Public Sector Catering Conference
I’m really flattered to be asked to address you today, though I suspect the invitation came, not so much for my knowledge of catering as for my cake-eating on telly.
I’m also a little surprised. About a third of you, the school caterers, will have heard me banging on at the LACA conference in the summer. I’m afraid that a lot of what I think about school catering I also think about university, college, prison, hospital, care-home, Whitehall and armed forces catering. I apologise in advance to those of you who have heard it all before.
I’d like to start with a general point that I think applies to all public sector catering. It is simply that the money spent on catering is the taxpayer’s money, and it should be well spent. It should not be spent on food that will cause harm, distress, or waste. Easier said than done of course, but I would argue that if the government is spending our money, they have a right, if not an actual duty, to dictate the sort of food it’s spent on.
Good food, as we all know, does you good, just as bad food does you harm. Some of you will know of the work done, some time ago now, in young offenders’ prisons by the Institute for Brain and Behaviour which found that violent behaviour among groups of inmates dropped dramatically when they were given the nutrients that meet Government guidelines, rather than the high fat, high sugar, high salt diet everyone else in the prison was eating.
Prof John Stein of Oxford Uni emailed me the following summary of some of their controlled studies.
“In our Aylesbury Young Offenders’ study, raising nutrient levels tripled the rate of progress in disadvantaged readers, improved sociability by 27%, and reduced violent behaviour by 37%. Improved diet also reduced self-harm in young people.
On the violent behaviour measures, results were measured by the drop in the number of prisoners being punished for reportable offences. Similar controlled studies were carried out in adult prisons in Holland, and also in U.K toddler’s groups, when time spent laughing and smiling was measured against grizzling and anger, with almost exactly the same percentage drop in unhappy behaviour by the children on a healthy diet as was seen in reduction of violent behaviour in prisoners.
Further impacts of a change of diet for the better was examined In the Avon Longitudinal Study of Parents & Children where results confirmed that the more fish and vegetables mothers and their children consumed throughout pregnancy and childhood, the higher was the child’s IQ aged eight.
Evidence from schools shows similar results. The charity, Magic Breakfast, has been providing free healthy breakfasts for children at school. Unsurprisingly, they’ve found that kids who have had nothing to eat before school are unlikely to be able to concentrate on their lessons. But they also found that those who’ve eaten a chocolate bar washed down by a fizzy drink, are likely to be hyperactive and almost impossible to teach, after which they tend to be too sleepy to listen. But once those children were getting a good breakfast (typically porridge or cereal, an egg or a toasted bagel and fruit and milk) they behaved better, concentrated better, and performed better academically.
Dame Sally Davis, the recently retired Chief Medical Officer’s departing advice for government was to ban junk food and fizzy drinks from buses and trains in an attempt to reverse the obesity crisis. I can understand her frustration at the rising tide of obesity in spite of Government targets to half it by 2030.
But wouldn’t it be better, and easier, to make healthy eating part of the curriculum, provide free healthy school meals as a lesson, albeit a relaxed and happy one, where children are taught to eat well as well as learning about sustainability, food politics, and, dare I say it? good manners.
The sad fact is that governments tinker with food education, depending on who the Secretary of State is and what the headlines in the Daily Mail are. But no one has the guts to really grasp the nettle and do something radical. A lot of very good work goes on in schools, led by caterers, or chefs, or sustainability charities, occasionally by teachers and wonderfully, but rarely, by local authorities or school governors. But in the majority of schools, food is just not a priority.
My generation has not served the planet well. If we want the next generation to do better, we could start by feeding them healthy, ethically-sourced and sustainable food, and teaching them to love it. And the way to do that is to ensure all schoolchildren learn about food and are taught to cook, everyone has a healthy lunch, sitting down, no choice. And the government pays for it. Wouldn’t that be great?
This is not a pipe dream. Even without universal free school meals, some schools manage it. I went to the Mercia secondary school in Sheffield last month to find children happily eating healthy food. Lunch boxes not allowed. Breakfast of porridge or cereals. Midmorning piece of fruit. Healthy no-choice lunch (vegetarian three days a week, fish twice a week with salads and followed by a small sweet pastry or pudding), sitting down with their teachers and taught what they called sharing and consideration, and I call good manners. Afternoon snack was a biscuit or a piece of watermelon. All for £2.20. It can be done.
