The NHS: serving sub-standard care one meal at a time

Last night’s really rather depressing Dispatches programme, on Channel 4, ended with a rousing signal to arms, a clarion call from journalist Mark Sparrow for there to be “a patients’ revolt”. Over what? Well, hospital food, now you ask. And good luck to him – and any patients who do decide to revolt over it. It’s a disgrace. But I can’t help thinking that nothing will be achieved in terms of patient care. There might well be a couple of new guidelines issued – I daresay perhaps a consultation or two launched – but what we’ll probably end up with is a new rule that every meal must be accompanied by a bread roll, or that lasagne must be served every ninth day. You know, the usual top-down, target-loving, bureaucratic rubbish.

There was a very telling moment halfway through the programme when Sparrow was talking to a ‘food consultant’. Why, he asked, was hospital food so bad across the board when everyone knows that a good diet is essential to recovery? The answer began with a few generalities about ‘cuts’ but then moved to talk about the directives that had been issued following a number of well-publicised MRSA scandals. Filthy hospitals were contributing to deadly infections and people who had gone in for routine procedures were leaving in the charge of a coroner. A disgrace. The government’s response? Centrally mandate that all hospitals be ‘deep cleaned’. In many cases, the hospitals’ response? Pay for such deep cleaning by siphoning the money away from the food being given to patients. No doubt savings could have been made elsewhere, but a bureaucracy never looks to cut itself.

Throughout the show we were invited to guess what meals we were looking at. The lasagne that looked like cold vomit, the chicken casserole that had travelled two hundred miles before being reheated in a microwave, the Hungarian beef goulash that was neither a goulash nor contained beef. It might have been blackly comic if the results weren’t often so tragic. We met the cystic fibrosis sufferer who frequently lost a great deal of weight whenever he had to go into hospital for treatment. Doctors knew that he needed a high protein, high fat diet because of his condition, but he could not get it because centrally-created regulations determined salt and fat levels in patient food. Nationwide. Regardless of circumstance. An NHS dietician lamely told us that a lack of salt might make the food taste “a bit bland”. Not quite the issue that the bag of bones on Ward C was concerned about.

Elsewhere we travelled to the midlands, to Good Hope Hospital in Sutton Coldfield (recently in the news again) where several old people had died through neglect. Food was being served to them; or, more precisely, put in front of them, where they lay too weak to sit up and feed themselves. No-one helped feed them; presumably because it was no-one’s job. And the hospital’s response to a family who had lost their grandfather in this manner? A weak apology and a promise that “systems had been put in place” to ensure that patients were now definitely fed. Saints be praised.

James Bartholomew’s seminal The Welfare State We’re In contains the chapter ‘The NHS: like a train crash every day’. It’s a provocative statement; but it’s also totally correct. The NHS falls well behind the health care systems of other developed countries in terms of mortality rates, cancer survival rates, stroke outcomes and heart disease. It also presides over huge regional health inequalities – when surely its sole remaining selling point is that it provides a universal service where “poverty must be no bar to health”. It does this because it is unwieldy, centrally-controlled, politically-directed, target-driven, and run for the benefit of those who work for it rather than those who are treated by it.

Throughout last night’s show we also met the many people working hard, on the front-line (to utilise a well-worn phrase), to improve standards for patients. We heard from Loyd Grossman, who had worked for five years, and had eventually given up in disgust, trying to improve hospital meals. It is a tragedy that the efforts of these people are wasted in the midst of a bureaucratic nightmare that, in Grossman’s words, has a “prejudice against common sense”.

So what are we to do? The programme asked us to sign a petition that will be sent to Andrew Lansley. Or we could write to Anne Milton, the “minister in charge of hospital food” we were told. And, yes, let’s do both those things if we want. They might change things a bit. Possibly.

But as free-marketeers we must do more. We must throw our energy into showing people that there is a way that things can be better. No longer must we, as a society, be wedded to the idea of centrally-run, politically-driven healthcare that is “universal” only in the sense that it is almost uniformly sub-standard. If we are going to write to Andrew Lansley, let’s tell him that we want our share of the collective pot, so that we can spend our money on the care that we want, and that we can be treated as clients and customers as opposed to afterthoughts. Let’s tell him we want the Singapore model of private accounts. Or let’s have our taxes lowered so that we can keep more of our own money and have the freedom to spend it as we wish.

Just let’s please not have all the entirely justified anger that last night’s programme will generate impotently culminate in a consultation and then a set of new directives. I simply can’t face having to eat lasagne every nine days while I wait for my stitches to heal. Not least when it looks like cold vomit.

