The full horror of hospital food: Last week, after the Mail printed shocking images of hospital dinners, Health Secretary Jeremy Hunt vowed to act. But the crisis is bigger than he thinks

The Mail has been publishing photographs of food sent in by readers



They paint an unappetising picture of meals served in hospitals

Doctors are expressing concerns about the dinners patients are eating

Michael Seres, 45, from Radlett, Hertfordshire, is a veteran of hospital wards

'The quality of the food is shocking,' he says. He now brings in his own



The essentials in Michael's suitcase for hospital include snacks, even sandwiches

Michael Seres is a veteran of hospital wards. The businessman, 45, has suffered from Crohn's disease - inflammation of the gut - since the age of 12, and has been in and out of hospital ever since.



'I've had 25 operations, intestinal failure and, in 2011, I had a bowel transplant,' he says.



Consequently, he has become something of an expert on what he needs to pack for a hospital stay.



Along with his pyjamas and toothbrush, the other essentials in Michael's suitcase include snacks, even sandwiches. Michael has learned the hard way that, if he doesn't take food, he may not eat.



For Michael, diet is especially vital, as his condition means he does not absorb as many nutrients as he should - yet, he says, what he is served on the ward is often inedible.

'The quality of the food is shocking,' says Michael, from Radlett, Hertfordshire. 'So much so that no clinician has ever advised me to eat it. they've told me to bring my own, or buy some from outside.

'The last sandwich I had in hospital was so soaking wet when I took it out of the packet that I could actually wring it out. Eggs and milk always seem to be powdered, which comes out as a congealed lump.



'When I've been served macaroni cheese, I've played games of “hunt the shell” with the nurses, because there will just be three tiny tubes in the entire dish. Part of the problem is that, over the past 30 years, I've seen a lot of hospitals reduce their kitchens, buying in food from elsewhere that's frozen and then reheated.



'By the time it's brought up to the wards, any goodness it had has gone, and you're left with a congealed mess. You just don't want to touch it. I'm lucky - I have family who can bring me food to hospital. And, whenever I go to hospital, I pack some food to take with me.'

Michael isn't the only one. Over the past week, the Mail has been publishing photographs sent in by readers of food they have been served in hospital - and they paint an unappetising picture of what's on offer.



Two boiled potatoes on a plate, accompanied only by gravy. A meagre-looking, white-bread sandwich, filled with a sliver of cheese. an overcooked mound of broccoli next to luminous-coloured sauce. Some photos sent in show meals that look as if they have been burnt.

Now doctors, too, are expressing concerns about the food served to hospital patients. One senior consultant told Good Health he finds it 'unbearable' to see seriously-ill patients unable to eat the food served to them.

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Sausage and fries at Royal Blackburn Hospital Kidderminster, and a hospital’s mushroom stroganoff

'My elderly patients, some of whom have dementia, or who are physically frail, probably have two-thirds of their food left on the plate,' says Anton Emmanuel, a consultant gastroenterologist at University College Hospital, London.



'Patients who are the most infirm are the ones who leave the most. That's common to the point of being almost unbearable. The food is almost always boiled, with mashed potato and broccoli so over-cooked that it's floppy.



'There are often things such as beef stew with gravy and bits of mince floating around it. When I see what's being served, it is mortifying.'

'I've seen a lot of hospitals reduce their kitchens, buying in food from elsewhere that's frozen and then reheated. By the time it's brought up to the wards, any goodness it had has gone, and you're left with a congealed mess'

The poor state of hospital food was brought home to Dr Aseem Malhotra, a London cardiologist, when his 64-year-old mother was in hospital recently with pneumonia.

'What they served her was atrocious - reheated ready meals consisting of salty lumps of processed meat and tasteless vegetables. she could barely touch it,' he says.

He did what many with a relative in hospital do: took in home-cooked meals for his mother. Her mood and physical health started to improve.

'That experience confirmed something I've known for years as a doctor working in hospitals in London and Manchester: hospital food, by and large, is appalling,' he says.

