Meals as medicine

In the second part of our spotlight on healthcare, Emily Manson discovers the challenges of catering to the sector and specialist frozen meal supplier Apetito provides recipes.

Catering for the old and infirm isn't easy or glamorous. Despite repeated calls from the sector for their own "Jamie" to champion the cause of these vulnerable customers, a knight in shining whites is yet to step forward.

It's well known that older people in care homes tend to lose their appetites and interest in food. In hospitals, there are also differing numbers of patients and levels of chronic illness (long-term) and acute (emergency).

On top of this, different types of illnesses require different diets, such as low salt, low fat, diabetic or coeliac, and all of these needs must be incorporated within patients' differing cultural and religious backgrounds.

Rosemarie Hoyle, healthcare divisional manager for specialist frozen meal supplier Apetito, admits the task isn't easy. "Certainly the complexity of patient feeding has increased massively as catering managers have to juggle many more balls these days to deliver good-quality food that meets food standards - and all achieved within a tight budget," she says.

GREATEST CHALLENGE

Graham Merchant, division director healthcare at contract caterer Aramark, which currently holds 11 NHS contracts, agrees, adding: "The greatest challenge in the care home industry is meeting the individual needs of each resident. We understand the importance of presentation and enticing patients to eat even when they may not feel like it."

With the increased focus on care standards, caterers are also legally required to provide a full nutritional breakdown of calcium, salt, saturated fats, and carbohydrate levels, either on menus or online.

Hoyle says: "The increasing focus on food as an integral part of the recovery process has meant greater attention to nutrition, to balanced menus and to accommodating special dietary requirements. However," she adds, "the most important part of patient feeding is making sure the meal looks and tastes good at the point of serving. Patients need to enjoy the meal, otherwise they won't eat it and our efforts are wasted."

To this end, Apetito - which provides 36 million-plus meals a year to 150 local authorities, 75 NHS trusts and care homes - offers a menu of over 200 frozen main meals and desserts, including dishes suitable for diabetics and patients with renal problems.

Hoyle explains that supplying meals frozen ensures consistency and quality as well as allowing patients to choose near the time what they feel like eating. "This helps aid recovery and reduce wastage. But it's important to remember that at the same time, exciting and varied menu choice is a vital starting point in encouraging patients to eat, including offering dishes for those with special dietary needs."

To inspire its customers, Aramark uses several tactics, such as cutting up fruit into neat and attractive slices and arranging puréed food into the shape of the original meal or item to stimulate their taste-buds.

ADAPT RECIPES

Merchant says: "It can be a struggle to encourage patients to eat healthily. The elderly especially tend to like the more traditional meals which are naturally higher in fat and salt but we find ways to adapt recipes to bring these levels down."

But he adds the majority of care home residents need a well-rounded complement of nutrients. "That means home-cooked, freshly prepared, traditional meals like stews, soups, and milk-based puddings are ideal."

Aramark also analyses all recipes to ensure that meals have the right mix of nutrients and breakdown of calories, as well as providing snack portions for patients who get put off by large portions and à la carte menus, as opposed to the old-fashioned cycle menus where the repetition can become off-putting for longer-term care patients and residents.

Hoyle explains: "One thing's for certain, it is a team game. To achieve all the criteria for a successful patient feeding operation requires a close working relationship between ourselves and the catering team at each individual hospital or site."

A TYPICAL HOSPITAL MENU

BREAKFAST

• Fruit juice
• Toast and jam
• Cereal

LUNCH

Starter

• Fruit juice
• Bread roll
• Celery and red pepper soup

Main course choices

• Pork and apple casserole with creamed potato or jacket potato halves and cut green beans and baby carrots
• Cod in cheese sauce with creamed potato or jacket potato halves and cut green beans and baby carrots
• Baked vegetable pie with creamed potato or jacket potato halves and cut green beans and baby carrots
• Cottage cheese and salad sandwich
• Turkey salad

Dessert choices

• Apricot crumble with custard
• Rice pudding with custard
• Yogurt
• Fresh fruit
• Cheese and biscuits
• Ice-cream

