Hospital food

More revision, Food and Catering module, all about how to feed people in hospital. Here's a quotation from Florence Nightingale in 1859:

"Every careful observer of the sick will agree in this, that thousands of patients are annually starved in the midst of plenty, from want of attention to the ways which make it possible to take food."

Things hadn't changed much by 1994, when it was found that of 500 patients admitted to hospital, 40% were malnourished, and by the time they came to be discharged they'd lost an average of 7% more weight. There have been numerous reports since then: "Hungry in Hospital" (1997), "Hospital Food as Treatment" (1999), "Managing Nutrition in Hospital - a quality service" (1999), leading up to the Better Hospital Food (BHF) Initiative in 2001.

Some in the UK may remember this initiative because it was headed by celebrity chef Loyd Grossman. Success was somewhat compromised when some of the recipes weren't executed in the manner intended, even where hospital kitchens still existed - newer hospitals have been built without cooking facilities, intending that food should be bought in chilled or frozen, with on-site facilities only for storage, defrosting and heating. The principles of BHF remain though, and seem very sound: protected mealtimes when nobody should be hauled off for X-rays or tests, and red trays to indicate people who need help to eat, for example.

It's not just England or the UK: the Council of Europe even published a resolution in 2003, under the heading "Food and Nutritional Care in Hospitals - How to Prevent Undernutrition", and listed 10 key characteristics of good nutritional care in hospitals. The National Institute of Health and Clinical Excellence drew up guidelines for nutritional screening in 2006, and the Department of Health has published "Improving Nutritional Care" in 2007.

I read a whole 60-page report on "Delivering nutritional care through food and beverage services", published by the British Dietetic Association in October 2006. It turns out that hospital dietitians play a key role in planning hospital menus, in conjunction with clinicians, nurses, patients, and most importantly, hospital catering managers. It's certainly a challenging business, with the hugely diverse hospital population, all of whom are ill or disabled in some way or another, many very old or very young, and everything in between. Just being in hospital is enough to put most people off their food, with the bedpans, noise, smells, and strange environment for meals - I don't normally eat my dinner at a time not of my choosing, in bed, and in a room full of strangers.

You might think that skipping a few meals shouldn't be a problem for our obese society, but actually living off nothing but body stores of fat isn't recommended; we do need a certain amount of vitamins and protein, especially when ill. Then there are those who need food that is low protein, low fibre, low fat, low sodium, low sugar or gluten-free, who have allergies or intolerances, who want vegetarian, vegan, kosher or halal food, as well as that undernourished group I mentioned at the start who need a high protein and high calorie diet. I certainly have a lot more sympathy for the hospital caterers now.