Garbage In—Garbage Out

It’s not often that techies invent a buzzword but when ‘FIFO’ (the technical term for a serial data buffering device in a computer—first in, first out) was bent into GIGO, a new OED term was born to mean the quality of output for any system is entirely dependent on the quality of what you put into it. As with many cool phrases that come into public use, GIGO has so many varied uses that it has become everyday.

Unfortunately, this applies to some areas where we all wish it was not so, This includes hospital catering. The NHS across the UK has a sterling reputation for dedication by staff and their universal commitment to health for all. That does not, however, extend to hospital food, which has suffered an evil reputation for decades. And now that NHS needs to cut costs in areas other than clinical services, catering has been in the firing line. So parsimonious have some administrators become that patients are being fed for less than £3 per day. (Western Sussex Hospitals NHS Trust = £2.57; Harrow Primary Care Trust £2.75; North Somerset PCT £2.76), to name but three.

On the other hand, Kirklees PCT spends £19.81, University Hospitals Bristol NHS Foundation Trust (£17.46) and Cumbria Teaching PCT (£17.85) but that has done nothing to give hospital food a decent name because they don’t taste six time better. Palatability aside, there are serious questions as to the nutritional value of what is being served. Sandwell and West Birmingham catering output has no proper dietary control because the kitchens don’t operate with menus; dieticians involved therefore must guess whether sufficient nutrients in the right balance are being delivered to patients.

And that delivery itself ought to be under better scrutiny. In the current system, caterers load up trolleys with similar-sized portions to be taken into wards, regardless of whether patients are hungry. Many kitchens have been centralised: meals are delivered from a large facility either in urns (for medium-sized facilities) or ‘plated’ (stacked on trays) for distribution to smaller sites and within the main hospital supplying it.

Catering administrators are supposed to regularly monitor both consumption and quality. Many seem to regard and element of the meal touched (e.g. a spoonful from a pudding) is a meal consumed; outlying facilities simply empty their urns and provide no feedback.

The resulting statistics are meaningless: many trusts report food wastage below 20%, which is bad enough. But more accurate surveys that actually follow the food to the patient and record what they do not eat come up with figures between 40 and 50% wastage. It is not for want of funding. In England, the Department of Health claims:

“The amount of money hospitals spend on food has gone up over the past five years, with the average at £6.53 per patient per day in 2005-06, rising to £8.58 in 2010-11.”

But, looking closer at actual catering, very often, contracts for bulk food prepared outside have been let to industrial caterers like Brakes, Bunzl, 3663, etc attracted by huge amounts of money paid to outside caterers who win the contracts and who are tempted to inflate their costs and use cheaper ingredients to maximise profits. This results in little by way of creative planning by catering managers, a production line for industrial glop in the kitchens and little to motivate—let alone inspire—chefs and staff.

The Campaign for Better Hospital Food claims that between 1992 and 2013 there were 21 failed voluntary initiatives to improve hospital food, costing more than £54m. Journalist and broadcaster Loyd Grossman and celebrity chefs by the cauldronful—Albert Roux, John Benson-Smith, Mark Hix, Anton Edelmann and Heston Blumenthal—have all been drafted in to help improve standards. Things have yet to improve.

But, rather than a few TV shows of terrified toques with bleeped-out swearing, surely the hale clamjamfrie could be fixed by management with a grasp of both spreadsheets and people motivation who set up a catering system with restorative nutrition at its heart, viz:

  1. Set a clear budget per patient that is reasonable and consistent—something like £5
  2. Investigate local produce availability and develop draft menus with dieticians based on sourcing fresh, healthy supplies wherever possible.
  3. Supply menus to the patients who can then order ahead of time = minimise waste
  4. Properly track consumption of meals, using feedback to adjust menu = minimise waste
  5. Allow chefs and other kitchen staff to contribute to new recipes.
  6. Extend this to staff canteens & consider opening them to the public. “Pat’s” at Scarborough hospital not only runs at a profit but has brought food waste rates in the whole hospital down below 10%.
  7. Train staff to serve food properly; medical staff who have other priorities will sling it about like in an Army barracks
  8. Though this may be the bleeding obvious, inappropriate food should not be served to people who have specific medical and healthcare needs.
  9. Establish a “protected meal times” policy on wards so that people can enjoy food without interruption

A culture far too prevalent among ‘administrators’, hired in the nineties to make the NHS more ‘professional’, is knowing the price of everything and the value of nothing. They will argue suppliers down 1p on a box of sauce sachets but ignore when local soft fruit growers have strawberries coming out their ears. Rather than dictating top chefs, they should be following chefs’ directions, all within a clear budget per head.

It requires thinking. But anyone on their salary should be doing that as a matter of course and not foisting some formulaic glop onto patients whose recovery is not helped thereby—just because it’s easier to let the Bunzl rep handle everything. The real scandal is that many patients are prescribed diet supplements just because of the poor nutritional value of much NHS food—and they have a wastage rate (by not being taken) the same as any other prescriptions of around 40%.

About davidsberry

Local councillor, tour guide and database designer. Keen on wildlife, history, boats and music. Stood for the Scottish Parliament 2011; lost by 151 votes.
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