Right recipe…

primary_care_training_chef_hospital_food_NHS

The food was spectacular.

Moroccan lamb and couscous, sweet and sour chicken and special rice, a fish dish in a sauce to die for… wow!

I guess it was no more than you would expect from the chefs at the globally renown, Celtic Manor Kitchens.

The Manor has hosted the Ryder Cup, celebrity weddings, international conferences and best of all a fabulous super-n-vintage prestige car show… not to be missed.

I’ve just spend a couple of days there and I can tell you five-star doesn’t do it. It was fab-u-lussssss.

I was the guest of the Hospital Caterer’s Association. A huge conference. This is an extraordinary, 70 year old organisation of dedicated professionals who may not stand at the bed-side, but every day, their work arrives at the bedside; to nourish us, cheer us up, respect our dietary needs, all for less than the small change you have in your purse.

Hidden health-heroes if ever there were any!

They ignore the political boundaries; Scotland, Northern Ireland and England were the welcome guests to the Welsh Branch, to spent time together in fraternity, collegiate thinking, the pursuit of excellence and learning from each other.

Just how it should be.

Based on the presentations I saw and the conversations I had, I’ll tell you what I learned… my personal observations of this extraordinary group of people struggling with doing more, for less, making a meal from it, without making a meal of it…

There are four ingredients procurement systems in play and in my view, of the four, the English system is about the most confused, unpopular and likely to fail.

However good they are, or not, English Trusts are obliged to pay for their services, whether they use them or not, however well they perform, or not.

Bad call…

Of the others; there is a rationale to their mission; no impetus to make money before saving money and the Welsh system, based loosely on the old English Hub model, owned by the Trusts, is the one I would go for because I well remember how popular and successful they were.

The other two are centrally run and there isn’t much to choose between them. Frankly, anything is better than the bewildered, opaque English system.

I have no idea why four nations have four systems to buy a can of beans. It’s bonkers. There is no political mechanism for them to work together.

What else did I learn?

‘Food is medicine’. That’s for sure, but… the problems are two fold:

Nutrition screening and assessments, obligatory in Wales are, now becoming flavour of the month elsewhere and are an obvious good idea.

We spot the deficiencies, prescribe supplements and special meals and here’s the but…

… when the patient is discharged… nothing happens. There is no follow-up in the community or care homes. No nutrition care pathway.

We might as well give everyone a bag of Maltesers and a can of Coke. It will need decisive political thinking to fix this.

The second but…

I also learned exciting new menu-software is emerging, reducing waste, pin-points choice and makes the job a lot easier for catering departments, procurement and better choice and easier ordering for patients.

However, for some unfathomable reason, it may not connect with hospital PAS systems, and does not inform patient records, to pick up dietary needs, preferences, ongoing nutrition red flags, discharge dates or any of the data, so valuable to contributing to a real understanding of how the organisation is working.

Reason? Some confidentiality non-sense that I really don’t understand and with political help, could be fixed. If food really is medicine, this is akin to locking the pharmacy out of the system.

And, that reminds me of something else.

Waste… we have no real idea what the numbers are. What we know is based on anecdote and interviews. It’s an educated guess.

Report here, see 1.4.

We can guess, in total, the stuff that gets chucked out, but… we don’t know, accurately, if it is chucked out in procurement, preparation in the kitchen or store or chucked-off the plate on the ward.

There is huge pressure to reduce waste but we can’t measure it properly. My guess is, there is far less waste than we think and in any catering organisation there has to be an element of managed capacity.

In the hospitality and catering industry on average 21% of food waste arises from spoilage; 45% from food preparation and 34% from consumer plates. Again, this is based on a guesstimate… how do we compare?

Dunno…

Hospital food is a global byword for bad food and at the butt of our jokes. It has to shake off this undeserved image…

… sure there are examples of tired sprouts floating in a lagoon of translucent gravy and that underlines the fact that it is the last nine-yards of the food’s journey, from the kitchens to the bedside, that matters.

There’s a hint that the more enlightened hospitals are starting to think about reinventing the ward kitchen… what goes-around, comes-around.

The Celtic Manor food was a real delight and here’s the kicker…

…the chefs had used the all-Wales NHS menu recipes… we were eating hospital food and didn’t realise it!

There is a lesson, hard learned lesson, a lesson that we are so slow to come to but a vital lesson… you can’t change anything from the top, behind a desk.

If you want to find out what’s good, what works, what could be done better, what need changing, ask the people doing the job.

The Hospital Caterer’s Association has a menu of change and all the right recipes.

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Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.