The food expert's tale

<em>NHS in crisis</em> - The food expert's tale

The National Health Service spends around £500m a year dishing up roughly 300 million breakfasts, lunches and dinners. Despite these huge figures, catering is a very, very small part of the colossus that is the NHS. And yet how, when and what we feed our patients and staff are issues of great importance, for two reasons. First, good and appropriate food can bring tremendous benefits to the health and well-being of both staff and patients within the NHS. Second, although catering may be a tiny corner of the battlefield, the effort to change and improve it may have lessons and implications for the way in which other parts of the NHS evolve.

In July 2000, Alan Milburn, the Secretary of State for Health, unveiled the government's ten-year vision for the future of the health service. In the weeks that followed, the newspapers were full of stories speculating, among other things, that a leading "television chef" was going to be approached to improve NHS catering. The names of the usual suspects were bandied about. Anyone who has been appearing on television for a while - I regret to say I made my debut in 1983 - knows that you are frequently asked to do any number of things. These may range from opening a Volvo showroom (I confess I once did so with Miss Sweden, who, in order to prove that her talents extended beyond mere Nordic beauty, dazzled the audience with an inexplicable a cappella rendition of "Santa Lucia") to slapping your name and face on a product, a charity or even a government initiative. Celebrity endorsements, which can generate large amounts of publicity, are quite easy to obtain - because, in many instances, money is involved. Celebrity involvement, however, is altogether different.

I happen to know a little bit about the difference between celebrity endorsement and celebrity involvement because I'm in the food business. Experience has taught me that effort has got to be made and time spent if associations are to succeed in the longer term. Because I'm not just a pretty face, I only do things that allow my complete involvement. This is important in relation to what comes next.

And what comes next came in October 2000, in the form of a letter from Alan Milburn, asking me to get together a team of chefs to look at ways of improving NHS catering. The usual discussions with officials followed. I agreed to take on the job on condition that I was not to be paid; that committee meetings and paperwork were to be kept to a minimum; and that we could concentrate, in the first instance, on simple and practical ways to get things done. I was satisfied that this effort was neither a stunt nor a gimmick; I also made it extremely clear from the start that I was not involved in any form of party politics, and intended to remain that way.

Seven of Britain's best chefs agreed to join my team, and we were off. Unsurprisingly, the involvement of the chefs and me was widely covered in the media with the usual mixture of amusement and cynicism: it wasn't long before there were stories circulating about "gourmet food" (whatever that is) and radicchio turning up on the NHS menu.

The cooks on the team were also described as "celebrity chefs". Although they may be at the top of their profession, I would say that only a couple of them are familiar names to the general public. You wouldn't expect to see any of them on a game show or opening a Volvo showroom. I should also add that I hate radicchio. Nor has there ever been any intention to introduce anything other than simply better food: the idea of trying to replicate restaurant-style dishes in a hospital environment is a non-starter.

Coincidentally, I had a long-standing arrangement to appear on the BBC's Question Time shortly after the appointment was announced. The Dome, privatisation of the air traffic control system and the so-called European army were all on the agenda in Bolton that November evening, but what really wound up the audience was the issue of NHS catering. There was a heated discussion which showed that many people in the audience - and presumably around the country - viewed any attempt to improve catering (or, it seemed at the time, any other aspects of the NHS) as a gimmick, and a politically motivated one at that.

I must admit that I was horrified and very cross. Was I naive? Or had I been misled? My simple view was that an opportunity to improve things for millions of patients was an opportunity not to be ignored.

As we began the real work of visiting hospitals around the country, it also became clear that there would be considerable opposition from within the NHS. After all, who were we to tell people far more experienced in the health sector how to do their work? Was our presence going to be regarded as proof that they had not been doing their jobs properly?

It was vital to collaborate with caterers and administrators, nurses and nutritionists and above all to listen to the patients. Fortunately, there was a growing feeling that the NHS must become a more "patient-centred" organisation. This may sound like management speak, but it makes the point that the needs and the feelings of patients have to influence every aspect of the way the NHS behaves.

Food is one very tangible and immediate way in which the health service could respond to patient needs. A commonsensical look at the catering gave us our first set of targets: more and fresher-tasting dishes, a change of mealtimes to reflect eating habits in the outside world, better provision of snacks and a move towards 24-hour catering.

After a year and a half, a number of things have happened. The team of leading chefs now feeds into a larger and very broadly representative group called the Better Hospital Food Panel. New, improved NHS catering is beginning to be offered in hospitals all over England. I wish that implementation was faster, but size (again) slows things down and old habits always die hard. Some patients have not liked what we've done - apparently, the thought of couscous stirred a minor revolt among the ailing of Preston - but most patients have welcomed the innovations.

This year, we want to focus on improving the status of NHS catering and to make more apparent how it would benefit our national health needs. Malnutrition and dehydration affect far too many NHS patients; food and drink is cheaper than the cost of treating the malnourished and dehydrated. We must do something about those bedside jugs of water, and see if we can find a better way of getting hot and cold drinks to patients when they want them. We are also trying to satisfy the mind-bogglingly varied demands for menus that are culturally, religiously and nutritionally appropriate. Are elderly patients getting the right amount and the right sort of food? What about NHS catering for children? And why do so many patients have to eat in bed as visiting family and friends perch awkwardly around them?

There is a lot to do. But nothing can be done unless we change the nature of the public debate about the NHS. Any public body that spends a billion pounds a week is bound to be an object of considerable scrutiny and subject to a million different opinions on how it should be run.

But, without question, the savage partisanship that seems to surround any discussion about the NHS is stifling progress and innovation. There is a great deal to be fixed in the NHS and catering is only a small part of it, but if goodwill and common sense are unwelcome, what hope do we have for improving it - or, for that matter, any other of our ailing public services?

(www.healthdebate.co.uk)