My Lords, I declare my interests, which are in the register. I am the executive director of two companies, Cumberlege Connections Ltd and Cumberlege Eden & Partners Ltd. I thank noble Lords who are taking part in this debate, in particular my noble friend the Minister, who I know is sympathetic to the cause. I hope that I will not be too disappointed. He may be interested to know that many other noble Lords very much wanted to take part in this debate. However, Friday is a difficult day for your Lordships as we are a voluntary Chamber, and many noble Lords have commitments that they fulfil on Friday when the House does not usually sit.
I thank the hospitals I visited, which generously, and perhaps with some courage, allowed me to see and taste the hospital food and to talk to patients. On the whole, I was disappointed. When the food is frozen and has to travel from Wales to hospitals in England and is then reconstructed by steam, is it surprising that fish and chips are soggy and that other food is not quite what you anticipate it will be? Finally, I thank the excellent briefings I have had from the Campaign for Better Hospital Food, whose supporters exceed 5,000 individuals and many other organisations.
At the age of eight I was sent to boarding school, and the most precious item in my trunk was my ration book. School food in post-war Britain was not good. Fish on Fridays was no surprise, because you could smell it at 10 in the morning. Jam was either red or yellow, and made with mangels, and resurrection pudding lived up to its name. After decades of prosperity, however, British food has now changed enormously and beyond all recognition. For instance, whatever happened to gravy? Gravy now masquerades as jus, and leek and potato soup is now vichyssoise.
Virginia Woolf said,
“One cannot think well, love well, sleep well, if one has not dined well”.
When in hospital we do not expect to dine well, but expect to have delicious, appetising and nutritious food—food that aids recovery. In the past 20 years successive Governments have spent more than £50 million of taxpayers’ money issuing guidance to hospitals about how to improve patient meals. When I was a junior Minister I was one of those who tried. I was responsible for food—that was before the Food Standards Agency was established—and introduced the nutrition task force, which in turn set up a hospital catering project team that produced nutrition guidelines for hospital food. Those were launched by the celebrity chef Albert Roux. In the foreword he wrote:
“Food should be regarded as an integral part of hospital service and treatment … Food provides us with the nutrients essential to our existence and general health … In providing comfort, food can also help to make patients feel more at home, reduce stress, and actively contribute to an ambience that can enhance the quality of medical treatment”.
Despite my efforts and those of successive Governments, in many hospitals the food is unappetising, non-nutritious and does nothing to aid recovery. Six out of 10 patients say that they rely on family and friends to bring them food because the food is of such poor quality, and sometimes barely edible. At many hospitals patient meals are viewed as a bureaucratic necessity and not as an integral part of care. Hospital life is boring. When in hospital, patients want three things. They want to go home, they want visitors and they want good nourishing food, because it is food which punctuates the day. That should be something to look forward to, but many patients dread it. The Francis inquiry into Mid-Staffordshire was deeply concerned about the attitude by staff towards meals, mealtimes, nutrition and dehydration. The witnesses’ comments are heartbreaking. I could quote many but will quote only one:
“On examining the food and fluid intake chart, mum had only had half a cup of tea over the last 20 plus hours. Some days nothing was marked as being taken, today there were three cups
of fluid on the table, all of which were full. She couldn’t have drunk them if she tried because all three of the cups were placed way outside her reach”.
I do not underestimate how difficult it is to serve meals to large numbers of sick people three times a day. People who choose a meal one day are discharged the next, so that an incoming patient is welcomed by a meal they may detest. Some people may have uncompromising diets or have an appetite which changes from day to day due to the medication they receive. Hospital food is complicated, but there are hospitals where they really think through these issues, have a love of food and organise it well—while in similar hospitals in the same city, of the same size, almost in the same catchment area, the food is simply appalling. I am sure that noble Lords will agree with me, and I know that the majority of people in this country find it unacceptable for hospital food to be unhealthy. However, much of the food served to patients is of a poor nutritional standard.
In 2012, a nutritional analysis of commonly served hospital meals showed that they often contain more saturated fat and salt than meals served at fast-food restaurants, including McDonald’s and Burger King. Hospital food which is high in fat, sugar and salt, is not helping to nourish patients, and much of it is wasted. Government figures suggest that as many as 50,000 people a year could be dying with malnutrition in NHS hospitals in England, and at least one in every 10 meals is thrown into the bin uneaten.
