Fresh approach to hospital food is just what the doctor ordered
Replacing frozen meals with a new menu utilising fresh produce in a combination with a made-to-order menu has proved a real success. David Edbrooke spoke to Paul Wells, one of the two hospital catering managers.
THINK of hospital lunches and images of lumpy lasagne or sloppy semolina cloud the mind.
Up until the tail-end of last year, Jersey Hospital was serving frozen food that would not have looked out of place in a 1980s school canteen.
However, thanks to some timely investment and a new menu, the quality and choice of food at the Hospital has been radically improved.
A change in working practices, with a new 14-day made-to-order menu replacing the old five-week set menu, and a policy of scrapping frozen food in favour of fresh, high-quality meals using local produce, has paid dividends.
The proof is truly in the pudding and since the launch of a new daily ordering system, far fewer meals have been wasted, meaning that more than £50,000 was saved last year.
In 2017 the Hospital’s hard work was recognised when its Patient Food Project won the Value for Money category in the Quality Improvement Awards, organised by Health and Social Services.
Paul Wells, one of two catering managers at the Hospital, has invited me on a behind-the-scenes tour of the kitchen facilities to see how their award-winning catering system operates.
CLOAK, HAIR NET AND HAND GEL
After handing me a long white cloak to put on and a hair net for hygiene purposes, we make our way through a heavy door beside his office into the food preparation area. Even before we pass through the door, we clean our hands using a soap dispenser. They are fixed to virtually every door throughout the sprawling kitchens and staff must use them when they enter or exit every room.
‘The problem with the five-week menu,’ Paul tells me as we walk into the food preparation area, ‘was that we were sending out food as if the Hospital was full every day. The patient didn’t see what they were getting on that day – they had no choice whatsoever – unless they were on a special diet.
‘Now, a patient gets the menu 24 hours in advance. They make their selection for what they want for lunch in the morning using a simple tick-box menu and that information is broken down ward by ward, so we know exactly how many portions of, for example, chicken casserole are required on each ward.
‘You are always going to have wastage because you might have somebody who feels unwell et cetera, but this way it means the wastage is minimised.’
MOUNTAINOUS AMOUNTS OF MEALS
According to a recent Freedom of Information Request, about 770,000 meals are produced for patients each year by the Hospital, and Paul says approximately 1,500 meals a day are served at the general Hospital site.
That process begins when the food is prepped.
‘All the goods come in from designated suppliers and after they are checked over, they are put into fridges,’ adds Paul, who has worked at the Hospital for 15 years having joined from L’Horizon Beach Hotel and Spa, where he was executive chef.
‘Our hospital chefs weigh out ingredients for the recipes, which are all predetermined. They have an entire area of one kitchen for vegetable preparation. Onions, carrots et cetera are already prepared with skins off and washed, and they are sent in from wholesalers as ten kilo transparent bags so we can see what condition they are in.
‘We do fish preparation on one side and meat preparation on the other side of the kitchen so there’s no risk of cross-contamination.’
My first impression of the Hospital’s catering area is that of a self-contained mini city, comprising a maze of stainless steel kitchens, corridors and a busy workforce populating it.
What follows is a whirlwind tour of the entire catering facility.
Paul shows me the main cooking area, where patient meals as well as food for the public restaurant, are heated. There are a lot of heavy-duty machines here, along with some conventional equipment such as chip fryers.
‘The room contains huge industrial fat pans capable of cooking 500 portions of a wet dish such as a chicken curry at the same time. We have soup boilers which can make 200 portions of soup at a time and traditional convection ovens.’
All of the food is cooked to above 75 Degrees Celsius and within half an hour of the food being cooked, it is apportioned out into containers, which are stored in walk-in blast chillers at between one and three degrees.
We take a look at the four walk-in blast chillers, which resemble ice chambers with doors either side.
‘As soon as the food is cooked it has got to go into the blast chiller, which is the legal requirement,’ explains Paul. ‘Otherwise there’s a risk of bacterial contamination or physical contamination.’
We walk into the adjacent room – sanitising our hands as we go – where the corresponding doors of the blast chillers are located.
He shows me a country vegetable pie which has come out the other end of the chiller.
‘The base has been cooked, my staff have layered the mashed potato on top, it’s gone through the chilling process and has just been probed.’
‘Yep, by that I mean its temperature has been recorded using a specialist food thermometer.’
On another table a kitchen worker is pouring cold gravy over chilled roast turkey portions.
‘They pour the gravy on cold so there’s no risk of bacterial infection.’
All the salad items including coleslaw are separately prepared and packaged, then labelled ready for distribution.
Many of the meals will be delivered to wards off-site, such as those at Overdale and Clinique Pinel.
There is also a separate cooking kitchen at the general Hospital which caters for patients who have specialist dietary requirements.
Paul is at pains to point out that all utensils used in the cooking and chilling process are washed separately so that cutlery, bowls and machinery used to cook meat are not washed with utensils that are used to prepare vegetables.
THE CATERING TEAM
According to Paul, there are about 25 to 27 catering assistants who work in the main kitchens and the ward kitchens.
