Your lunch in his hands?
In October last year Loyd Grossman, best known as the presenter of TV series Masterchef, got a phone call out of the blue from officials at the Department of Health (DoH). They asked him whether he would be prepared to get involved in an initiative to improve hospital food and, specifically, whether he would recruit and head a team of leading chefs to look into the issue.
Grossman (left), who believes he was picked by the department because of his reputation as a strong advocate of good food, found the proposition interesting but says that he did not agree without asking a lot of questions first. "I liked the idea of being involved with something that was going to help a lot of people but I didn't want to get involved with a time-wasting exercise," he explains. "I wanted to ensure that this was a serious initiative and that it had backing from the highest level - in other words, health secretary Alan Milburn."
Reassured by officials that this was indeed a genuine, heavyweight project, Grossman agreed to take part, despite the fact that he was not being offered any financial reward. Public funds could not stretch to paying Grossman, nor any of the chefs he managed to recruit, a consultancy fee.
Remarkably, though, seven of the eight chefs Grossman invited to take part in the project signed up. They were: Shaun Hill, chef-proprietor of the Merchant House in Ludlow, Shropshire; Eugene McCoy, proprietor of McCoy's Restaurant in Cleveland Tontine, North Yorkshire; Mark Hix, executive chef of London's Ivy and Caprice; Anton Edelmann, maitre chef des cuisines at London's Savoy; Cyrus Todiwala, chef-proprietor of Café Spice Namaste, also in London; Michael Caines, head chef of Gidleigh Park in Chagford, Devon; and John Benson-Smith, head chef at Hazlewood Castle in Tadcaster, North Yorkshire.
Grossman says that he involved chefs who he knew were "creative, intelligent and good at problem-solving". He adds: "I also wanted a good geographical spread of people because one of the key issues in the NHS is that there is loads of variation between different trusts. We needed to get out there and see that. And it was important to get people who had clear interests in particular areas. For example, I knew Mark Hix was especially interested in catering for children, and I wanted Cyrus Todiwala because catering for different ethnic groups is a big issue in the NHS."
As for the chefs, they all say that they wanted to participate out of a sense of public duty, because they saw it as a way of contributing to the community and to raise the profile of good food. As Edelmann puts it: "We all use hospitals, so it seemed only right we should help them improve their food when we were asked."
With the team formed, each member visited three or four hospitals in his own part of the country to gauge the current standard of hospital food, to identify where any problems lay and to come up with ideas for solving them.
"But there were no strict criteria or guidelines to which the chefs were working," says Grossman. "I made it clear to the DoH from the outset that our modus operandum was going to be taking the freshest possible look at the whole issue. The chefs knew very well the cost context in which they were working - the average food budget per patient is £3 a day or under - but, other than that, they were given no rigid parameters."
Following the hospital visits, the chefs individually wrote reports detailing what they had seen and their ideas for change. Additionally, John Benson-Smith and Cyrus Todiwala began holding demonstrations for hospital chefs and catering staff, to show them what they believed was possible on a tight budget. Benson-Smith says: "I really believe there are a lot of good people in the NHS and what I've tried to do is inspire them and get them thinking up new dishes."
Then, in late January, Paul Cryer, the man appointed by NHS Estates as project manager of the hospital food initiative, asked the chefs to use their skills to revamp existing dishes being offered in hospitals and also to come up with their own ideas for new dishes.
Each team member contributed between 10 and 20 dishes - among them braised lamb in cider with herb dumplings (Hill), paupiette of pork in smoked bacon with Bavarian cabbage and a caraway seed sauce (Edelmann), sticky toffee pudding (McCoy), and roast cod with garlic mash and white sauce (Caines) - and in early February they gathered at Westminster College to demonstrate them to a large group of hospital caterers, contract caterers, and officials from NHS Estates and the Department of Health.
Since then, a number of hospital chefs and contract caterers have spent time recreating the dishes in their own kitchens, the chefs have been invited back for a couple of tastings, and the dishes have been piloted with patients in 12 NHS trusts.
All this has been done in preparation for the launch of the so-called National Menu across the NHS next month, which a Department of Health spokesman tells Chef "will lead to an almost immediate and visible difference in the quality and style of food being served in hospitals". He adds: "For the first time, all hospitals will have to choose dishes from the same menu, using the same recipes, so there will be minimum standards. The food should be a damn sight better than what's available at the moment."
So, on the face of it, that will be it - project finished, a job well done.
But, in reality, all is not well. A number of the chefs involved have serious and growing concerns about the project, and more have doubts about whether any real improvements will be achieved.
For a start, say some of them, one of the biggest issues that needs addressing - catering production systems in hospitals - is being entirely glossed over. "When I got involved in this," says Edelmann, "I thought it was a long-term project, where we were looking at everything from sourcing ingredients to production methods and techniques. I voiced my opinion and said that the food wouldn't improve without looking at these fundamentals, but the NHS didn't seem interested, and responded by asking for recipes and menus. As far as I'm concerned, that doesn't even scratch the surface of the problem."
McCoy and Hill say that they share the same concern that their ideas on tackling hospital catering systems are being overlooked. "I have some fears that this is a purely cosmetic exercise," says Hill, "although I sincerely hope I'm wrong."
Caines, meanwhile, says that he and others were staggered by being asked to hand over their recipes to contract caterers for trialling, without being asked for any guidance on how to make and present them. "We should have been involved in showing the caterers how to produce our dishes," he says. "I have a real concern that our dishes aren't being recreated as they should be and, from the tastings I've been to, I don't think they yet represent the dishes that we demonstrated back in February. There is a big question mark over whether these dishes are good enough to go into hospitals yet."