I know very little about prison food but I do know that it is impossible to feed anyone with good healthy food, locally sourced and sustainable with a budget of £2.02 a day to include three meals and drinks. I know the caterers try really hard to do well by their charges. Inmates choose their menus a week in advance with five options which between them cover all diets, vegan, vegetarian, carnivore, halal, healthy and a range of medical diets. But there is nothing to stop a prisoner choosing nothing but carbs, of which, at £2.02 a day I guess there’d be a lot.
There is a current initiative to educate prisoners about diet and health. Tough job. If you have been brought up on chips and pizza, pot noodles and doughnuts, white bread and jam, you might just riot if deprived of them.
And I’m glad to say that the Institute of Brain and Behaviour that did the original work on diet and violence, is working with some womens’ prisons, which, with luck, will lead to some improvement.
Sadly, it won’t lead to an improvement in the experience of lunch or supper. Most prisoners eat in their cells, because most prisons lack dining rooms or communal space. I do find that shaming. Socialising is a really important part of rehabilitation and not encouraging it at mealtimes is a missed opportunity.
The good news is that new prisons are to be built with communal dining rooms. Let’s hope new buildings come with renewed attempts to send prisoners out of prison eating more healthily than they came in. At the moment we don’t know how much good or harm prison food is doing. We don’t compare the health and weight of arriving or departing offenders. I guess, as a society, we just don’t care.
So, from schools to the Armed Services.
Napoleon’s adage ‘An army marches on its stomach” comes to mind. We cannot expect young men to be fit for active duty if they are overweight and eating junk. And to be fair, the MOD tries. When I emailed the head honcho of MOD catering to ask if they had a food policy he replied “Yes, the policy is articulated in a Joint Services publication titled JSP 456 – you can access all 4 volumes through the Gov.uk website.” Mmm. I confess I didn’t read it.
But I did find that the MOD does try to steer personnel towards healthy food choices. But while in barracks at home all catering is outsourced and the individual now pays for their food and decides what to eat, just like the rest of us.
Where the MOD has more influence is when personnel are away on operations or exercises, where the specification for ration packs and field kitchens are nutritionally balanced for a much more active life than at home.
But it’s really sad thing to hear that our military, in any theatre of war where they are billeted alongside NATO allies, prefer to eat at the French commissaries. The good old NAAFI is often avoided while our men and women throng the French mess for the freshly cooked French food (Salad Niçoise, Steak Frites, Ratatouille, Cassoulet and so on) and also, regrettably, the US facility for KFC, Big Macs and Dunkin’ Donuts. But then, the Americans are even more obese than we are.
When I first came to England, in 1960, some of the best cooking was done by the armed forces. Each service had its own catering school and the Army Catering Corps won most of the prizes in international cooking competitions. Head chefs, especially Army chefs, were giants to be respected. Today the much diminished military, the decision to make catering part of logistics, budget cuts, the trend to buy food ready prepped, the increasing culture of snacking rather than proper meals, and the outsourcing of catering to the private sector has partly eroded a fine tradition.
Still, the glamour lingers on. If you watch the recruitment video for army cooks it would be hard not to sign up at once. There they are, bush cooking: roasting meat in an earth oven on the forest floor, stir-frying fresh veg over an open fire, cooking casseroles in the embers. I wonder how often that happens in real life?
There are, of course, still great chefs in the military, but 80% of military personnel are now fed by civilian contractors, some very good, some dreadful, just like everywhere else.
I’m told the best food in the Navy is on a submarine. Because the crew are under water for weeks, maybe months, at a time, and there’s no smoking and no drinking on board, and not a lot to do when off duty, meals become enormously important. “Home Cooking” with traditional Bangers and Mash or Roast Beef and Yorkshire pudding are the most popular dishes. Cooking from scratch, as close to the customer as possible, will generally produce good food. Not least because the customer knows who to blame – it’s no good moaning about a reconstituted meal that came in a foil container because the guy who heated it up can do nowt about it.
Now, to hospital food: Some of you will have raised your eyes to heaven in disbelief and scorn when the government announced my appointment as advisor to the new Hospital Food Review. I don’t blame you: my reaction was: Here we go again. Some government minister looking for votes or his face in the paper, announces a new initiative and attaches a celebrity name to it in the hopes that the Daily Mail will take notice. We’ve been here before, and some famous cooks have really tried hard (and done some good) but then the money dries up, or a new minister is appointed and quietly drops the initiative. Lloyd Grossman spent 5 years corralling top chefs to adopt hospitals, giving their time for free, and they really helped improve things, with the hospitals affected enjoying improved ratings for their food. But then, instead of the roll-out promised, the effort was dropped as unaffordable. James Martin worked with the cooks in one hospital, only to have the whole operation outsourced from a factory somewhere and the chefs made redundant.
