Health and Social Care (Amendment) (Food Standards) Bill [HL]

Lord Rea Excerpts

Friday 8th November 2013 Lords Chamber

[Lord Rea (Lab)]

My Lords, not only the Members of your Lordships’ House but the whole country should be grateful to the noble Baroness for securing this debate.

For too long the topic of hospital food has been a running sore. It has a reputation for being of poor quality and indifferently served, as borne out so clearly by my noble friend Lady Gibson. Often too little help is given to those who have difficulty feeding themselves. This is not to say that nothing has been done about it. As all the previous speakers have said, a large number of initiatives have been launched over the years at considerable cost but with, by and large, disappointing results. Governments of both political persuasions have launched initiatives and guidelines but these have all been on a voluntary basis with no sanctions for non-compliance. Although there have been a number of successes where good standards have been reached, as has been mentioned, many more remain far from satisfactory. Many of us are grateful for the briefing provided by Alex Jackson of Sustain, co-ordinator of the Campaign for Better Hospital Food, which has been referred to. He has drawn up details of no fewer than 21 voluntary initiatives since 1992 which have come to nothing after initial fanfare, as the noble Baroness, Lady Miller, said.

At least four celebrity chefs have been called in to advise the Department of Health. Sadly, their hard work has not had a lasting effect. Albert Roux, for example—to continue the quotation given by the noble Baroness, Lady Cumberlege—said:

“If we have learned anything from the last 20 years it is that meetings, speeches and gimmicks do not work—what we need now is change to the whole hospital food system, starting with the introduction of food standards for every patient meal”.

This lack of progress is shameful when the results of a number of studies demonstrate that good nutrition has a beneficial effect on patients, thereby speeding recovery from infections and other diseases as well as from surgery.

Good, enjoyable food, as has been pointed out, boosts morale, which in itself has healing qualities. A surprisingly high proportion of NHS in-patients have some signs of malnutrition—around 40% by several estimates; an amazingly high number—which delays recovery and lengthens hospital admissions. There is evidence that this has improved little over the years. Good nutrition is likely to save the NHS a lot of money. A recent international study published in the Lancet has shown that faulty or inadequate nutrition plays a part in 40% of deaths world wide. That applies not only to the developing world but to our main problem—chronic, non-communicable disease, which is also very much diet-related.

Another important possible benefit from good nutrition in hospital is that it could act as an example of good practice, or a beacon—an overused word—demonstrating the principles and practice of providing a nutritionally sound diet. In other words, good nutrition could play an educational role in helping patients and their carers to improve their diet after they are discharged. This would be an appropriate task for any institution looking after the nation’s health.

Of course, providing for large numbers of patients in an average-sized hospital on a limited budget is not easy; the logistics of the operation can be formidable. Quality tends to be inversely proportional to the size of the hospital. However, there are examples of good systems in large units that work. Earlier this year I spent a week in UCLH having a knee-joint replacement, and it was clear that thought had been applied to the catering on offer. For one thing there was a choice of menu, although you had to decide on this a day in advance. The food was unexciting and rather too substantial for my post-operative appetite, but was of fairly good quality, courteously served and adequately hot, having been reheated on the ward. A healthcare assistant was on hand to help those with a problem feeding themselves. I am not too sure of the food’s nutritional credentials, however. I found that the halal choice was the most attractively presented and tasty, though a bit too spicy for a westerner. But the experience of friends and relatives in NHS hospitals has not been so good, as my noble friend Lady Gibson most graphically pointed out.

The ward kitchen has an important role. While it is mostly not used for the actual preparation of meals, it is important in their presentation to patients. Its role could perhaps be expanded to include the preparation of simple meals such as a boiled egg or piece of toast for those unable to eat the main meal provided. Perhaps ambulant patient should be able to use the kitchen, when convenient, with the help of their visitors, relatives and friends. They could make a cup of tea, for instance, when they felt like having one.

Sadly, poor nutritional standards are still to be found in some hospital food, as has been graphically pointed out. Recently, as the noble Baroness, Lady Cumberlege, mentioned, one hospital meal was found to have a higher fat and salt content than a Big Mac. As we all know, the diet of many people in England is far from optimal and contains too much sugar, saturated fat and salt, and too few of the vitamins and trace elements found in fresh vegetables, fruit, fish, lean meat and eggs. Dietary intake is more often than we realise too low in many older people. In hospital there is a captive audience, an ideal population on whom to demonstrate how well cooked good food can be attractive, delicious and not too expensive. The food will taste better and may have better nutrient value if it comes from sustainable sources with good animal welfare standards. I am glad that there is provision for that in the Bill.

Why have so many initiatives failed? My guess is that hospital food is of low priority on the agenda of hard-pressed managers who are often struggling to meet targets and stay within budgets. The effects of poor diet do not show up in most hospital statistics, whereas mortality rates or waiting times can easily be measured, and executives and clinicians held to account. The considerable benefit that good nutrition can have is not fully appreciated. Poor ward diets are often complacently tolerated by management because their quality and acceptability is often not monitored. The introduction of mandatory standards with strong sanctions for non-compliance would eliminate any complacency because the relevant manager would be held to account. As the noble Baroness, Lady Cumberlege, said, other public sector institutions and schools are now required to conform to and have adopted mandatory nutritional standards, as has the National Health Service in Wales and Scotland. Interestingly, Compass, probably the largest catering firm in the country, has said that it supports mandatory standards because they level the playing field among suppliers and caterers while maintaining a high standard.

I am puzzled as to why the Government have been so reluctant to adopt mandatory standards for hospital food. A response to Sustain’s hospital food standards campaign was published by the Department of Health in September this year. It does not directly give the reasons for the Government’s reluctance, given that mandatory standards have been widely adopted elsewhere in the public sector. However, I hope the noble Earl can report that the Government are coming round to the idea and will agree to support the Bill.

Before sitting down, I have one question for the noble Baroness, Lady Cumberlege. Clause 1(6) states that the Bill,

“applies to … food provided to patients at a hospital”.

Does this apply to a private hospital as well as an NHS one?