'Yet we know that poor nutrition is a risk factor for patients being re-admitted to hospital within 30 days of discharge, often with a condition entirely unrelated to what they were [first] admitted for.'

The Government now says it is going to take action to help ensure that all hospitals - not just a select few - serve good-quality food.

Last week, Health Secretary Jeremy Hunt said that, for the first time, there would be 'mandatory food standards' enforced through legally-binding NHS contracts, and hospitals that don't provide good enough food could be fined.



Michael, who had a bowel transplant, has seen a lot of hospitals reduce their kitchens, buying in frozen food

Food will be rated on criteria such as quality and choice of meals and published in a league table on the NHS Choices website.



The results so far show while some hospitals have made headway, others have some way to go. For example, Lee Mill hospital, in Plymouth, scores 35 per cent for food quality. Some hospitals scored the full 100.



It's not the first time a government has tried to improve hospital food. Since 1992, £54 million has been 'wasted' on 21 initiatives to try to raise standards, according to the Campaign for Better Hospital Food.



And they would appear not to have worked - a report by Age UK in 2010, for example, found that 180,000 people each year still leave hospital with malnutrition.

And, last year, figures from the Office for National Statistics revealed that 499 hospital patients had died from conditions linked to malnutrition since 2003.



Over the same period, there were 1,323 deaths in hospitals where dehydration was the underlying cause. The Patients Association says it receives complaints - not just about the quality of food, but also the portion sizes.



Mash with carrot at West Suffolk A tiny salad at Newcastle's Royal Victoria Infirmary Chelsea and Westminster's offering

'Patients don't expect restaurant-quality, but they do expect, and deserve, decent and nutritious food,' says Katherine Murphy, chief executive of the Patients Association.



'Great advances have been made in medicine and surgery, but hospital food has, sadly, been ignored. For too long patients have been offered unappetising, unacceptable food.'

So, will the proposals help, and do they go far enough? Many have their doubts, but what is not in question is the importance of giving patients good-quality food. 'Without good nutrition, nothing else works - the antibiotics, the recovery from surgery, or the treatment for diabetes or heart disease,' says Catherine Collins, principal dietitian at St George's Hospital in London.



Not much of a meal at the Aberdeen Royal Infirmary (l) Sausages in a sea of gravy at Southport, Merseyside (r)



A casserole at Barnsley Hospital (l) and A sandwich at Brighton's Royal Sussex (r)



'The problem is no one sees the immediate effects of good nutrition as they do with, say, surgery, so its importance to patients can be undervalued. Yet the people in hospital are generally in worse health now than 20 years ago, as many conditions that would have been treated in hospital in the past no longer are.



'Only the more serious cases get admitted. So the cases in hospital arguably have a greater need than ever for good food, but hospital food is something of a Cinderella service.'

Even simple adjustments to the food and the way patients are fed can have dramatic results, she says.



'Feeding people in the first 24 hours after surgery - rather than giving them the traditional nil by mouth - can speed up recovery and reduce the length of stay in hospital by three days.' Yet not all hospitals follow this principle.

And Dr Malhotra says his heart patients are often served the type of food that is contributing to their condition in the first place. 'I remember one of my patients, in his 40s,' he says. 'I had performed a life-saving procedure after he'd suffered a heart attack. The next day, I was horrified to see he was being served a burger and chips.



Jacket potato at Brighton’s Royal Sussex Hospital (l) Quiche and wedges at Stoke’s Haywood Hospital (r)



Mince and mash at Frimley Park, Surrey Quiche and mash at Aberdeen Royal Infirmary Macaroni cheese at Stoke's Haywood Hospital

Rice pudding at James Cook Hospital, Middlesbrough (l) and Fish, chips and dried up peas at the Royal Sussex



'As I tried to give him counselling about improving his diet and lifestyle, he asked: “How do you expect me to do that when you're serving the same rubbish that brought me here in the first place?” '

So, how did it get to this stage? For some, the issue is the sheer number of meals involved. Regional hospitals have closed, and those left are far larger: St George's Hospital, for example, has 1,000 beds.



