat melted its seals and light covers.

Other problems included control boards on ovens needing to be replaced and a spare part being needed for a power spray to wash trolleys. Compounding the situation was the fact that all the equipment was out of warranty.

As a result, the hospital has needed support from maintenance companies, which has not always been as efficient as it could be. "We've had a lot of hassle from some of the big boys," says Walker.

But he singles out one small company for praise - Café Pronto, which provides services for the vending machines. "Absolutely fantastic service," he says.