Nutritious meals have been shown to be beneficial to hospital patients, reducing the time spent in care, yet the quality of Irish hospital food varies greatly and is under increasing pressure as cost-cutting threatens catering budgets, writes CAROL RYAN
DR ANTHONY O’Connor, a registrar in gastroenterology at St James’s Hospital, recently spoke out about an issue that seems so obvious it’s surprising it has not been given more attention. The food served in Irish hospitals is often unhealthy and even patients with diet-related diseases or cardiac complaints are sometimes fed fatty, deep-fried food.
Irish hospital meals need an overhaul similar to chef Jamie Oliver’s initiative on school dinners in the UK, says Dr O’Connor. “It would be a good template for hospitals to follow. There are a lot of very talented people around the hospital and in the dietetic department who I am sure would love to get involved in improving things,” he says.
The reputation of hospital food is about as poor as that of airline meals. A poll on ratemyhospital.ieallows people leave feedback about what they are fed in hospital; one person wrote: "I have never had jelly with cracks in it before, and heaven only knows what the icy-cold, tasteless white paste was, it was pudding, I think. When people are sick they need tempting food. There was nothing tempting about what was served."
A patient in one of the country’s maternity hospitals was similarly unimpressed: “Poor food (disgusting muck) . . . not exactly what you need when you are seven months pregnant and the cause of being admitted is high blood pressure.
The quality of food served in Irish hospitals varies greatly. Some hospitals cook meals on-site while others contract catering out to companies producing food in high volumes and at low cost. In 2008, 68 hospitals were ranked on food quality, with only one public hospital, St Luke’s in Rathgar, making it into the top 10. The other nine hospitals in the top 10 were private, suggesting cost is a big factor.
Asked whether public hospitals are under pressure to keep catering costs as low as possible, the Health Service Executive said: “Cost would vary across hospitals . . . no price limits are set, hospitals are responsible for delivering on their commitments set out with the Service Plan within their available budget.”
However, the Irish Examiner recently reported that catering budgets have been cut by 20 per cent from €30.5m in 2008 to €24m last year and that meals in 33 of the 45 hospitals that provided figures cost less than €3.90 each. Some Irish hospitals are spending as little as €2 on meals for patients.
Waterford Regional Hospital served the cheapest hospital food in the country last year, spending €2.03 per meal on average.
In the Bon Secours Hospital in Dublin, all inpatients are screened for malnutrition and obesity to make sure they get proper nutrition.
“After [the patient is] assessed, we decide which hospital menu they receive – for example, a cardiac or a high-protein, high-calorie menu,” says Ilona O’Reilly, the hospital’s dietetic manager.
“It is one of the most important aspects of our job because if someone is ill and malnourished their healing is impaired and they are likely to stay in hospital longer.”
Because hospitals have different catering budgets, she says, food standards lack consistency.
“I have only ever worked in a private hospital and the standard of food and range of menus is second to none,” she says.
“I trained in public hospitals and this was not always my experience. The bigger hospitals don’t have the dietitians and the funding, so a lot of people can slip through the cracks.”
There is increasing awareness that patients’ diets can speed or slow their recovery but the concept is not new. Nearly 2,500 years ago Hippocrates, one of the founders of western medicine, said: “Let food by thy medicine and medicine by thy food.” Malnourished patients can suffer from decreased appetite, reduced cardiac output, slower healing of wounds and higher rates of mortality, so there is good reason to examine the meals served in Irish hospitals.
Designing hospital menus is a delicate balance. Ironically, if some patients are fed in accordance with healthy-eating guidelines, their risk of becoming malnourished can increase. For example, cancer patients need high-calorie foods because their energy needs are greater than those of healthy people and they may already have lost weight because of their illness. Ordinary hospital food is unsuitable for patients with chewing or swallowing difficulties who may need a semi-solid diet. According to dietitians, a tailored approach gives patients the best chance of recovery.
The HSE has said there is a “serious problem of undernutrition in Irish hospitals”.
In 2009 it produced a report that set out minimum standards for hospital nutrition and said “food has to be seen as an integral part of the patient’s medical treatment rather than part of a ‘hotel service’ provided by the hospital”.
One study found 11 per cent of people who go into Irish hospitals are malnourished and 30 per cent show nutritional decline during their stay. Proper nutrition for hospital patients could also save money for the HSE. A study carried out in 70 US hospitals showed patients who got proper nutrition stayed in hospital 2.1 fewr days on average, saving nearly $700 dollars per bed day.
With the health service seeing the effects of the obesity epidemic on a daily basis, more care should perhaps be taken to serve balanced meals.
When health professionals preach the virtues of healthy eating, their message is undermined if a plate of sausages and chips is put in front of the patient.
“Coming to hospital should be a real opportunity to look at your lifestyle,” says Dr O’Connor.
“As doctors we tell people to eat more healthily and often they nod and smile and go back to the same bad habits. We can show patients that healthy food can be tasty and nutritious . . . it is an opportunity to show that we are serious when we recommend healthy food.”