Further complaints from several of the chefs centre around poor communication about how the project was developing and what was expected from them at various stages. And some of them are also furious at the publicity drummed up by the DoH about their participation, without their prior knowledge or consent.
Moreover, they argue, some of the targets that the department has set for hospitals are utterly ridiculous - in particular, that all hospitals should be offering food 24 hours a day by the end of this year. "I don't think anyone should be worrying about offering 24-hour room service until they've made the three basic meals a day taste better," Hill says. "That should be the first goal."
But the key criticism from the chefs is that the entire project has been far too rushed to be thorough. And some even feel that the timescales suggest the initiative may have been more about scoring political points instead of improving the lot of patients. "We were given some silly short-term dates to work to," says Edelmann. "The thought has to cross your mind that this is all being rushed through, pre-election."
McCoy adds: "This should have been a long-term project. There are no quick-fix solutions with something as big as the NHS." And Caines says: "We all have a definite concern that this is turning into a publicity stunt. If it's not, then let's take things slower and get everything right first. This magnitude of challenge - improving the food in hospitals - can't be achieved in a couple of months."
Even Grossman admits that "the timescale has been very short. I would have liked more time." However, he and a few of the chefs do remain enthusiastic about the project and are optimistic that it will prove successful in bringing about positive change.
Hix says he believes that it is far too early to be negative - before the National Menu has even been launched. And Todiwala, a director of the Asian & Oriental School of Catering in Hackney as well as chef of Café Spice Namaste, says that he plans to keep working with the health service for the next two or three years to help improve things. "I am very serious about this," he says. "I am really giving my heart to it, and I see it very much as an on-going commitment to train guys in the NHS, to bring them into my kitchen for a couple of days and do demonstrations for them."
Similarly, Benson-Smith is continuing to run demonstrations for NHS chefs, and believes that he is helping them to improve their cooking.
Grossman's ultimate hope is that the work his team has done will have a number of lasting effects. "I think this project has drawn attention to hospital food," he says, "and I hope that will raise the status of catering within the NHS in the long term. I also hope that we've demonstrated the possibilities of producing good food within the constraints of a tight budget.
"Finally, I hope that this is just the start of something, and that it will encourage the DoH and NHS to put greater resources and effort into catering to ensure that there's continuing improvement."
The Hidden Panel
Last November, when the Department of Health announced that it had recruited Loyd Grossman and a panel of leading chefs to help improve hospital food, it upset a lot of health service caterers and hospital chefs, as Caterer's letters page was to bear witness over several weeks. Many said that they found it insulting that outsiders were being consulted on the issue, rather than those working at the coalface, day in, day out.
But, in fact, the Department of Health was consulting with those working within the NHS - although it made no public announcement on this subject. Completely separately from the panel of leading chefs, it had also established a team of some 40 NHS staff to look at the issue of hospital food. This team included catering staff, dietitians, clinicians and nurses.
"The team of high-profile chefs was just one part of a much bigger project to look at hospital food," asserts Pam Miller, national chairman of the Hospital Caterers' Association. "Hospital caterers have been very much involved in this, too."
Ian Robinson, catering manager at Kettering General NHS Trust in Northamptonshire, was one of those who participated in the NHS team. In particular, he was involved in a working party looking at the issue of how to offer food 24 hours a day. He believes that the publicity surrounding the project has been extremely badly handled by the Department of Health. "Lots of NHS caterers have been upset by this project because all they know about is the high-profile chefs," he says. "They have not been made aware of the fact that NHS people have taken part, too."
Like Grossman's team, the team of NHS staff fed their findings and ideas to Paul Cryer, NHS Estates' project manager responsible for co-ordinating the entire initiative into improving hospital food.
NHS Catering
Facts and figures at a glance
Annual catering budget: £500m
Number of meals served: more than 300 million
Food budget per patient: varies from NHS trust to NHS trust, but the majority spend between £1.40 and £3 a day per patient
Estimated annual wastage of food: £45m
Additional government funding for improving catering: £40m, spread over the next four years
TIMETABLE
Catering announcements made and action taken by the Department of Health and NHS Estates
July 2000
Health Secretary Alan Milburn launches the Government's strategy for the health service, the NHS Plan.
Catering is included in the plan - the Government says that hospital food must be improved and serving of it must become more flexible.
It promises the introduction of national minimum quality standards, new menus "designed by leading chefs" and 24-hour food service for all hospitals during 2001. It also promises the introduction by 2004 of ward housekeepers to oversee the quality of patient meals.
November 2000
The Department of Health announces that it has recruited a panel of leading chefs, headed by television presenter Loyd Grossman, to help with improving hospital food and menus.
Separately, a team of about 40 staff from within the NHS is established to analyse catering, although this group is not publicised by the Department of Health (see The Hidden Panel, opposite).
February/March 2001
Grossman's team of chefs presents a wide selection of dishes to officials from the NHS and Department of Health.
These are then recreated by hospital chefs and contract caterers and trialled on patients in 12 NHS trusts.
April 2001
The new National Menu will launch across the NHS, including some 450 dishes - some already served in hospitals and some new, designed by Grossman's team - from which all NHS trusts must draw.
New minimum standards will also be introduced from April, stipulating that all trusts must at least offer a Continental breakfast, a hot lunchtime meal, a hot two-course evening meal, and snacks twice each day.
By the end of the year, trusts must also be providing food on demand to patients round the clock.
USEFUL WEB SITES
NHS Plan
Department of Health
National Menu
For more information on this and the minimum catering standards that will be required by NHS trusts after April, a new Web site will go live at the end of March.
Hospital Caterers' Association
Source: Caterer & Hotelkeeper magazine, 15-21 March 2001
Photographs: Sam Bailey
