Food is medicine, hospital meals review finds

A shake-up of hospital food is an opportunity for “radical change” that could improve food safety, quality, and sustainability according to a new report.

The Independent Review of NHS Hospital Food has made eight key recommendations on supporting and training catering staff, integrating nutrition and hydration, boosting food safety, improving kitchen facilities, using digital technology to assist, improving sustainability and reducing food waste, enforcing standards, and the way forward.

On food safety the report said hospital trusts must nominate a food safety specialist and a named board member responsible for the food service. There should also be robust food safety management systems, with mandated reporting procedures for concerns, with penalties for not reporting. NHS Trusts must also recognise as food business operators, they are responsible for ensuring food safety. 

The review found “very little evidence” that food standards were being monitored closely enough, and recommended mandatory NHS food and drinks standards (as there are for school meals) enforced by the Care and Quality Commission.

On environment, it recommends trusts use the Defra balanced scorecard to ensure quality and sustainability is factored into procurement as well as straight cost. Food waste needs to be consistently monitored across trusts, and a plan to reduce waste rolled out.

There will be change 'this time'

The review was led by the former head of the Hospital Caterers Association, Philip Shelley, with a panel of advisors including celebrity chef Prue Leith. Both Shelley and Leith admitted there was some initial cynicism among those taking part about whether any action would be taken, as previous attempts to improve hospital food have been kicked into the long grass.

However, they wrote in the report’s foreword “we truly believe this time it is different” due to the involvement of “senior people” and the backing from the PM Boris Johnson and health secretary Matt Hancock.

Johnson’s government has committed to set up an expert group of caterers, dieticians and nurses to take forward the recommendations and decide on the next steps.

The review concluded that its recommendations should be acted upon as “a matter of urgency”.

“It’s in the interest of government to support everyone to lead healthier lifestyles. This cannot be achieved without making food and diet a priority. The good news is that this government does seem to have woken up to the importance of food to our economy and to our health and happiness.

“It stands to reason that where government can directly influence the nation’s diet, it should do so, starting with where it spends our money. Bad food is likely to lead to future ill health and therefore more cost to the taxpayer. The public sector must lead by example.

“Equally, since we urgently need to reduce our carbon footprint and preserve our natural resources; the government should, where possible, prioritise buying sustainably-produced food from UK farmers, rather than foods produced to lower environmental, social, or animal welfare standards, imported from other countries.”

Part Two of the National Food Strategy due to be published next year will include recommendations on how the government can ensure food bought by public bodies – including hospitals – is healthy and sustainable.

Diet related diseases are also equality issues

The report also found the pandemic had “shone a light on the importance” of good food and proper nutrition, including food insecurity and malnutrition, and obesity. And it noted COVID-19 outcomes were correlated with obesity and diabetes, and diet related diseases are also equality issues.

Paying credit to the hospitals already serving “first-rate” meals, the review argued that quality hospital meals could be provided by both in-house hospital teams and by out-sourced private contractors, but that success was marked by common factors.

These commonalities included: a ‘whole hospital approach’ integrating food into the life of the hospital, and valuing the chef and catering team as much as other staff; a CEO who leads change and understands the value of food and nutrition; a focus on what patients and staff care about such as appetising, nutritious food; and integrated multi-disciplinary working bringing together catering, dietetics, and nursing. Best practice examples and further recommendations are included in the report.

Watchdog welcomes report 

The FSA welcomed the report and will be supporting the delivery group. Ceo Emily Miles said: 'We have seen the devastating consequences that foodborne disease outbreaks can have.”

The “root and branch” review into NHS hospital food was launched in June 2019 after nine people contracted listeriosis, across 43 hospitals, and five people died.

The outbreak was traced back to North Country Cooked Meats that had been supplying food service companies providing sandwiches to hospitals.

When news of the infections and deaths broke, there was widespread criticism that high-risk foods like sandwiches were being used to feed patients at all, and why more nutritious meals were not being made available. It reignited the debate around “food is medicine” and public health funding.