Where next for hospital food as BHF is scrapped?

The Better Hospital Food programme (BHF) was established by the Government in 2001 with a one-off war chest of £40m and a high-profile panel of advisers headed by Loyd Grossman. Accompanied by the usual banging of publicity drums, it set sail on a sea of good intentions under the manifesto "to make effective changes to hospital food services countrywide".

Specific aims included producing new recipes, redesigning the menu and introducing 24-hour catering.

But the Government announced the scheme's demise earlier this month, adding that cash would no longer be ring-fenced for hospital food.

Looking back, Alison McCree, chairman of the Hospital Caterers Association (HCA), believes the BHF had a positive effect in hospitals. "It raised the importance of food at trust board level," she says. "It forced hospital executives to take notice."

Raising the profile This sentiment is echoed by Martin Cantor, catering manager of the Heart of England NHS Trust. "The programme did a great job of raising the profile of hospital catering, which made my job easier," he says.

John Hughes, catering manager at Nottingham City Hospital, agrees that BHF put catering on the radar. "Loyd's inclusion was key, as the press interest forced the Government to support its initiative and not just announce and reannounce it," he adds.

Meanwhile, Matthew Merritt-Harrison, a hospital food consultant, points to the programme's establishment of national targets. "When it came to hospital catering, some trusts were already doing a good job. The benefit of the programme was to set common standards nationwide," he says.

Shaun Hill, one of the chefs brought in to create new dishes, claims the scheme was "better than a gimmick but not as good as a true commitment". Hill, who left the programme in 2002, reckons the problem with hospital food was not lack of choice, but lack of quality. "The food was usually put on to heating machines until it was convenient to serve," he says. "Serving food had a low priority as nurses focused on taking care of patients' medical needs, not acting as waitresses."

Hill also found that input from dietitians wasn't always helpful. "They insisted that food was often overcooked to make perfectly sure that it was safe," he recalls. "The result was that you weren't going to die from eating it but you certainly weren't going to look forward to it. Similarly, they avoided the use of salt on health grounds, but the real result was a lack of taste."

The scale of the funding was another major drawback of the scheme. The NHS serves 700,000 meals a day at a total cost of £500m a year. "An additional £40m was peanuts," says Merritt-Harrison. "It didn't even put garnish on the plates. Instead, individual trusts were forced to find the extra cash."

Hughes agrees. "The £40m was a one-off boost that never came near the front line. It only meant an increase of about 30p per day per patient," he says.

For McCree, the BHF's main failing was that it concentrated on food only as a product. "If the food is not eaten then it has no benefit. The programme wasn't targeted enough at nutritional intake at ward level," she says.

Five years after BHF's launch, the Government announced that responsibility for hospital catering would be handed back to local NHS trusts, without any ring-fenced central funding. "BHF was an excellent example of how a national approach can support local improvements. But central initiatives can only go so far. It's local action that matters to patients, and it's local action that we're now looking to see," said a Department of Health spokesman.

Those involved with the programme have expressed their concern at the decision. "Hospital catering is a national issue that needs national focus and direction. It shouldn't be devolved to individual NHS trusts," argues Grossman. "There's now a danger of slipping back to the bad old days when hospital food was unimportant."

Backward step Money, inevitably, is crucial. Merritt-Harrison agrees the end of the programme is a backward step. "There are huge pressures on hospital costs and food is an easy target for cuts," he says.

For Cantor, the biggest challenge is to provide the best food and service within the budget. "For us, food continues to be highly important," he says. "We're always seeking to innovate and to use fresh, locally sourced products. However, in trusts where food has a lower profile, the impetus may well be lost."

McCree doesn't believe the situation will worsen, but does think that "the relationship between nurse, dietitian and caterer - with the patient at the centre - needs more focus".

For Grossman, the face of BHF, hospital catering remains hugely important, but the future depends largely on the internal politics of the NHS. "Catering doesn't naturally have a life of its own. It needs advocates who will drive it forward," he says. "I worry that without dedicated champions, hospital food won't continue its success."