Revolutionising hospital food
London's Royal Brompton Hospital is unusual in having full kitchen facilities. "Most hospitals can't prepare meals on site any more because they only have regeneration units," says catering manager Mike Duckett
Home-made cakes for afternoon tea, asparagus on the menu and a daily delivery of locally sourced organic meats perhaps don't conjure up the kind of images you'd expect from the typical hospital kitchen.
Add in freshly prepared meals for every patient and dietitians on hand to offer nutritional advice, and it could all sound like a utopian dream. In fact, at London's Royal Brompton, a 250-bed NHS specialist heart and lung hospital in South Kensington, it's an everyday reality and one that catering manager Mike Duckett has worked hard to achieve over the past five years.
For Duckett, the difference lies in having a patient-centred approach to food. That means not relying on convenience foods and instead using as much fresh, local produce as possible. "The public perception is that hospital food is pretty rubbish, and unfortunately that's still true in many cases," he explains. "To move on from that, we've got to come away from ready meals and give people a healthier choice. Why shouldn't patients have the best available if we're trying to help them get well?"
In hospital catering, where the focus is often more on costs than the quality of food on offer, the Royal Brompton is unusual, not least because it also has full kitchen facilities. "Most hospitals can't prepare meals on site any more because they only have regeneration units where chilled or frozen foods are brought in, ready-made, and reheated," Duckett points out. "But we have a proper production kitchen, which we run like any hotel or restaurant would, with a pastry section, wash-up and so on."
When he first joined, one of his first decisions was to deliberately recruit his head chef, Michael Fontaine, from outside the NHS. Most hospital chefs come from within the cost sector but Duckett felt that a different take on F&B was needed. "He'd worked on cruise ships before and he had no idea about hospital food," he says. "So, right from day one, he was serving up restaurant-style dishes. That came as a shock for some people but it's really helped to turn the place around."
Since then, Duckett and his team's innovative attitude have won over not just hospital staff and patients, but others too. The catering department recently won the Public Procurement category at the 2006 Caroline Walker Trust awards, which recognise those who have improved public health through food, and Duckett himself has been featured in the Observer and Which? and has appeared on GMTV to talk about his ideas.
Despite all the publicity, though, he remains firmly focused. He heads up a team of 67 staff, including a kitchen brigade of 12, in the hospital's catering department. This incorporates a staff restaurant, coffee shop and snack bar, plus an outside catering function, which helps to boost the catering budget.
Not surprisingly, money is tight, with "everyone fighting for the same pot", as Duckett puts it, but there's a policy of putting as much of the budget towards the patients' food as possible. The NHS average spend per patient is £2.90 per day, but at the Royal Brompton it's £3.50, aided by the fact this particular NHS trust is more flexible with funds. "I'm very lucky because the trust supports what we're trying to do and that makes all the difference," he says. "For instance, when I first came here, I was allowed to use some of the non-food budget on higher food costs, and that meant I could change things quickly."
He has also introduced cost-saving measures, including cutbacks in areas such as administration, and careful houskeeping on more expensive food items. "We've made reasonable savings on milk, for example, by giving organic to patients only and making sure staff don't drink it," he explains.
Another important source of income is the staff restaurant, where premium foods, such as strawberries and asparagus, are put on at higher prices.
"People don't mind paying a little bit more if they're getting top quality," Duckett says, adding that Fairtrade coffee at £1.20 rather than normal instant for 60p is another popular choice. "It's an easy way to increase our income and it makes the menu more interesting for everyone. We put asparagus on in the summer and it went down brilliantly."
As well as using varied ingredients, the kitchen aims to make dishes healthier for staff and patients by replacing salt with fresh herbs and spices. Similarly, mashed potato is flavoured with spring onions and garlic. A particular success so far have been home-made soups, made daily using fresh vegetables and organic stock, and sales are now up by 40%.
So has Duckett had good feedback from patients? "In the beginning, attitudes were negative because people didn't understand what we were trying to do," Duckett admits. "But when you talk about what's involved, people understand more. When you say the milk is organic, or the potatoes come from Kent, they notice that the milk's creamier or that the apples have a better flavour. A lot of the success we've had is down to engaging patients with what they're eating."
Educating people about food is one reason why patients are encouraged to see dietitians during their stay. "One chap was spending more than £10 a week on supplements. But we were able to explain that if you're eating five portions of fruit and veg a day, you don't need to spend all that money," he points out. "Even just little things like that can make a difference to people's everyday lives."
It's not just about the food on the plate, though. Duckett is especially keen on using locally sourced, sustainable products.
"It's sustainable in the sense that we think about seasonality, and food doesn't have to travel miles to get here," he says. "When I first started at this hospital it was crazy because we were buying food from all over the place, like asparagus from the USA, spring onions from Cairo and apples from New Zealand. When we've got suppliers on our doorstep, it just doesn't make sense to do that."
That's one reason why Duckett got involved with the Hospital Food Project two years ago, run by London Food Link in partnership with the Soil Association. The project was all about increasing the amount of local, seasonal and organic food for patients in four London hospitals, including the Royal Brompton.
Now, just under 20% of supplies are locally sourced. Duckett uses 50 or so small producers, many based in nearby Kent, buying supplies such as organic beefburgers, bacon, seasonal vegetables and fruit.
One supplier is Bank Farm in Kent, where Duckett buys his free-range eggs. "They also sell eggs to the Ritz and Savoy, so they drop off our delivery at the same time. It's a good arrangement," he says. Another bonus is that the company uses recycled biofuel in its delivery vans. "We give them our used vegetable oil, and they recycle it at the farm. It might sound strange, but it's a no-brainer, really."
Finding suitable suppliers hasn't all been plain sailing, though. Some were too small to cope with minimum orders, while others weren't able to comply with the hospital's stringent health and safety standards.
Purchasing produce has to be planned carefully as NHS procurement regulations can be restrictive, limiting local buying agreements before going to tender. But Duckett has clearly been determined, saying it's taken him three years of not taking "no" for an answer, being endlessly enthusiastic and talking to as many people as possible to get where he is now.
He's keen not to lose momentum, either. He's started a London supplier group, developing a network of small local producers and suppliers that he works with. He hopes the group will be useful for other hospitals and public sector bodies trying to adopt similar "buy local" principles.
Building on the Hospital Food Project, Duckett's also working on the Good Food on the Public Plate initiative, in conjunction with Sustain and supported by the Department for Environment, Food and Rural Affairs. This aims to work with at least 20 hospitals, as well as schools and care homes, to increase the amount of sustainable food being served across the cost sector.
Duckett hopes the public's changing attitudes towards food will push the issue. "Awareness of healthy eating has grown hugely," he says. "People want to know where food comes from and issues such as sustainability are on the public agenda at last."
Better waste management is another priority this year. Duckett plans to team up with London Remade, a not-for-profit organisation that gives businesses advice on recycling and waste management. "We use more than 10,000 paper serviettes a week and God knows how many plastic cups," he says. "But from next year, we're going to use paper cups that we can recycle, and provide different bins for plastic, glass and paper."
Asked how his colleagues would describe him, Duckett is quietly modest, despite all his achievements so far. "To be honest, I think they get a bit fed-up with me banging on about it all," he grins. "I'm pretty vocal and they do take the mick out of me a bit. But they also know there's still a lot to be done."