SUPPER

Starter

• Fruit juice
• Bread roll
• Butter bean and bacon soup

Main course choices

• Fricassee of chicken, mustard, tarragon with creamed or boiled potatoes, sweetcorn and cauliflower
• Baked mince and potato pie
• Pasta, mushroom and leek mornay
• Ham sandwich
• Cheese salad

Dessert choices

• Rice pudding with custard
• Fruit cocktail with custard
• Yogurt
• Ice cream
• Fresh fruit
• Cheese and Biscuits

FACT

Of the 129 million hospital meals that were ordered by patients last year, 10.7 million were thrown away uneaten at an estimated cost of £144m, according to NHS figures.

http://www.caterersearch.com/Articles/2009/09/07/329721/care-home-recipes-carrot-cake-by-apetito.html" target="_blank" rel="noreferrer">RED LENTIL BROTH](http://www.caterersearch.com/Articles/2009/09/07/329719/care-home-recipes-red-lentil-broth-by-apetito.html)

INGREDIENTS
(makes eight portions)

• 60g vegetable oil
• 110g diced onions
• 1 litre water
• 200g red lentils
• 210g diced carrots
• 60g leek, finely cut
• 60g celery
• 60g diced parsnips
• 110g frozen diced potatoes
• 15-30g vegetable bouillon, according to taste
• Pinch of ground cumin
• Pinch of salt
• Pinch of ground white pepper
• Pinch of frozen thyme
• Small clove of chopped garlic in oil
• 1tsp of tomato purée

METHOD

Sauté garlic, oil and diced onions in a pot. Add water and 110g of carrots to the pot, bring back to the boil and cook until the carrots are soft and stir until smooth. Add remaining vegetables, carrots and lentils, return to the boil and cook until soft.

Mix the dry ingredients with water and tomato purée and add to the pot stirring continuously until boiling. Adjust water level to recipe weight and bring back to the boil.

[CURRIED LAMB WITH POTATO AND TOMATO](http://www.caterersearch.com/Articles/2009/09/07/329720/care-home-recipes-curried-lamb-with-potato-and-tomato-by-apetito.html)

INGREDIENTS

• 200g sliced onion
• 160g diced fennel
• 25g vegetable oil
• 1g chopped garlic in oil
• 650g diced leg of lamb
• 270g diced lamb shoulder
• 100ml water
• 120g creamed coconut
• 1g chopped ginger in oil
• 1g chopped seeded red chillies
• 2g tomato purée
• 2g curry powder
• 330g chopped tomatoes
• 1g fried chicken stock powder
• Pinch of salt
• 10g frozen coriander
• 30g modified starch
• 1g Justfibre BH100

METHOD

Sweat the onion and fennel in cooking oil until softened. Add the chopped garlic, meat, creamed coconut and water and cook until the meat is tender, about 80 minutes. Add more water as needed.

When the meat is cooked, add the chopped ginger and bring back to the boil. Now stir in the tomatoes - however, do not allow them to break down. Add the remaining ingredients, apart from the fibre, while stirring continuously until boiling. Then blend in the fibre, continuing to stir.

Adjust water level to recipe weight and bring back to the boil. Ensure the sauce reaches a core temperature of 85°C. If this is to be blast-chilled, it must reach 3°C in 90 minutes.

[CARROT CAKE

INGREDIENTS
(makes 20-24 portions)

• 390g granulated sugar
• 420g cake flour
• 10g bicarbonate of soda
• 10g cinnamon
• 52g dried egg powder
• 460g fresh grated carrot
• 140g walnut pieces
• 160ml water
• 350ml vegetable oil
• Pinch of salt

METHOD

Place all ingredients into a high-speed mixer and mix well for three minutes. Weigh into foil loaf tins.

Bake at 170°C for 40 minutes until risen and golden brown. Now chill.

Read the other articles in Caterer's three-part focus on healthcare catering

Care home malnutrition: time for action
At the heart of care catering