Why better hospital food may lead to more waste
Consultant Matthew Merritt-Harrison looks behind the headlines at the latest figures on food waste in NHS hospitals.
Recent figures from the Department of Health showed a rise in food waste from 8.9% in 2001-02 to 10.7% in 2003-04.
While the number of meals thrown away may have increased, to suggest that this is because of failings in the Better Hospital Food programme or declining standards in hospitals is a gross misrepresentation of the facts.
Moreover, the method of calculating waste has been changed and the figures are not on a like-for-like basis.
In hospitals that use a plated system, meals have to be ordered in advance to allow the production and plating process to happen, and while there is low waste in the kitchen, the wastage at ward level is higher, usually for medical, admission and discharge reasons.
Bulk systems also have low levels of kitchen waste, but even higher levels on wards. Once food is sent to a ward, unless it is consumed at that mealtime, it cannot and should not be re-used in any way.
The Department of Health's recent report, Managing Food Waste in the NHS (2005), set targets of 6% waste in plated meal systems, 12% for bulk and 10% plate waste at ward level. These are tough but not unrealistic targets.
A number of developments have taken place in hospital catering, many of which have improved the quality of food and service to patients and yet, as a side effect, have increased the wastage levels.
One of the key aspects of Better Hospital Food is to increase nutritional intake by extending patient choice. As the number of options available is extended, this has a resultant impact on portions left at the end of service.
Would those criticising the level of waste prefer lower waste even at the cost of reducing nutritional intake for a vulnerable group?
There has also been a movement towards choice at the point of service, which brings real benefits to patient care.
Yet this, by its nature, increases the level of food remaining at the end of meals. If only the correct number of portions is sent to a ward, the last patients to be served may have no choice at all. This is unacceptable.
The trend towards cook chill/freeze, particularly in the growing number of PFI hospitals, results in significant space and capital savings. However, the majority of cook chill/freeze products are packed in eight- or nine-portion containers (although some suppliers do offer smaller containers). The consequence of this is that, in regenerating larger packs, some wastage is inevitable.
The question we have to ask is not "Why is waste so high?" but "Is the current level of waste reasonable in order to improve the quality of meals and speed the recovery of those we have a responsibility to care for?"
Of course we all want to minimise waste and save costs in the NHS, but is it not better to offer a quality meal to a patient, which in the end they do not eat, rather than withholding a meal in order to "reduce plate waste" and have a patient going hungry?
by Matthew Merritt-Harrison, managing partner of Merritt-Harrison Catering Consultancy, independent specialists in advising and assisting clients with catering and related services in all sectors, including healthcare, higher education and staff restaurants
