Delicious hospital food

When Mike Duckett joined the Royal Brompton Hospital in November 2001 he made an increasingly rare discovery.  The hospital had its own kitchen.  He says 'it was heaven for me because this was what Iʼd always wanted.  Before I worked for 10 years at another NHS hospital serving food that was made down in South Wales, warmed up and reconstituted and it never worked.  And here was the opportunity to make a name for the Royal Brompton and the catering service.'

The changes he had in mind were a switch to fresh, local and often organic produce and away from processed, reheated foods.  The result has been that patient satisfaction with food is 20% higher than the national average. 

The Royal Brompton Hospital has a worldwide reputation for the diagnosis and treatment of heart and lung disease.  Duckett sees his work as part of the healing work of the hospital.  'Morally Iʼve got a responsibility to actually look after peopleʼs health and what weʼre eating these days is totally unhealthy, all this pre-packed food, pre-cooked food: itʼs high in salt, fat, it doesnʼt do anyone any good. I want to help my colleagues on the medical staff by making sure food is healthy.  Itʼs no good them operating on somebody if the patients return to a cycle of unhealthy eating.'

Duckett's inspiration comes from the very beginning of his career, back in the 1960s, when he worked at the Royal Brompton's sanatorium in Surrey. 'There were none of these drugs for heart disease, what the patients had to do was go for these long walks.  We had our own gardens with three gardeners who grew our vegetables.  They used to come to the back door and say "Mike, what do you want for the meals this week, weʼve got so and so".  So we used what was available.  We had an orchard for apples, and they were available from September to March .  And it was a better style of life, the local butcher used to come up.  And it was a community, and I think hospitals should still be part of the community.' 

The barriers to local producers supplying hospitals today can be considerable: guidance comes in a densely written 50 page document and hospitals need guaranteed year-round supplies.  The complications are too much for most small farmers.  Duckett turned to Sustain and the Soil Association for advice and then started procuring locally from Bank Farm in Kent which is a hub for 70 or 80 local suppliers.   'We started off with free range eggs but we now get our oil there, our Kentish bacon and seasonal vegetables - which at the moment is carrots, leeks, cabbages and potatoes.  Thereʼs a big difference - we donʼt want strawberries at Christmas.  I think itʼs more sustainable if you look for seasonal stuff.'

Chemical soup

Duckett gives soup as an example of his journey of nutritional rediscovery.  'We looked at the NHS national contract foods and some soup has no food at all in it.  It's chemically made, all flavoured.  So we looked at some of the named tinned soups.  When we looked at the actual content of mushrooms in some mushroom soups, it was 7%.  There's 7% chicken in some chicken soups. That's ridiculous, like giving people flavoured hot water.  The best one we found was vegetable soup with 24% vegetables.'  The Royal Brompton Hospital now makes its own soups with a 50 - 60% vegetable content.

Patient choice

Duckett is realistic about how to persuade people to eat well, especially younger patients.  There is a 30 bed unit for children and a school at the hospital.  'With children coming here, they expect the things that they have at home like chips or chicken nuggets.  We change the burgers to all organic burgers, additive free sausages, whole chicken breast nuggets.  So the quality of the food has improved and children are getting food that they recognise.'  Teachers at the hospital also tell him that behaviour has improved since he arrived - 'though I'm not saying that's all down to me!'

He believes that the care that goes into preparing food has a psychological effect as well as a physical one.  'When I speak to patients and say your potatoes come from Kent, your vegetables are locally grown, they think "Oh good, someone is looking after us".  And if you give people a good meal, they feel satisfied and more relaxed when medical staff come to give them treatments.'

There are several meetings a year with patients to discuss the food and understand what they want to eat.  But Duckett also argues that more choice is often a fake choice:  'In the 1960s there was one choice, but it was a good choice, cooked to a good standard.  Bringing in multiple choices lowers that standard.  Still, we do offer patients a choice of three main courses a day plus a starter and dessert.  We do kosher, halal and vegetarian Asian meals to cater for all tastes.'

Cost

The hospital does not have a vast catering budget.  The average cost for patient food in London is £2.80 - 2.90 per patient per day - the Royal Brompton Hospital spends about £3.50 for its improved menu.  Duckett says it's possible because they are often cutting out the middle man and going direct to the farmer.  The money they do spend has a local benefit too 'Every £10 I spend generates £25 for local businesses.  It's taxpayers money and we should be putting it back into those taxpayers'.

What's most striking about Duckett though, is the breadth of his ambition.  He points to the vast buying power of hospitals and other publicly run institutions.  He believes these should be exploited to insist on a better standard of food across the whole system.  Locally, he has his eye on Chelsea primary schools, a nearby care home and churches - which all cater for large numbers of people.  Distrustful of the power of supermarkets, he still muses about harnessing their desire for good publicity to create a campaign for better hospital food. 'Working together is the answer, but I have a very busy day job to concentrate on so I leave most of the campaigning to other people.'

He has however produced guides with Sustain for other hospital caterers who want to create better food. With the NHS providing 300 million meals a day, the implication of repeating the Royal Brompton blueprint across the system could be huge - for the re-centering of local communities, for hospital design and for the health of many fighting serious illness.