So my first reaction was to say No. But I was persuaded by Secretary of State Matt Hancock, whom I believe to be a really good guy, pinning his own reputation on the success of reforms to the NHS and spending the enormous amount of money already promised, wisely, and not on consultants’ salaries or more bureaucracy.
And then I had a one-on-one breakfast meeting with the Prime Minister in the garden of No 10, when I asked him point blank if he was serious about the Review, implementing its findings and providing the money and impetus for it. He said all the right things. Of course, we could all be dupes, but it’s got to be worth a try, surely?
(A quick aside. Asked what breakfast I thought we should have I suggested something British, sustainable and healthy, like yogurt, raspberries and granola which was one the table when we got there. We had the all-important chat for the camera, and then the PM went back to his office. I was pretty starving by now. (I’d been up since dawn doing Good Morning Britain and LBC and ITV news banging on about the review) so I reached for the yogurt, but not in time. The PM’s aid scooped everything onto a tray and set off with it. “Hey, where are you going?” I said, “What about my breakfast?”
“I’m taking it up to the PM’s desk” she said.)
So much for breakfast with Boris. Back to what matters:
The Review panel is only half way through studying the issue, so we don’t yet have all the answers. But by Christmas we will have. I’m absolutely confident that we mean business. Phil Shelley, ex-chair of the Hospital Caterers Association and catering lead at Taunton and Somerset NHS Trust. is the right man for the job. Nearly all the 15-strong committee are NHS professionals, dedicated to the reform of hospital catering. The panel boasts an impressive number of doctors, nutritionists, caterers, nurses and administrators who have been trying, and sometimes succeeding, to improve food in their areas, and are themselves perfectly placed to drive improvement.
The best news I can give you is that the intention of the review is to improve, not just the nutritional value of hospital food but also to make it delicious and sustainable, and to ensure that cooking, as far as possible, takes place as close as possible to the end customer.
Those of you working in the health sector will understand the size of the challenge and will, I hope, forgive me running through problems you know only too well.
First, there is the difficulty of getting good staff: Two years ago I heard Steve Cenci, the head of Compass Healthcare talking at a conference, where he said something like this:
“Imagine a restaurant where 1000 people must be fed at once, where your kitchen is half a mile from the diners, where half your customers have no appetite because they are sick and none of them want to be there anyway, where you must have written permission to put any seasoning in the food, where menus must include options to satisfy dozens of different personal, dietary, medical, ethnic and religious demands, where 66% of diners are between sixty-five and ninety years old, and where your budget for a three-course meal and a drink is £1.60. Welcome to the world of patient catering.”
Steve is lucky. Most of his hospitals have a prep-kitchen not too far away and main courses are cooked in small ward kitchens, using the company’s patented individually steam-cooked meals. The patients order about two hours in advance, and each tray takes around four minutes from cooker to bed-side. 75% of his customers say they would recommend the food. That wouldn’t satisfy a half-decent restaurant, but it’s pretty damn good for the health sector.
We need to somehow raise the self-esteem and the public standing of cooks in public service, so that more young people will join the profession. But they will never be proud of what they do until what they do warrants that pride. So the training of cooks and chefs is vital. This is an industry-wide problem. Even top restaurants struggle to find staff. We are not helped by the disappearance of catering courses at A level. If you are not cooking seriously in your last two years at school you are unlikely to think of taking cooking up as a career.
Of course, in a massively complicated business, like catering in the NHS, you are not going to get starry chefs in the kitchens worrying about micro-leaf garnish, parmesan crisps and yuzu drizzle. But with the years of assembling pre-made, often pre-wrapped items, real cooks are a thing of the past in many hospitals and will need to be recruited and trained. Dieticians are experts in their field but cooking and flavour are not part of their remit. They mostly cannot interfere and have little to do with the catering service. Dieticians need to work with the kitchens.
Next, the kitchens: Many hospitals have antiquated kitchens, a reflection of the low priority given to food in the NHS. And then over 30% of hospitals ripped out their kitchens under the Private Finance Initiative. This has been something of a financial disaster for the country, with trusts spending far too much of their annual budget just meeting their interest payments.
