Building health on food foundations

To kick off our Inside Healthcare supplement, we asked movers and shakers in the worlds of hospital and care home catering what they felt were their most significant issues. Rosalind Mullen reports

Ian Robinson, general manager for hotel services, Salisbury NHS Foundation Trust

"What's worrying is the absence of a formal programme for continuing professional development for hospital catering managers.

"Unlike dietitians, catering managers are not required to hold specific qualifications or be registered to practise, yet hospital catering managers have patients' welfare in their hands.

"The absence of formal registration and minimum qualifications, and the perceived lack of professionalism that comes from this, undermines what we are trying to achieve.

"This ties in with another point I would like to highlight - the hands-off approach by the Department of Health. Currently, the only body giving leadership is the Hospital Caterers Association.

"The Government's Better Hospital Food programme effectively finished in 2005. I predict that, by 2011, someone will realise the need to have a more hands-on approach again.

"Hospital trusts currently are applying the Healthcare Commission standards in different ways, which means that some are taking the initiative to achieve best practice while others will seek to do the minimum. I believe the service will become so diverse that someone will come up with another programme.

"Financial pressure is a problem. Everyone clearly has to operate from a budget but, with the patient's high-street expectations at one end of the scale and food cost inflation at the other, many hospital caterers are working in a competitive world with very tight budgets. Some will receive inflationary help, but not all.

"It would be a step backwards if patients had to pay. That prospect sends shivers down my spine - it would mean that nutrition was seen as having no bearing on health.

"In short, we produce the food, but we need multidisciplinary commitment to implement best practice and support patients with food."

John Hughes, catering manager, Nottingham University Hospitals

"The NHS is important. What has come home to me this year is that the vast majority of us will eat our first and last meals in hospital.

"However, contracts have been squeezed, so it is getting harder to make money in the industry. In addition, the market is shrinking because changing health policy means there will be fewer acute hospitals - probably a 10-15% reduction in the next five to 10 years, with more investment in care in the community.

"That said, we are doubling the size of our catering operation, as our sister hospital, Queen's Medical Centre, will be bringing its catering back in house by 2010. We intend to follow the Cornwall model and build a carbon-neutral CPU. There are no negative cost implications and, as we already spend £600,000 a year with local suppliers, it can be a major boost for the local economy.

"Economies of scale mean it makes sense for us to bring this in house, and I see this as definitely becoming a trend.

"At Nottingham, coffee shops have also been a great trend. We now have 12 of them, taking £250,000 a year each.

"Elsewhere, PFIs have had their day. They are too large and expensive at a time when hospitals are getting smaller. More importantly, most have no kitchens, so they are unable to serve proper fresh food. Hospitals will revert to traditional models or build large CPUs that provide employment."

Pam Miller, associate director of facilities, Pennine Acute Hospitals NHS Trust

"We need to address the fact that food should be part of the clinical treatment of patients. Drugs cost thousands of pounds, but patients still won't get better if they are not eating and drinking properly.

"There is still a long way to go in working with our nursing colleagues. We need to make sure we work with dietitians, chefs and the nurses who do the food service at ward level. Our service is judged at the bedside so, if nurses are not trained, our service can fall down there.

"There are some useful initiatives. The HCA has produced a good practice guide for ward level - Good Practice Guide for Healthcare Food and Beverage Service Standards - and the Council of Europe is looking at ways to assess patients' nutritional needs. We are also looking at the variety of food choices on the menu to make sure patients are getting enough calories.

"The other aspect of our job is feeding staff. We follow guidance on the obesity strategy to guide people to make healthy choices. We welcome guidelines, but it is important that they don't become too prescriptive. You need to make an informed choice."

Alison McCree, associate director of estates and facilities at County Durham and Darlington NHS Foundation Trust

"The problem is that patients are still not receiving assistance to eat. There has got to be a partnership with the nursing staff - ensuring patients eat on the ward is a nursing responsibility. Maybe a solution is to train volunteers to assist with patient feeding.

"The Better Hospital Food programme raised the issue, but the nitty-gritty still has to be addressed. Food is of no nutritional value to the patient if it is not consumed."

Sue Ullmann, chair, National Association of Care Catering

"The major issue in care homes now is the lack of staff training. This has been identified by the Government's Nutritional Action Plan NAP] and it will be an issue until training becomes mandatory. But that has to come from Government.

"The NACC is represented in two working groups for the NAP and I hope that, when they receive our feedback and submit it to care services minister Ivan Lewis, they will take action.

"The malnutrition among the elderly issue is getting better, but we can't become complacent. It is important to keep it in the public eye. We are piloting a project to combat malnutrition in sheltered housing, so we are constantly keeping on top of the problem.

"The NACC is also looking at meals on wheels, as there has been a steady drop in this service across the country. The findings of our research will be ready in May,P but it is clear that there are nutritional issues. Many old people going into hospital are malnourished already, so the problem needs to be addressed in the home.

"We are pleased with uptake of our care home manual, which was published last year. It has outsold any other document that we have produced."

"Drugs cost thousands of pounds, but patients still won't get better if they are not eating and drinking properly" - Pam Miller, Pennine Acute Hospitals NHS Trust