Imagine you are feeling unwell, in pain, lonely and worried about your future health, and you just don’t feel like eating. It is unlikely that you want to eat a large, hot meal that arrives in front of you at a prescribed time, where you are sat in an awkward position and the food is some distance away. This is the reality of mealtimes for millions of people in hospital every day.
Health secretary Jeremy Hunt’s recent announcement that NHS hospitals in England may be fined if not providing “healthy” foods. In the storm of opinion and rhetoric, some asked why the NHS wasn’t already providing healthy food, while others were simply confused about what healthy food the NHS should be offering. The truth is that healthy food as we think of it may not be what patients really need.
What is healthy food?
“Healthy eating” in the popular mind is reducing fat, salt and sugar in food. And as the National Obesity Observatory indicated in 2011 the general public’s perception of healthy was getting their “five a day” of fruit and vegetables. And indeed, Hunt stated that fruit should be freely available on NHS wards. Now there’s nothing wrong with this per se, but these are the very things that aren’t suited to everyone in hospital.
Rather than healthy eating; nutritious, appetising and edible hospital food should be the message. Here’s why: staff and visitors, who are healthy, require a balanced and varied diet, but the vast majority of NHS service users are patients who by definition are ill. Hospital patients have a huge range of needs which may not be met by a traditionally healthy diet that is high in fruit and vegetables.
It is estimated that 3m people are at risk of malnutrition and under-nutrition and as highlighted by the British Dietetic Association, malnutrition results in a poorer quality of life, increased hospital admissions and greater cost to the NHS as a whole. The needs of these patients are best met by a nutrient-dense diet that is higher in energy, protein, and which meets vitamin and mineral requirements.
Fruit and vegetables, though important, may dilute nutrient density, making a diet lower in energy. The second need of this group is that food has to be palatable and easily consumed – small and frequent meals rather than a strict regime of three larger meals a day.
Perhaps provide small portions of appetising foods when patients want to eat, not when it is convenient to do so would be one solution. Or how about offering a wider range of easy-to-eat foods or small snacks rather than large hot meals; assistance with positioning and eating that makes for a dignified, pleasant eating experience? That sounds more palatable to me.
Hunt’s proposals suggest a scheme whereby we advocate change, but to another large-scale, economically-driven system of food provision. But rather than implementing draconian punishment for failing to provide foods which may not meet the needs of the population for which it serves, the NHS should be encouraged to provide food in the same way they do with other aspects of patient care – where they come first.
Food as rehabilitation
I am going to be bold here; I think that patients should not only be screened on admission but that patient food preferences, requirements and nutritional status should be considered as part of their essential treatment plan. Every patient that is admitted to hospital doesn’t receive the same blanket medication, so why should they receive the same food? Food provision must be valued as central to the rehabilitation of patients rather than as a service industry.
I can just hear the cries of “cost, cost, cost”, but these are simple suggestions that could be easily implemented, will reduce wastage, and increase patient satisfaction. This can only make for faster and more effective patient recovery, higher levels of patient experience and a healthcare service to be proud of.