Under the scheme, the building of new hospitals was contracted out to the private sector who paid for their construction or rebuild. In turn, those companies awarded long-term contracts to private sector caterers who agreed to pay for replacing cooking facilities with regeneration kitchens and providing Central Production Units miles away. I’ve seen one of those contracts. There was nothing to require the caterer to produce good quality or sustainable food. Nothing about customer satisfaction. Little about patient-related diet. The overriding requirement was for the lowest possible cost.
Minced, dehydrated, grey chicken, lamb or beef, pelleted to the texture of grape nuts or grits, can be imported from the lowest-cost supplier abroad. And then it is reconstituted in some cheap sauce and moulded into portions in a factory, built hundreds of miles away where tax relief or grants for new job-creating enterprises, like food factories, were available. These meals, fancifully given names like Chicken a la King or Lamb Korma or Beef Stroganoff are ordered by hospitals to be regenerated in the basement and sent up to the wards in trolleys, often to sit in them for an hour or more.
Of course. I am painting a picture of the worst scenario. But sadly that scenario is still common.
Without the staff, the kitchen, and the budget to produce decent food, who can blame caterers for doing as they are contracted to do? Especially when chemists in food factories can work such magic – make ice-cream with no eggs, no cream, no milk; chocolate mousse with no chocolate; ‘yogurt’ without the bacillus that defines yogurt and makes it good for you. In my opinion this junk should not be fed to anyone, let alone a hospital patient. 55% of the 140 million meals served to patients every year is trucked in from elsewhere.
But it is not all poor quality. There is nothing intrinsically wrong with factory made food. Some CPU’s produce excellent food. After all, where do the ready-meals from M&S, Tesco’s Finest and Waitrose Food Partners come from? Factories of course.
But if the hospital catering contracts make anything but cheap, poor quality food impossible, something needs to be done about them. Personally I’d like to see an end to those deals. But sadly, the cost of breaking those contracts and compensating the caterers is beyond the hope of cash-strapped Hospital Trusts.
We can’t wait for 25 or 30 years for a chance to improve things. I am hoping that Government will step in and do what it takes to alter those catering contracts, ideally bringing the cooking (using fresh ingredients and well-trained chefs) closer to the patient. And if not that, at least insisting on fresh food, made with British ingredients. I like the adage “Only eat ingredients that your grandmother would have heard of. Anything else is not real food.”
One of the encouraging things since the Review was announced has been the number of people in Hospital Catering who have told us what they do, that works. We are visiting a raft of hospitals from which we hope to learn.
Could for example, a system used in the Ede Hospital in Holland work for us? Basically, patients fill in a questionnaire about their personal likes and dislikes. And then their medical condition, allergies, etc are taken into account and fed into the patient’s profile. The result is that her or she is then offered a short but varied menu that is tailored for his or her personal taste and dietary needs. So no chance of a coeliac being offered a gluten-heavy pudding or a heart attack victim being given meat pie and chips. The kitchen is on site and you can order anything you like at any time of the day or night, and it comes within 45 minutes.
We might not be able to offer such luxury service, but surely we can find a way to provide finishing kitchens on each floor that could make fresh toast or rustle up soup and a sarnie for someone who has missed a meal, or boiled eggs and soldiers for a patient finally awake and hungry after heavy anaesthetic and the prolonged sleep that follows it, or a cuppa and a biscuit for worried patients who cannot sleep. Food and kindness can be just the medicine they need.
Surprisingly, the cost per patient for ingredients and labour is not always the problem. Some hospitals manage very well on very little money. Porridge is cheap and healthy. Fish cakes, Shepherd’s Pie, Bangers and Mash, lasagne, curry and kedgeree are all popular, easy to do well and not expensive. Vegetables cost very little.
But many of the complaints I get are about these dishes. Watery mash, flavour-free curry, stodgy kedgeree, gluey gravy, pasta like rubber.
However technically nutritious a plate of food is, there’s no benefit to the patient if it goes in the bin. The Patients Association produced a report that stated, unsurprisingly, that patients’ chief desire is for meals that taste good. They complain about tasteless food, tepid food, revolting looking food, (and also about not being offered anything to eat if they have to miss meals, not being given help with eating when they need it, being given food they cannot chew or swallow, not being able to reach the food or water by their bed, or failing to find anything on the menu that fits their dietary requirements.)
