The shock of the stew

When French new wave film maker Francois Truffaut asked fellow director Alfred Hitchcock about a dream project that he might one day complete, the British auteur replied that the life cycle of a fruit or vegetable from field to fork was a journey that might receive his unique cinematic treatment. The master of the macabre would surely have, apart from pre-empting our modern fascination with the provenance of our food, been extremely interested in foods gruesome demise in the hands of Irish hospitals catering departments.

Of the recent fallout and huge public distrust in the health service the one area that seems immune to any real change is hospital food and catering. A sort of culinary elephant in the room. A recent survey by Rate my Hospital, the Irishhealth.com's Michelin type guide to the winners (some) and losers (more) in the kitchen gongs, revealed that 40% of patients and their relatives thought hospital food and service was 'below par'. And a patient survey, carried out by the Healthcare Commission in England, has revealed that a massive 81% of people were dissatisfied to some extent with the food on offer in hospitals.

In fact anybody who has the rotten luck to end up in hospital at all has the extra misfortune of encountering its food. The usual cast of characters make their sorry appearance on hospital menus. But of course it is how they are utilized that makes their appearance so sterile and flacid.
Amid the gristle and gruel, the overcooked and the uninspired surely there is an institutional beacon that respects both food and patients alike?

Although the cooking of food doesn't bear much relation to how much it costs, most people would agree that a slighter higher budget would improve the overall quality and choice to patients. But with continuing budget cuts across the health sector it seems enlightened attitudes regarding more funding for hospital kitchens are to be shelved. However in Cornwall a success story has galvanised the public into thinking of a more sanguine future.

The Cornwall Food Programme (with a little help from the Soil Association), which is run at three different Cornish hospitals, aims to increase the “amount of fresh locally produced and organic food to patients, visitors and staff.” And apart from “boosting the local economy” and “cutting down on carbon emissions”, by all accounts, the food is'nt half bad either. What is remarkable about the food programme is that it all comes within the NHS/government food budget of £2.50 per patient that has lead to an “increased turnover” and all round feel good factor for the local population and economy including the “local farmers and food companies.”

The Cornwall Food Programme, run by the Cornwall NHS Hospital Trust, is doing what 'Jamie's Dinner's' did for canteen food in schools but without the celebrity zeal. But while Jamie replaced the dreaded 'turkey twizzlers' with something far more wholesome it was still catering on a large scale. In Cornwall, with organic and local to the fore, a sense of intimacy and respect for food has been acknowledged. Roy Heath, the Sustainable Food Development Manager at the Cornwall Food Programme said the need for re-evaluating the role of hospital food in the south west of England came about by his boss, the head of the Cornwall Hospital Trust, who felt compelled to act on a grievence of one particular patient. “It was the concept of my Boss Mike Pearson. A patient (in one of the Cornwall hospitals) saw a sandwich that had travelled 300 miles and asked why we were buying sanwiches that came from Oxford? He wanted to find local companies who could make sanwiches. (The idea of) having local milk, yogurt, vegetables and cheese was not driven by the government but by us. It was very logical.”

The government in Britain, however, has been slow to see the benefits that the programme has brought to the south coast of England, worried that the needs (i.e. bigger kitchens, specifically trained chefs) of the hospitals are far too great to invest in. But paradoxically, like a lot of hospital kitchens in Britain and Ireland where the kitchens are so small that the food is usually outsourced, the food in the Cornwall Food Programme's three hospitals are prepared off-site and cooked in mobile units. “The hospitals don't have kitchens, they have mobile fridges and ovens on wheels”(or Recove trolleys), says Roy Heath.

Although conventional kitchens with real working chefs who chop, dice, pluck and gut should always be top of any hospital agenda the reality is far more complex for institutions with little or no kitchen space. “Its about us being innovative. All food and dishes are designed for the regeneration process . Its a varied menu with dietary elements”, remarks Heath. He uses the example of freezing sponges for cakes. These sponges are easily re-heated in a Recove trolley, almost on demand and that cabbage and kale are ideal for freezing also.


The paucity of fresh and local produce in most hospitals, unfortunately, is not enough to provoke largescale ire among patients and the public. In Cornwall however the umbiblical chord from farmer/producer to patients in hospital beds is one that doesn't look likely to be severed anytime soon. Roy Heath has seen the benifits first hand. “What do patients like? People in Cornwall like food they can relate too, like the fish is local and the beef comes from the South West. That is very reassurring.”

The catering department in Irish hospitals have a reticent ally in the government. The less government meddling and involvement with food the more likely we are to accept its fate as something peripheral to our lives.

There is no doubt that giving patients better and tastier food would speed up the recovery process. But if patients aren't inspired by whats on offer and reject the food either physically or psycologically there will be an obvious slow down in the rehabilitation process. Hospitals will tell you that all their food and cooking adhere to all the nutritional guidelines, but somewhere along the line our fascination with diet and nutrition has become more important than the pleasures of eating and taste.
Nutritionist Paula Mee agrees. "This is not really a nutrition issue – they may be following the nutrition guidelines drafted by the government but its how they execute it – that is how and when the food is prepared and cooked that has an enormous bearing on the palatability, look, and taste of the food. Mee sees the advance preparation of food as a stumbling block for any nutritious value “Even if you start with top quality fresh ingredients, preparing food in advance to cater for large numbers can leave it nutritionally compromised”, she says.
Besides how much nutrition can a carrot or broccoli have once its inherent usefulness have all been cooked out of it?

Roy Heath would dread a return to the, fairly recent, dark old days. “Some of the food was good but some was dire. Yogurts were dire, the icecream was like wall paper paste. Contracts were hampered by money. (We now) have fish cakes using sustainable local fish and cornish potatoes. And the fish supplier makes the fish cakes to our own recipe. We control the salt.”

Projects like the Cornwall Food Programme, with their ethos based around the idea of sustainability and awareness of the local community, may seem a long way off over here but with the recent public mobilization and huge interest in animal welfare, organic and local growing and the allotment movement we can remain cautiously encouraged that that energy will trickle down, or possible up, to the powers that be. Whether Alfred Hitchcock would have made a suspenseful and ghastly mystery out of it is another matter.

http://www.cornwallfoodprogramme.co.uk/

Hospital Food Blogger.

The Blog, Notes from a hospital Bed is an irreverent look at, among other things, the culinary tribulations of a bed-bound journalist, Traction Man, as he negotiates the NHS's daily kitchen menu. The self confessed 'Poor Sod' asks us to ponder what the effect of using your soup spoon to eat your pudding has such matters of taste. "Not necessarily a bad thing, depending on the unpleasantness of the dessert". He queries his 'last supper' of cream of vegetable soup before an operation. "I would have thought a condemned man might have been able to choose something a bit special like a juicy steak, guinea fowl or humming bird tongues in aspic, but, in the NHS, it appears not". And questions the ubiquites nature of that liquer blanket we call Custard. "There to keep old people hydrated. Old people may not drink water but they lap up custard like a cat". His posts, accompanied by his own, sometimes goulish, photographs, will come as no surprise to anyone who has had to undergo the turmoil of an overnight stay in hospitals over here.

http://hospitalnotes.blogspot.com

This is an extended version of an article that was first published in the Irish Examiner on 19/02/10.

Ken Doherty is a chef and journalist.