I worked in the NHS briefly (during the 1990s, in the South East). Although it was fascinating, the fascination came from having a daily display of how not to run things. On the meals front, the daily budget was about 50p per meal per patient. At the time, prisoners were budgeted £1.20 per meal. I do not wish to bring the debate down to the level of "why are they getting better food", but would like to point out some public services can and do offer better food. I hesitate to suggest a supine invalid is less threatening to those with the purse-strings than a chair-leg-wielding rioting prisoner, and as a result budgets for prisoners are higher, but the conclusion is hard to avoid, so one can forgive Mr Sparrow his call for revolt. However, on the basis that almost everyone I worked with in the NHS could see the ludicrous nature of some - most - practices on a micro level, all baulked when it came to macro solutions. Thus forcing change via break-up of our "beloved" NHS (ie beloved insofaras the nostalgic view we have lasts right up to the point where one, or one's loved ones, are admitted and run into the less-wonderful areas of service) really is the only option. We just have to find a name for change that is deemed acceptable.
Discussing with a devout believer in the NHS is like discussing with a devout socialist: If you name the failings of socialism, they will not deny any of them - they will simply respond: "But the idea is noble." There is a strange disconnect between the real NHS that everybody complains about, and the "idea NHS" that is still very popular. Winning the war of ideas is like a bathe in dragon's blood: It makes invulnerable. Nobody who believes in the nobility of the NHS will change his mind because of the occasional scare story (although this one is scary indeed). It's the idea itself that has to be confronted head-on.
Very interesting and fair review. I would say that, wouldn't I? I'm sympathetic to all sorts of solutions to tackle this scandal. I'm convinced choice and competition can work. If hospitals insist on reheating food and not having kitchens, then ask Birds Eye, Tesco and M&S to stock the food cupboard and let patients choose. Whichever supplier the patient chooses gets the cash. Competition keeps them on their toes. THis could be paid for by better meals which would mean people could get out of hospital earlier and stay out. It could be revenue neutral or even save money. The multinational pedlars of cook-chill rubbish could then close down.
I agree that standards in NHS nutrition are poor and the facts speak for themselves that most patients come out of hospital malnourished. However I thought Mark Sparrow's approach was a little childlike at times. The lasagne admittedly looked gross but the chicken pie looked like chicken pie, the sausage casserole looked acceptable and did a gristly piece of bacon prevent him eating any of the potato or vegetables that accompanied the dish? Jordan remarked 'it tastes like smash' to his potato balls - I had a friend that pretty much lived on smash for 3 years at uni and it didn't appear to do her any harm. I do not believe patients need venison sausages in order to get better - we do keep forgetting that the NHS is free healthcare. I have paid for food and received worse meals than some of the examples Sparrow was showing, and you bet that only the worst meals he had made the Dispatches edit. I don't wish to sideline Sparrow's arguments - I think NHS meals are poor, they provide too few calories for an individual needing to make a recovery and they need improving. With the massive cuts the NHS are receiving, we are losing precious frontline services. I think we need to be grateful for our free healthcare and accept that the food we receive isn't going to be like our wife or mum cooks. There are many NHS Trusts that are doing well with the limited money available to them, without going to the extravagence of venison sausages, and it would have been nice if Sparrow had touched upon them too.
How can you expect to be taken seriously with a fatuous comment about the NHS being free? It's not free! We pay a lot of money for it through taxes and NI. As for venison sausages, they were great and a good sources of low cholesterol protein. The Royal Brompton spends the NHS average of £4 a day so it's no more expensive than slop. I wish people like you would pay attention and listen. It's your view that we should be grateful for whatever the NHS gives us because it's free that stops it becoming a better service.
I must agree with Mark, the NHS is most certianly not free!! and nor should we be lying there with cap in hand meekly accepting whats being dished out to us by commerical catering contractors. It's not the food thats the problem it's the arrogant attitude of self important, overpayed executives trying to justify thier jobs to some board of trustees who will never set foot in a NHS hospital as they (and the hospital chiefs) have private medical schemes. Until we seriously start putting patient care at the top of the agenda, there will be no change in the quality of hospital food. Even the best food in the world will do no good for the patient who is unable to feed themselves. Good Food will not stop hospitals from incubating and spreading MRSA While there are multi-million pound catering contracts to supply primary care hospitals up for grabs, where the tender invites the contractor to administer a profit percentage kick-back to the hospital, there will NEVER be good hospital food. Sad but true
'Flic' says: "With the massive cuts the NHS are receiving, we are losing precious frontline services. I think we need to be grateful for our free healthcare and accept that the food we receive isn't going to be like our wife or mum cooks." For a start there are no "massive cuts" in the NHS. HNS spending will continue to rise (albeit slowly) in real terms. Secondly, it's not free - it is paid for by our taxes. Thirdly, according to the NHS Institute it costs around £225 per day just to keep someone in an NHS bed. We know that nutrition is extremely important for health - more so for those already ill, so the savings from skimping on food will be tiny in proportion to the total. How come we do this while paying our medics more than any other country in Europe and subsidising guaranteed index-linked pensions to all the staff?
As a mother whose 26 year old daughter spent 3 weeks in Good Hope Hospital let me state that most of the ill people I seen never ate. The food was placed on trays they were either to weak it was too far away from them and every body ignored them.i spent every day on the ward and found it intriguing the idea of protected meal times. Protecting who I never saw one person being helped with food or drink.I think hospital managers/nurses need this Protection so no-one can see what is actually going on.Most depressing to see all the wasted food thrown into bags.
[CONTENT REMOVED BY MODERATOR] Sort it out NHS, get Jamie Oliver to fix the problem [CONTENT REMOVED BY MODERATOR]. Food is for healing, particularly in hospitals! Don't serve slop, the public deserve BETTER, especially of the vulnerable patient kind!

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