Hospital Food

Food for the Sick

Krankenhausessen

It’s so fucking weird that people are still allowed to smoke at hospitals. It’s ironic, and seems counterintuitive.

A lot of people said this, or something similar, to me during my recent one-month stay in hospital. What people don’t seem to look at with the same irony, though, is hospital food.

I don’t just mean the unappetising, sloppy piles of mush we usually think of when we think of hospital food. The alternative on-site food options for patients (and staff) were basically limited to vending machines stocked with sugary soft drinks, fatty snacks and chocolate bars.

Slamming hospital food is not exactly groundbreaking. Hospital food’s bad reputation is well established basically everywhere. Some hospitals are bucking the trend and consciously trying to tackle the problem. For example, dozens of New York City hospitals have voluntarily signed up to the Healthy Hospital Food Initiative since 2012, which means they adopt the Health Department’s Food Standards, promising to meet certain nutritional criteria in the food they offer through patient meals, vending machines and staff canteens.

Some people become institutionalised and like hospitals, including the food – I certainly felt a pang of sadness the first morning back at home, when 8am rolled around and I realised nobody was going to bring me breakfast in bed – and many people would say that it’s not the most pressing issue in healthcare, which is arguably true (after all, people are being fed, aren’t they?).

In general, however, it’s safe to say this – hospital food is in a sad state. It’s symbolic of the modern western medical system as a whole: the holistic, preventative approach gets ignored in favour of the instant, reactive remedies. The box of pills served on lunch trays is more important than the food beside it.

Most hospitals – at least in Europe, the UK, North America and Australasia – now serve meals supplied by third-party catering companies. These are usually made in massive industrial kitchens, frozen, and shipped or trucked all over the place to be reheated (microwaved or put under intense steam) at the hospital. The main advantage of this system, and the reason hospital boards and executives so readily sign up to it, is that it’s cheaper than making your own meals on site. The fact that such a long production (not to mention procurement) chain can be considerably cheaper than making food on site gives you an idea of the mammoth scale on which these industrial caterers operate.

This system has obvious drawbacks. Although there are (often arbitrary) minimum nutritional standards that need to be met, there’s little goodness left in the food after the process of cheap procurement from hard-to-trace suppliers, additives to help the food survive its long journey, and the freezing/microwaving process. This is not your grandmother’s fresh, hot chicken soup that cures all ailments.

Then there is the issue of food waste, which is bad enough in hospitals with their own kitchens but enhanced in this industrial supply system. In addition to the fact that these meals are often aesthetically unappealing, or may have been over- or under-heated by hospital staff (remember, in these instances most of the kitchen staff were fired so it’s often the nurses’ task, and they have other things to worry about) there is little control over meal type and portion size. This means little admission can be made for various requirements (for example, a smaller serving for elderly or young patients, or meals prepared according to different cultural, religious or personal preferences) so more meals go uneaten, or partially eaten.

Orders are often made days in advance, so patients may be discharged, in surgery, or on a special diet by the time it arrives. Once these meals are heated, though, they cannot be served or reused (unlike, say, a hospital kitchen that prepares too many fish fillets one day and can then use them in a fish pie the next), so they’re thrown away. The same goes for any untouched sachets of jam, plastic-wrapped muffins or the like – hygiene regulations, you know.

Despite the economic benefits of this system, there are ‘hidden’ financial costs – well, at least less obvious to hospital executives keeping an eye on the budget. For one, that food waste issue not only has environmental and ethical elements, but clear-cut economic ones: in UK NHS hospitals alone, between 10 and 30 million meals are thrown away each year, costing about £230 million in wasted meal or waste disposal costs.

There is evidence to suggest that huge costs are incurred from long-term hospital patients requiring dietary supplements and additional care once they leave hospital, due to malnutrition. A British University Hospital recently released a report detailing significant – we’re talking 20% significant – energy savings when they removed the electrical costs of freezing and reheating those millions of ready meals by switching to a local kitchen. That report also found that when patients were eating freshly made meals, using quality, traceable, locally sourced ingredients (let’s ignore the whole ‘stimulating the local economy rather than outsourcing to a multinational’ factor for now), they wasted much less because the meals tasted better, and patients actually ate them. More importantly for those balancing the books, patients on average returned to health and were discharged much sooner.

In my case it was easy to see hospital food in a funny way – a temporary evil, a cliche that provided a good topic for small talk with visitors. Although my diet in hospital was much worse, nutritionally, than what I usually eat, the worst effect I had to deal with was thanks to the scarcity of fibre in the hospital diet (it’s not easy to produce a stool sample on demand when you’ve been eating mostly refined carbohydrates, cheap meat and plasticky cheese for weeks). A lot of people don’t have the same luxury. They have no alternative to the meals they are given, and they may not be out of hospital any time soon.

Hospital food has been in the news in New Zealand this year, after a certain major international catering company – the same one that provides the bulk of meals for NHS hospitals in the UK, and the same one that was embroiled in a scandal a decade ago for bribing the UN to win contracts to supply meals for peacekeepers in the Middle East – signed a 15-year contract with the Southern District Health Board to take over their meal supply, as a cost-cutting measure. The response was harsh, and very public, with protests, complaints, massive wastage from uneaten meals, and reports that doctors are now advising patients to have relatives or friends bring food into the hospital for them, rather than eat the provided meals. At that point, it’s clear there is a problem.

Well, there are numerous problems, and given the big boys involved behind the scenes, it’s hard to see the system changing any time soon. If it was easy to convince board executives and budgeters that closing kitchens and outsourcing hospital meals will save money, it seems almost impossible to convince them that investing millions into installing kitchens again, and paying kitchen staff, will save money in the long term.

But surely it’s not just about money. How do we so readily accept something potentially damaging to health in the places we believe are making us healthier? Hospitals and other institutions are largely immune to the consumer-led changes that have seen supermarkets and restaurants slap marketing buzzwords like ‘organic,’ ‘bio,’ ‘local’ and ‘high-welfare’ on their products to make them more attractive. Still, there must be something we can do. Even if it’s just lingering a little longer next time we joke about bad hospital food to consider that it’s actually not that funny. In fact, it’s pretty sad. Scary, even.

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