Is hospital food on the mend?

It’s one of the most talked-about aspects of being in hospital, and usually for all the wrong reasons. “How’s the food?” is often the first question people ask when visiting a sick friend or relative in hospital, and the answer is almost invariably “Horrible”.

But does it really have to be this way? Why do we have to associate stodgy porridge, cold scrambled eggs, tasteless meat and gravy, chips and dried-up peas with the average fare served up to patients in wards across the State? Can catering staff do better and, if so, how?

Helen Bourke-Barnwell couldn’t believe the poor quality and choice of food available when her daughter was in hospital recently to have her appendix removed.

“When children are recovering from an operation, they need to have food that is appetising and nutritious, and all she was offered were cereals, which were high in salt and sugar, and white toast,” she says.

“We know now that the digestive system is so central to health and this point is ignored in Irish hospitals, from children’s hospitals right up to the private hospitals,” says Bourke-Barnell, who has observed the diets of sick older relatives in private hospitals in Dublin too.

“My daughter had been fasting for three days, yet she nearly retched when she saw the food she was offered. There was no tasty smell and nothing appealing about it. I felt I needed to get her home to give her good food to get her better,” she says.

As a parent staying over in the hospital, she also felt the quality of food in the canteens and vending machines was very poor.

Financial cutbacks
Bourke-Barnwell says that, like everyone, she is aware of the financial cutbacks within the HSE but she firmly believes there needs to be a Government initiative to set aside funds for integrating nutrition into the healthcare model.

“We’ve known about superfoods for a long time now – that green juices are healing and how to use berries and honey instead of sugar – yet adults, children and mums who have just given birth are still getting deep-fried chicken breasts with potatoes and peas, and sweetened yogurts, in hospitals.”

Prof Donal O’Shea, consultant endocrinologist and head of the obesity unit at St Columcille’s Hospital in Loughlinstown, Dublin, agrees that hospital food is often awful. “Hospitals need to put nutrition higher up on the scale because the implications for long-term health are huge if we all eat more healthily,” says O’Shea.

He says that when people are in hospital they are more open to making changes and this opportunity is lost if more attention isn’t placed on nutrition.

“The HSE is one of the State’s biggest employers and if healthy eating was prioritised by all staff, you would change a significant percentage of the population.”

The HSE recently came under the spotlight when leaked tender documents showed the organisation was ordering 90 tonnes of frozen chips, 62,000 sausage rolls and other processed foods over the next four years. A spokesman said only 3 per cent of the HSE’s €32 million annual spending on food went on processed items such as pizza, sausage rolls and burgers. He said some 72 per cent was spent on fresh food such as meat, bread and dairy products, while 20 per cent was spent on dry foods such as cereals, and 7 per cent on frozen food.

The quality of food in hospitals depends not only on what food is bought where but on how it is prepared, how it is cooked and how soon it gets to the wards.

Samantha Cushen is a research dietitian at the Mercy University Hospital in Cork city. Prior to this post, she worked as a catering dietitian, a position that doesn't exist within the HSE, at King's College Hospital in London.

She says the first issue about hospital food is budget. “I don’t think the food service and nutritional care are given a high priority in hospitals. When the overall budget is constrained, food costs will be cut. The nutritional needs of the patients shouldn’t be compromised by budget.”

The second issue, according to Cushen, is who is involved in menu planning. "The Department of Health suggests that every hospital has a hospital nutrition steering committee with the head caterer, head chef, hospital management, nursing management, dietitians, medical doctors and patient liaison officer," explains Cushen.

“The problem is the food service is seen as separate from the patient’s treatment. It’s a simple task that a good food operator can handle, but it should be an integral part of the patient’s care,” she adds.

Planning nutritionally balanced menus for patients’ food is one of the roles of hospital dietitians, but the preparation and cooking of food is the job of the catering staff.

Cushen says the first Irish guidelines on food and nutritional care in hospitals for preventing under-nutrition were published in 2009. “We need to make these nutritional standards compulsory, and have nutritional screening of patients on admission mandatory,” she says.

Review of menu
The quality of the food at the Coombe Women's Hospital, in Dublin, was highlighted earlier this year when a photograph of a patient's meal consisting of a sausage roll and apparently burnt wedges went viral. The photograph prompted the hospital to review its menus.

"We removed [potato] wedges from the menu and replaced them with fried, diced potatoes, and we have taken away a lot of fried food including chips," says Fiona Dunlevy, senior dietitian at the hospital.

She admits that before the review, the percentage of fat in patients’ food was high.

“We offer a salad choice twice a day now and we offer the choice of a rice or pasta dish, or mashed or boiled potatoes, with each meal. We’ve added fruit as a dessert option and increased the amount of vegetables on the plate. And we offer milk with meals.”

Alongside this menu review, the Coombe Women’s Hospital has started educating catering staff on optimal nutrition.

“The catering managers are in charge of the food budget so the quality of the food depends on their decisions and almost all staff have attended the 90-minute nutrition class now,” says Dunlevy. “Soda bread, salads and desserts are all made in-house, and the meat, fish and chicken are bought in fresh. But we are aware that a lot of mums want high-energy foods after delivering a baby,” says Dunlevy.

Nazih Eldin, head of health promotion in HSE North East, leads an expert working group of dietitians, catering managers and buyers on food provision in the HSE.

There are three strands to the work of the recently formed group: to make healthy options more prominent within hospitals; to raise awareness of healthy eating in hospitals; and to improve the choice of food in vending machines in HSE facilities.

“We intend to put calorie posts on all menus in canteens for staff and visitors. Catering managers will improve the cooking methods and presentation of food, and 60 per cent of food and drinks available in vending machines will be healthy options,” explains Eldin. The group aims to finalise details of these objectives between October and December of this year.

But is it really about multidisciplinary steering committees and national guidelines? Sometimes, the best health initiatives are developed by passionate leaders with enough control over budgets to sustain their projects. “The HSE is moving in the right direction,” says O’Shea, who concedes the bulk-buying of food by hospitals is an industry problem.

“I agree that if individual hospitals had some flexibility on their food budgets, this would improve the local economy as well as the quality of the food,” says O’Shea.

sthompson@irishtimes.com

How have you fared in hospital? Please send photographs and/or descriptions of your meals to health@irishtimes.com