‘We’ve got somewhere between 45 to 48 staff within the whole of Health who are based in the catering department, including those who are at Overdale and the other satellite Health campuses.’
Paul explains that the kitchen staff will typically cook two to three days in advance because they do not work at the weekend.
The food is then loaded into temperature-controlled boxes, which to the layman look like giant picnic hamper containers.
A WALK THROUGH THE WARDS
Every ward has a kitchen and a trolley to transport the food containers up to it. At ward level, the food is reheated – but not in a microwave.
‘In a microwave?’ exclaims Paul as he lets out an incredulous gasp. ‘No, no, in a convection oven – we had some investment to buy new ovens for all the wards.
‘We were quite restricted with the old ward ovens because they only reheated meals from the bottom up and sometimes you had variant results, so we’ve invested in convection ovens on all the wards. These enable us to do things we weren’t able to do in the past, like oven chips.’
Is it a good thing to offer patients oven chips?
‘The entire menu is assessed by the dietician team so the nutritional factor of every dish has been analysed,’ says Paul. ‘In some cases you want people to have things like fish and chips because they may need that.’
In fact, the dietetics team analysed ingredients in more than 177 recipes to provide fully nutritionally-assessed meals before the 14-day menu was even launched.
Once the food has been reheated, it is temperature-checked once more.
We head up to Plémont ward, where meals that have gone through the process described above are being plated up by service staff, before being distributed to patients.
Paul tells me there are eight different diet categories on their normal menu.
‘Previously, 67 per cent of our diets were requests for gluten-free, but now the vast majority of the menu is gluten-free.’
As anyone who has spent time in hospital knows, one of the welcome distractions from the drudgery of long hours lying horizontal is the food – but only if it is of an acceptable quality.
‘The average stay for a patient in Hospital is about 3.5 days so having this 14-day menu with four different choices each day for lunch gives people a good amount of variety.
‘It’s what I call normal home-cooked food – chicken casserole, vegetable curry, cottage pie.
‘And on Sundays there is always a roast option. We also serve up traditional deserts, including sponges and crumbles, and there is also a choice for breakfast – porridge, toast, fruit and yoghurts. In the evening people generally have soups, sandwiches or salads.’
He adds: ‘If you were vegan you would get the choice at lunch of one vegan dish and if they wanted something like a quiche or a jacket potato with a filling instead, we can always get something from the staff dining room – it’s flexible.
‘And if you were on a special diet or you needed high protein, we have a supplementary menu for that.’
RECIPE FOR SUCCESS
Part of Paul’s job involves coming up with new recipes. However, unlike a restaurant kitchen where the head chef can experiment with ingredients and flavours on a whim, at the Hospital every recipe must be thoroughly studied first.
‘You can’t just say, “I think we should cook this tonight”, a recipe has to be analysed by the dieticians to make sure it is suitable for the patients, and they have to be cost effective.
‘There is a yearly budget for the food and it probably costs £4 to £5 a day to feed a patient because you are talking about breakfast, teas and coffees, lunch, pudding and dinner.’
Paul says each recipe uses standard ingredients and is written down for every chef to see in the kitchen.
‘Every single dish has got a standardised recipe behind it. If it requires these guys to make 500 portions of chicken curry, the recipe will be for 500 portions of chicken curry. You could come in, be given the recipe and easily go through it step by step.’
And as you might expect, every possible aspect of a person’s dietary requirements are considered at the Hospital, including portion size.
‘People may have lost their appetite or they may feel overwhelmed by portion size so the sisters on the ward make sure their service staff know exactly what each of the patients’ requirements is.’
On the back of every menu given to patients is a feedback form on which they can score their lunch experience using a tick-box system. Lunches are rated across categories including food quality and how well it was served.
‘The results are collated every day and it gives us a good indicator of what people thought about the food,’ Paul explains. ‘In general, the feedback has been really good.
‘Occasionally people might say “it’s a bit bland”, but we are not allowed to use loads of sodium and we can’t make fresh meat stocks. We’d love to do something more, but you can’t from a dietetics point of view and fresh meat stocks could have bacteria in them.’
Up on Plémont Ward I have a chat to patient Barry Wilshaw, who is preparing to be discharged after lunch.
The 76-year-old, who lives in St Peter’s Valley, has plumped for fish and chips, which I’m told is the most popular dish on Fridays.
‘Today it’s been nice,’ he tells me. ‘You start with a fruit juice and the apple juice I had was very nice. You can also have a tea or coffee. It is a nice portion of white fish, the chips aren’t bad and the peas go pretty well with them. Earlier this week I had a rather nice beef stew and once you’ve eaten everything you feel pretty good.’
Acting Ward Sister Kathleen Hawksworth says the main benefit of the new made-to-order, 14-day menu is that everyone gets the meal they want, whereas before it was akin to being in a plane – if you were at the back you might miss out on the most popular dish that day.
‘In the old days they used to send up a load of everything and if you were last to be asked, you might not have got your choice because we could have run out of that particular meal. This way, patients have a choice and they actually get what they want.’
She adds: ‘On the whole, the feedback from the patients has been positive. They like the way it’s presented and the way it’s served to them.’