Hospital Food With Intensive Care

Reposted in full from The Telegraph, 23 March 2011

'Mike Duckett doesn’t seem like an obvious revolutionary. Softly spoken and grey-moustached, he has a year to go before retirement from his job as catering manager of the Royal Brompton Hospital in west London. But his approach to food could destabilise the received wisdom about feeding people in large organisations, through a truly radical concept. Provide freshly cooked, locally sourced, seasonally appropriate meals – yes, the sort of food anyone would like to eat. It sounds an impossibility: the equivalent of a farmers’ market brought to the hospital bedside every mealtime. Mike has shown that this miracle can be achieved, even within the cash-strapped NHS, where yesterday it was disclosed that patients’ meals can cost little more than £1.

To understand the immensity of this innovation, you need to know the way that mass catering has gone in recent years. When the flagship NHS Chelsea and Westminster Hospital, a few streets from the Royal Brompton, opened in the 1990s, it had no kitchen. This was not an oversight but part of a trend – other hospitals have been closing their kitchens to provide linen rooms and other services. ''Efficiency’’ dictates that food should be prepared on the airline principle, perhaps in a factory in South Wales, and merely ''regenerated’’ on site.

This system, which must delight the bean counters, has only one drawback: the end product is – how shall I put it? – disappointing. ''How can you regenerate fish and chips and peas?’’ cries Mike, indignation throbbing in his voice. If there is one category of person who needs proper, sustaining food, it is the hospital patient, for whom good nutrition is an aid to recovery. Fortunately for the heart and lung cases in the Royal Brompton, Mike has his own kitchen. Every meal served in the hospital is prepared and cooked in it.

That, however, is only where the revolution begins. With its 300 beds, staff canteen and hungry visitors, the Royal Brompton is a prodigious consumer of food. Every year, 50,000 eggs, 9,000kg of sausages and 40,000kg of potatoes will pass through the kitchen. Mike realised that he could buy better if he bypassed the NHS supply chain (which he uses only for dry goods such as flour) and went straight to farmers in the South East. This was partly a matter of conviction: ''Public catering should support regional British food,’’ he told the Aldeburgh Food and Drink Festival stoutly last year. But it also ensures freshness and quality. The eggs from Kent are free range. The milk from Bedfordshire is organic. The sausages from north London and Bedfordshire are bespoke recipes. While most government-procured bacon comes from Denmark, Mike buys his from farms in Essex and Hertfordshire. Each year, orchards in Kent crush enough apples and pears to provide him with 250,000 litres of pure juice. It sounds too much like traditionally based common sense to be true of a modern bureaucracy.

There is a modest cost implication. Mike’s meals work out as slightly more expensive than the NHS average, although still within the budget set by the Royal Brompton and Harefield NHS Foundation Trust. The nutritionists in the hospital evidently think that the price is worth paying. Besides, there are other advantages. Many more people are eating in the staff canteen, which is also open to visitors. Mike’s changes have therefore increased revenues, while also contributing to the welfare of staff, some of whom rely on the canteen for their main meal each day.

The menus will surprise anyone familiar with government catering. Venison is served. ''We weren’t sure about wild rabbit to begin with,’’ remembers Mike, ''but it proved so popular we had to put it on again. It’s cheap.’’ Unlike Jamie Oliver, he doesn’t expect to tempt children out of their food comfort zones. “We offer them additive-free burgers and chicken nuggets made from 100 per cent breast meat, rather than skin and feet. In the burgers, we replace salt with herbs. They love them.’’

The loss of Mike’s menus would surely be a sadness to the young patients of the Royal Brompton’s children’s heart surgery unit, currently threatened with closure as part of major NHS reorganisation.

As Mike admits, there is nothing complicated in what he does. The techniques are those used when he started his career with the NHS, 44 years ago. ''Then, patients were served only one meal option, and if they didn’t like cabbage, it was bad luck. Now, budgets are stretched by the number of choices you have to provide, not least because of allergies. Nobody seemed to have allergies in the old days.’’

Clearly, it takes passion and commitment to break the mould. Mike loves visiting his suppliers. He is proud of having saved 60,000 road miles a year. He is thrilled that the Royal Brompton food waste is composted, rather than put down a waste disposal unit. But could other catering managers lift their eyes from the 120-page government rule book on food procurement and do likewise?

Yes, and more, is Mike’s answer. Why don’t groups of hospitals collaborate on menus and buy in greater bulk, with concomitant savings? The Swedish government has noticed what has happened at the Royal Brompton: it has asked him to speak at a conference in Malmo. If only British institutions could pick up on it too, we would be a happier nation.'