The British Association for Parenteral and Enteral Nutrition estimates that three out of four patients are not eating enough during their hospital stay, and that the majority of them lose weight while in hospital. This problem is particularly rife among elderly patients. Only today, the Campaign for Better Hospital Food published new data showing that hospitals in England spend more on nutritional supplements for patients than on the meals served to them during their stay. While of course I recognise that nutritional supplements are vital in the cases of some patients, should they have become the routine prescription given to patients who are unwilling to eat hospital meals, or failing to gain nourishment from them? Patients should be nourished with enjoyable food rather than by nutrient and vitamin pills administered as medicine.
We look forward to hearing later in this debate from my noble friend Lady Miller of Chilthorne Dormer, who has expertise in this area and chairs the All-Party Parliamentary Food and Health Forum, the noble Lord, Lord Rea, the previous chairman, and other noble Lords who have experience or knowledge of this issue. I suspect that my noble friend might be tempted to address in his reply the subject of foundation trusts in the context of mandatory standards for hospital food, which is the purpose of this Bill. Both Scotland and Wales now benefit from mandatory standards for hospital food.
The Government have given hospital trusts greater control over how they manage and care for patients and have given them the opportunity to influence the shape and direction of the NHS. That is absolutely right, and I strongly support it. However, it is no less important to have a safety net to ensure that the NHS
does not fall below acceptable levels and that standards of care are regularly monitored and enforced. Standards are not goals; they do not restrict a hospital’s freedom. They provide basic levels of assurance for organisations commissioned to provide healthcare. So we are not setting a precedent; there is an abundance of standards already in place in the NHS, which reflects the important role that they play, including employment standards; care standards for patients with specific ailments, such as diabetes; and standards for financial auditing, to name but a few. Standards for hospital food should be no exception.
The Bill requires the Secretary of State to appoint a body of experts to draft hospital food standards and make it mandatory for all patient meals to meet those standards. The Care Quality Commission and the Chief Inspector of Hospitals will be required to check that the standards have been adopted and are met. If they are not, it gives the CQC power to act, ultimately by withdrawing a hospital’s registration. The CQC is working hard to increase the regularity and effectiveness of its monitoring exercises, and is ensuring that patients participate in them. The CQC already evaluates patient satisfaction with meals, so this Bill would require only that monitoring is carried out to assess adherence to more specific standards. This solution does not in any way necessitate burdensome regulation, and does not require the Government to take greater administrative control over the provision of hospital meals. In fact, patients themselves are likely to take a leading role in monitoring hospital food, as more and more of them sign up to join inspection teams, as encouraged by the Care Quality Commission’s new Chief Inspector of Hospitals, Professor Sir Mike Richards.
Finally, I address the issue of cost. At the moment, taxpayers are being doubly charged for poor hospital food. Not only are they paying for the cost of patient meals but they are funding the associated costs that bad hospital food incurs, such as food waste, malnutrition and longer recovery times. I frequently hear people say that good hospital food is expensive and costs too much for hospitals to afford, but the facts do not bear this out. It has been shown that there is no correlation between the cost of patient food and its popularity with patients. Many of those hospitals serving the best food, produced and prepared to very high standards, are actually paying less for it than are hospitals where patients are dissatisfied with what they are being served and where food is wasted. For example, according to data from NHS Estates, Ipswich Hospital NHS Trust spent an average of £13.59 on food for each patient per day in 2012, yet less than half of patients at the hospital surveyed by the Care Quality Commission rated the food as good. In contrast, the Royal Marsden NHS Foundation Trust in London spent £5 on food for each patient per day in the same period, and more than seven out of 10 patients surveyed by the Care Quality Commission described the food as good. So those public sector organisations that have set standards for their food have done so without incurring extra cost.
In 2010, the Department for Environment, Food and Rural Affairs carried out an extensive evaluation of the costs of introducing government buying standards for food served in central government, including prisons
and government departments. The standards mandate was that organisations buy more organic food, more fresh fruit and vegetables, and sustainable fish. The evaluation concluded that the organisations would not pay more—and, indeed, they do not now pay more—for higher quality food. If patient meals contain high-quality ingredients and are cooked by highly skilled caterers, they are more popular with patients, more likely to be eaten and therefore less likely to be wasted.
In conclusion, this Bill has widespread support from the public and from 97 national organisations, including Age UK, the British Heart Foundation, the Hospital Caterers Association, the Royal College of Physicians and thousands of members of the public. I contend that hospital food standards must be made mandatory if all patient meals are to be of a sufficient high quality, are to be nutritious and made to minimum standards of production.
This is a modest but sensible Bill with widespread support, and I urge my fellow Peers, as well as my noble friend as the Minister responsible on behalf of the Government, to support it. I look forward to my noble friend’s sympathetic response. I beg to move.
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