But the biggest single complaint is of no toast for breakfast, or toast undercooked and the texture of pipe-lagging. (The excuse for this mean-minded failure is “health and safety”. Odd, since plenty of hospitals manage to serve hot crisp toast, made on the ward. And I’ve yet to hear of a toaster setting fire to a hospital.
It’s not only the patients and their families who complain. NHS night staff complain of vending machines full of junk with nothing hot or healthy. Visitors complain of poor-quality restaurants and only chocolate bars, biscuits and overpriced sandwiches in the foyers.
Poor food leads to criminally expensive waste, with an estimated 30% of meals being left uneaten.
The fundamental problem with the current situation is that food is low down the list of hospital priorities. Many administrators see feeding the patient as a regrettable expense, and the morale of the caterers, doing their best in an impossible situation, is rock bottom. Much of the NHS just does not accept the argument that good food is medicine.
I personally think the unintended consequence of a hospital or trust not receiving direct payment for every patient fed, is that hospitals would much rather not feed anyone. If, as in schools, they were directly compensated for every meal ordered (not just for the number of patients in the hospital) they would put more effort into doing it well. In schools, because the school is paid, either by the government or the parents for every meal served, the more they serve the more likely they are to break even or even make a profit.
But in hospitals the cost of catering comes out of the general hospital budget and is seen by some purse-holders as a necessary evil. I am not suggesting that any hospital manager actually says, “Let’s make sure the offering is dire, then no one will have it, and we can cut down on the catering and get the relatives to buy stuff for the patients in our shop foyer, on which we earn a cut”. But there is certainly no financial incentive to do things better. Rather the reverse.
The scale of the problem is scary but there is no doubt it can be fixed. If the North Bristol Trust and the Robert Angus Trust in Suffolk can cook fresh food on site and please their patients, obviously others could. I’m not suggesting that one size fits all, and different approaches will be necessary, but we should insist on food that has not been over-processed, that is largely fresh, prepared with skill and care, and is tailored to the patient.
The cost of overhauling the catering in the NHS will of course be huge. It is our job at the review to propose how that is to be done and get a handle on the likely costs. The big expenses will be for new kitchens in the hospitals or production hubs near them; recruiting and training staff; and tackling those disastrous contracts. We know the government is committed to a massive boost in NHS spending. We need to make sure a big chunk of that comes our way.
It’s been suggested that patients who can afford it should pay some contribution, say the cost of ingredients, which they’d be paying for if they were at home. Perhaps, but I’d argue we’d need the food to be delicious before we suggested that. And make sure that the bureaucracy of establishing entitlement and collecting the money doesn’t outweigh the money brought in.
But it is so obviously in the government’s interest to get it right. First of all, it will cheer patients up and make them happier with the beloved NHS. Secondly, patients will recover faster and vacate those much-needed beds sooner if eating well. And it will remove what is currently a national disgrace: horrible food in hospital.
TO SUM UP: It’s in the interest of government to get its citizens as healthy as possible. This cannot be achieved without making food and diet a priority. The good news is this government does seem to have woken up to the importance of food to our economy and to our health and happiness. The first sign of this was the establishment of the National Food Strategy which Henry Dimbleby is chairing for Michael Gove and which will map the principles that will underlie future policy in farming, food production, food education, government procuring and much else, with an emphasis on quality, health and sustainability.
It stands to reason that where Government can directly influence the Nation’s diet, it should do so, starting with where it spends our money. It may sound draconian and dictatorial but I would argue that is quite wrong for hospital and care-home patients, school children, prisoners, civil servants and the military to be fed a poor diet at the taxpayer’s expense because bad food is likely to lead to future ill-health and therefore more cost to the taxpayer.
Equally, since we urgently need to reduce our carbon footprint, the Government has no business buying food, that could be grown in the UK, from half way round the world, or to be supporting foreign producers whose animals are raised in appalling conditions or whose produce depends on the wholesale use of chemicals.
And perhaps I could just end with a personal plea to everyone in the catering business. We all know how important good food is, not only to health, but to morale. Cooking can be a joy. Food should be a pleasure. Serving really good food, whether a sandwich or a banquet can be the most satisfying of jobs. We are in a great industry, and we should be proud of it. But we do all need to bend our efforts towards the best, and not ever be satisfied with junk.