To help cater for so many patients, while keeping budgets down, this hospital, like others, has outsourced catering to private firms.



So, whereas once meals would have been freshly cooked on-site, now, they are often bought in frozen and reheated in the hospital. The chef at one Devon hospital, who has worked in NHS catering for 30 years, says this system rarely produces satisfactory results.

He says: 'In the past few years, my hospital has cut a lot of catering staff and switched to a system of buying in frozen ready meals from an external company, then reheating, or “regenerating” them to serve to patients.



'It's quite clear how patients feel about these meals. They don't want them - they ask if they can have salad instead. They'd much rather have something produced from scratch in the kitchen, instead of being served slop on a plate.



'Chefs like me now have very little control over the meals and how they are presented. I have no professional pride any more.'



Nationally, the amount spent per patient per day in our hospitals has increased. Last year, on average, hospitals spent £9.77 a day feeding each patient - up from £8.77 in the previous year.

However, that figure hides large variations. Cannock Chase Hospital, Staffordshire, spends £16.90 per patient, whereas the Northern General in Sheffield spends just £5.48.



It also hides the fact that food still takes up a tiny proportion of the NHS budget - less than 1 per cent. even tiny tweaks to a menu can cost a hospital thousands.

Aberdeen's luminous sauce Meagre fare at Lister Hospital Macaroni at Southmead, Bristol

'A few years ago, we wanted to improve the yogurts we gave to patients,' says Catherine Collins.

'the better-quality yoghurts cost 2p per pot more - over a year, that would have come to something like £8,000. to fund that, we would have had to make cuts elsewhere to the menu, and we just couldn't do it.'



So, with record numbers of hospitals overspending their budget (65 have overspent in 2013 to 2014, compared with 45 the year before) it's unlikely they will be significantly increasing the amount they

spend on food. Yet Peter Gibson, spokesman for the East and North Hertfordshire NHS Trust, which runs the Lister hospital, which still does its own catering, says it's not just a question of money.

'We have 450 in-patient beds. every day, our catering staff have to provide 450 breakfasts, lunches and dinners. the challenge of such mass catering is huge,' he says.

'If there is any delay in getting food to the ward, the food can become a little colder, or the gravy can start to look unappetising.

'If someone serves too much, there will be little or none left for others along the way. Then there are special diets to consider. There are a lot of challenges.'

A pasty, potatoes and beans (l) and Potatoes, gravy - and very little else (r)



So, will the new rules for hospital food make a difference? Dr Malhotra doubts it. 'Although I welcome the fact that Jeremy Hunt is bringing it to the public attention, I think these measures are very weak,' he says. 'What we need is legislation, not legally-binding contracts.



'And he has not addressed the issue of junk food sales in hospitals, either through vending machines, or fast-food chains on-site.

'This is equally important - it's been found that people are more likely to consume junk food if they've been at a hospital that has it on-site. It legitimises it and makes it more acceptable.'



Catherine Collins is less gloomy. 'I think Jeremy Hunt is behind the times,' she says. 'He talked about making sure every patient had water by their bedside and getting dietitians involved in planning menus, but that already happens.

'I'd like better quality, or more snacks, such as a slice of homemade fruit cake in the afternoon, and I'd like to be able to offer a cooked breakfast. With many patients, the struggle is to get enough calories into them - but I'm pragmatic. Where I am, it is about as good as it is going to get.'

The hospital chef from Devon is less impressed: 'I don't think these new rules go far enough. “Standard” is a clever word. Our trust use it a lot.



'They say the system of reheated ready meals, known as “cook-freeze”, is designed to “standardise” the quality throughout.



'That's fine if it's a standard that everyone agrees to be good for the patients, but I don't think it is.'

And what of the patients? Michael Seres says: 'For me, unless there is a cultural shift, unless my hospital food is treated as importantly as my medication, the problem will never be solved.'

