Hospital food: The meals here are ‘by and large inedible’

Hospital food, that staple of medical debate, is back on the menu after the Minister for Health this week promised the early introduction of new policies featuring better menu choice and greater flexibility for patients.

Simon Harris says the policies will ensure patients have access to regular, good quality meals and snacks, and get replacement meals when needed. A renewed emphasis on nutrition is intended to put an end to the more egregious tales of soggy chips, rubber eggs and cold dinners on hospital wards.

And not a moment too soon, to judge by the response from Irish Times readers on the issue this week. Too often still, it seems, patients are being served bland, unappetising food, or they can't get the food they want because they've been out for a test, or have special dietary needs that are not catered for.

“The food is by and large inedible,” says Laura, currently recovering from surgery in an Irish hospital. “Dinner at noon, smell is nauseating, has been cooked hours beforehand. Choice of dried fish or chicken with lumpy yet overcooked veg. Dessert is high-sugar jelly and ice-cream.”

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Laura makes the point that she cooks healthy, nutritious meals for her family at home on a tight budget “often for less than €1 per person”, so cost should not be an issue.

Yet in her hospital one night this week, dinner was “breaded fish that was both dried out and soggy in one portion. And that’s it until the next morning”.

For Michael Keaveny, the issue was less about food quality – which was relatively good during his hospital stay – but the problem of missing a meal when he had to go for a test. This usually meant having to go hungry, he says.

Also, his condition meant he was unable to eat certain foods but the menu didn’t cater for this and on occasion he had to rely on the hospital canteen for dinner.

The good news is that change is afoot and, in some hospitals, improvements have already been implemented. In 2014 The Irish Times reported Leo Varadkar, when he was Minister for Health, "declaring war" on bad hospital food. This was shortly after the Coombe maternity hospital was forced to introduce healthier options when a patient posted an online picture of a particularly sorry meal of sausage rolls and burnt potato wedges.

National guidelines

Dietitian Margaret O’Neill was appointed to lead the HSE’s national efforts to improve standards in the area and her efforts over the past four years will shortly bear fruit in the form of national guidelines on the quality and nutritive value of hospital food.

While some patients may chafe at the quality of food being served at their hospital bed, O’Neill says that 30 per cent of patients come into hospital in a malnourished state. “For many people, hospital food will be healthier than what they are eating at home,” she points out.

People should be able to look forward to their meals, even in hospital when there is so little else to brighten the day

And it has to be. As a dietitian, O’Neill knows her first task is to ensure the food served in the 50 or so Irish public hospitals is “nutritionally adequate” as well as being tailored to the patient’s specific health needs. “It’s not the same as a restaurant. Standards have to be met in order to keep the patient well fed in hospital.”

Few of us are likely to choose a restaurant for a slap-up meal on the basis of “nutritional adequacy” but O’Neill is certain “it is possible to produce therapeutic meals that taste good”.

The question is why that so often fails to happen. Galway chef JP McMahon puts failures down to an “absence of imagination and creativity”.

‘Too high, too much’

“There’s a massive gap between what they know should be served up and what is being done,” he says, adding that hospital food is too often cooked “too high and too much”, causing it to degrade.

He says he doesn’t “buy” the various arguments put forward in defence of mediocre hospital food – that the numbers involved are large, or the distances from kitchen to bedside are considerable, or the budget is limited.

“Cost is being used as a scapegoat for a lack of imagination. Modern kitchen technology can be used to keep food moist. And caterers are used to keeping some types of food hot for a number of hours without loss in quality.”

McMahon, who is in the early stage of making a television documentary on the issue, says he has on occasion been forced to drop in food to patients who were averse to the fare served in the local hospitals in Galway.

Based on the comments coming to his Twitter feed, though, he says some hospitals are doing a better job than others – Mayo, and the Rotunda and Beaumont in Dublin, get favourable mentions.

Patient recovery

Patient accounts also indicate it isn’t all bad news for the public hospitals. Enda Foley was in the Mater in late 2016 and says the food served was “very good with a great choice of fish dishes. The sauces were exceptionally good prepared by a very good chef who knew what he was doing”.

Niki Byrne found the food in the maternity unit of University Hospital Galway “quite good. Tasty and lots of choices. Only negative was the lack of fruit”.

Perhaps unsurprisingly, private hospitals get consistently good feedback from patients. Cathal Kavanagh, executive chef at the Blackrock Clinic, says the quality of his food is “all about the system” but also involves “a bit of thought”.

In the hospital, food is served “a la carte”. “It’s cooked for and served directly to the patients, with almost no reheating,” he explains.

It was his father’s experience of “bland, unimaginative” hospital food that prompted Kavanagh to complete a masters in culinary nutrition and to switch to the hospital sector. “People should be able to look forward to their meals, even in hospital when there is so little else to brighten the day.”

Timing is another key element in getting the right food to the right patient at the right time, he says, and “it is as easy to use fresh produce as frozen”.

A patient’s experience of a hospital stay may be defined, or at least heavily marked, by the quality of food. “The quality of hospital stay is often benchmarked against the food the patient eats,” O’Neill agrees.

And although public patients, and patients with health insurance in public hospitals, may not be paying directly for their hospital stay, this will seldom cost (the taxpayer or health insurer) less than €1,000 a night. It does not seem unreasonable to expect some palatable food to be served during this time.

There’s a cost too, for the hospital, as O’Neill points out – badly nourished patients spend longer recovering in hospital and therefore cost more.

The public hospitals in the State use a variety of arrangements to deliver food to patient bedsides. Some use cook/chill methods – similar to the hot meals served on an airplane. This is effective in delivering food hot but entails greater waste if a patient misses a meal as the food cannot be reheated.

Protected meal times

Other hospitals rely on cook/fresh, canteen-style delivery. Meanwhile, some hospitals do their own cooking and food supply while others depend on the services of large corporate caterers.

The task for O’Neill and her team is to impose some uniformity on these diverse arrangements that satisfies patient tastes and nutritional needs. They also have to take account for an increasingly diverse population and the varying requirements of different age groups – which could be boiled down simplistically to meat and two veg for older patients and “healthier” options for younger groups.

Steering groups have been set up in each hospital and improvements have already been introduced.

In one hospital, for example, it was found that the soup being served as a nutritious starter at lunchtime was killing patients’ appetite for the main course. As a result, the soup is now being served earlier in the morning.

In Mayo hospital, protected meal times have been established so that patients can focus on their eating without disruption from ward rounds.

Further work will focus on the nutrition needs of two other groups frequenting hospitals – the staff and the visitors.