Tough new rules aim to drive out variation in spend on hospital food

Crackdown on poor quality nutrition as new figures show some trusts spend £10 more per patient than others

The Government has announced a drive to improve the quality of patient food and ensure value for money in catering services

Despite a 10% increase in the amount of money the NHS spends on feeding patients, significant variation in cost still remains across the country, with some hospitals spending double that of others, a new report shows.

Department of Health figures published this week show the average amount spent per patient per day has increased over the last two years to £8.77.

However, the hospital at the top of the league table spends £15.65 per patient per day, over £10 more than the trust at the bottom of the scale.

Hospital food doesn’t just need to be healthy – it also needs to be fresh and enticing enough to tempt patients who may not feel hungry

Across the NHS the cost of food remains very low, at less than 0.5% of the overall health service budget, and previous studies have shown there is no direct link between quality and cost when it comes to hospital food. But the high levels of variation across the country suggest some hospitals may need to spend more, while others could become more efficient.

The figures come just days after the new Health Secretary, Jeremy Hunt, launched a drive to improve the quality of food, which will address this variation by seeking out those hospitals that are providing high-quality food and examining how this can be replicated across the country.

The new drive also includes clear directions for hospitals on reducing fat and salt, including the provision of more fruit and vegetables and making sure food if procured in an environmentally sustainable way.

It also lays out eight clear principles the NHS must follow when planning patient meals, with patient-led hospital inspections carried out to make sure these rules are followed and that standards actually improve. The principles are:

  • All patients should be able to choose from a reasonably varied menu that meets their social and religious requirements while complementing their clinical care requirements
  • All patients should have access at all times to fresh drinking water unless this is contraindicated by their clinical condition
  • Access to food and drink outside planned mealtimes should be available where appropriate
  • Hospitals should promote a healthy diet to staff and visitors
  • The criteria set out in the Government Buying Standards for Food should be adopted as standard where practicable and supported by procurement practices
  • > Hospitals should regularly evaluate their food services and act on feedback from patients, demonstrating improvement and aiming to achieve and maintain excellence
  • Commissioners of NHS-funded care should seek and reward excellence in hospital food when contracting services

Hunt said: “Patients need high-quality, nutritious food – this a crucial part of their care, particularly for older patients. The figures published today show that, while the NHS is spending more on food as a whole, costs vary wildly across the country.

“What’s not clear is whether when the price drops, quality drops too. I want to find out if there is a link between what is spent and the quality of food delivered; and if not, why not.”

Hospital food can often have a very significant impact on the speed of recovery, susceptibility to infection and mental and physical wellbeing

Teams of inspectors, half of whom must be patients themselves, have now started pilot inspections across the country looking at the aspects of food that are important to patients including taste, quality, temperature, and the cleanliness of ward kitchens. Hospitals will be marked down if food is poor quality, if menus do not have suitable optinos for patients with special requirements and if hot meals are not provided in the evenings. Financial incentives for hospitals which deliver exceptional service are also being explored.

And the Government has teamed up with charities and professional bodies, including Age UK, the Patients Association and the Royal College of Nursing, to drive up food standards further.

In 2011-12 a total of 136.1 million patient main meals were served.

Welcoming the improvement drive, Katherine Murphy, chief executive of The Patients Association, said: “Patients tell our helpline that high-quality nutrition is an essential ingredient in improving their care and outcomes. But it is equally important that support from health professionals accompanies these changes so that vulnerable and elderly patients, such as those with dementia, experience the full benefits.

“The Patients Association is delighted with these new principles and in particular the commitment to introduce patient-led inspections, ensuring they actually make a real difference on hospital wards though is the key test.”

Dr Peter Carter, chief executive and general secretary of the Royal College of Nursing, added: “Hospital food can often have a very significant impact on the speed of recovery, susceptibility to infection and mental and physical wellbeing. Hospital food doesn’t just need to be healthy – it also needs to be fresh and enticing enough to tempt patients who may not feel hungry.

The Royal Cornwall Hospital is one facility that has improved its catering services, with more than 80 per cent of food being sourced locally

“Giving patients the ability to choose their food is a welcome move, which already works well at many hospitals. These principles should help hospitals to procure good food, cost effectively. We also recognise how important it is for patients to have ready access to drinks. Aside from this, the experience of nurses shows that there are other factors which can help patients with their nutrition – for instance, keeping wards quiet during ward rounds, and involving family members where possible.

“These principles should help the NHS to roll out good practice wherever a patient is treated.”

The Patients Association is delighted with these new principles and in particular the commitment to introduce patient-led inspections, ensuring they actually make a real difference on hospital wards though is the key test

There are already examples of where improvements to catering services have been made. Northumberland Healthcare NHS Foundation Trust has begun using a colour picture menu following feedback that many older patients, sometimes with dementia, would order the last thing on the menu as they found it difficult to remember the other options. A trial of the system showed a drastic increase in the amount of food being eaten by vulnerable elderly patients.

Meanwhile, the Royal Cornwall Hospital has improved the quality of food for its patients by increasing use of fresh, organic and local ingredients. More than 80% of the trust's food budget is spent with local Cornish companies, and sourcing food locally has cut carbon emissions from road transport by two-thirds. The food at the hospital has also been endorsed by the His Royal Highness the Prince of Wales.

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