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CASE STUDY: getting good, local food into hospitals

Dixe Wills

22nd January, 2009

It’s fresh, organic and locally produced. It’s hospital food, but not as we know it – yet. Dixe Wills meets the catering manager who’s transforming the canteen kitchen

Mike Duckett’s tiny office is, rather endearingly, jammed with piles of paper. ‘I’m not very good at filing,’ he apologises, while riffling through them in search of an old menu to show me. Anyone entering this nondescript windowless room off a hospital kitchen could be forgiven for thinking that nothing much of significance ever happens here. It looks just the sort of place to which, in times past, employees might have slunk off for a quiet puff. However, it is from here that a quiet insurgency is taking place, and if I were part of the status quo I’d be mighty worried.

If Mike has his way, hospital food will not only be transformed from the pauper to the prince of the culinary world, but also will be a darned sight greener too (and, for the sceptics out there, that’s not soggy-cabbage green). The targets in his sights include wastage, food miles, additives, idiocy, supermarkets and anything that is not top quality.

We have to go back to 1964 and the unlikely surroundings of the Brompton Sanatorium in Surrey to witness the sowing of the seeds of this uprising. Dodging between recuperating patients taking their endless prescriptive walks around the grounds, the sanatorium’s kitchen gardeners would come to the back door and ask Mike what vegetables he would like to use for meals that day. Pesticides and artificial fertilisers were yet to come into use, so, without really trying, Mike found himself taking delivery of organic vegetables whose food miles could be counted in yards and whose freshness depended solely on how long it took the gardeners to walk up the path. He cannot have known then that he would never again have it so good.

The nadir came in 2001 when he was the catering manager at King’s College Hospital, in London. In a bid to become meaner and leaner, the hospital got rid of its kitchen and started shipping in ready-cooked meals from a factory. A factory in south Wales. Mike left.

‘I started at the Royal Brompton the same year… on 5 November,’ Mike says with a mischievous air, making sure I’ve picked up the date’s significance. Happily, whatever other revolt he might have ignited, he didn’t have to put dynamite under the hospital’s management. They not only had no intention of scrapping their kitchen, but also, just as importantly, were open to Mike’s radicalism.

And this is radicalism on a grand scale. Take his campaign to get in more locally produced food, for example. His milk now comes from an organic herd in Bedford (to reduce food miles still further he’s cut deliveries from five or six days a week to three). His bread hails from north London. Organic oats for the morning porridge arrive from east London (Mike’s impressed too by the supplier’s use of solar power to generate heat). His kitchen’s cucumbers, tomatoes, potatoes, leeks, carrots, onions and asparagus are grown in south-east England. His pears are all English, while eating apples are supplied in season from an orchard in Kent. I make a mental note to sneak a peek at the apples on my way out, just to remind myself of what a homegrown example looks like.

And don’t get Mike going on what the NHS does with fish. Apparently, they are hauled all the way from Grimsby to a depot in Somerset, whence they are distributed to hospitals around the country, including, of course, to those around Grimsby. ‘How stupid is that?’ he asks. So the Royal Brompton buys its fish direct from a chap in London who gets them straight from Great Yarmouth.

Mike’s ‘buy local’ policy has not been brought in without a struggle, however. There are the government procurement regulations for a start. ‘I told them that no catering manager has the time to read through a 50-page booklet – we have to take a commonsense approach to this.’ It took him five years of wrangling with NHS executives to be released from national contracts so that he could set ones up on a regional or local basis. Although sometimes even these go by the bye. ‘With a farm you don’t need contracts,’ he explains. ‘You just pick up the phone and say, “Send me an extra case of free range eggs, please”, and it’s done just like that. With all these things it’s not rocket science’ – unless he’s procuring local rocket, of course. As for organics, they already account for 5 per cent of his purchases, but his intention is to raise this to 25-30 per cent.

There was also the time, not so long ago, when Mike and a representative of the Soil Association spoke at a meeting in front of 250 NHS caterers and dieticians and were booed – 'we were actually booed. They thought we were off our heads. Of course, the same people who were booing me then are now coming round to ask me what I’m doing.’

As a result of his measures, he’s now spending 24 per cent of his food budget locally (‘that’s within a triangle from Bedford to Dover to Salisbury’) and he’s hoping to increase that to 30 per cent next year. Compare that to the low single-digit percentages achieved by most hospitals in Britain and you begin to see it for the feat it is. And the quality of the food is not in question, either – one of Mike’s farm suppliers also has The Ivy and Buckingham Palace on its books.

The road to rouxing

It’s all a far cry from Bath University, and the Catering Management course Mike took in the early 1960s. On graduating, he spent time as a chef in a Taunton hotel, before embarking on a catering management career that took him to Kensington’s St Mary Abbots Hospital (‘it’s a housing estate now’), Greenwich District Hospital (‘that’s closed too’) and three others in south-east England. His worst experience during this time came at Greenwich, where a state-of-the-art conveyor belt meal system went awry. ‘The first day we opened all the sewage flowed up into the kitchen.’

Understandably, there came a point when Mike felt it was a good idea to get some catering experience outside the health service. This included stints at Grand Metropolitan, Barclays Bank directors’ dining room (‘the waste of food was absolutely frightening’), London Transport (‘if the drivers didn’t get their cup of tea they brought the buses off the roads’) and the Royal Mail, before returning to the fold at the Chelsea and Westminster Hospital.

Back at the Royal Brompton, it’s the sheer range of innovations that Mike has introduced that is so impressive. There’s the installation of a ‘healthy’ vending machine; the ousting of all bottled water; monthly meetings to find out what patients want on the menus; a switch from small bottles of milk to three gallon boxes; and as little frozen food as possible. Local farmers have their invoices prioritised to improve their cash flow, and as much washable crockery and cutlery has been reintroduced as possible (he’s even brought back the teapot).

Meanwhile, Mike’s way with suppliers is demonstrated in my presence. A patient had recently pointed out that one of his sandwiches contained 25 per cent of the recommended daily salt intake. Mike is just telling me this when his sandwich supplier pops his head around the door to announce that he’s found some low-salt breads locally and that they are going to switch over to them as of Monday. Previously, Mike had politely asked the same supplier to make its packaging compostable. They duly did so.

Cooking the books

This is all well and good, but how does Mike balance the books? One way is by gently persuading his suppliers that they should make their money from their corporate clients while giving him a discount. He might also pay for a switch from non-organic to organic beef by offering it with slightly less frequency. It’s a quality versus quantity thing.

Although Mike’s conversation is peppered with wry asides, he’s equally happy to rage against the machine (albeit in a soft Wiltshire accent). He blames supermarkets for the nation’s love affair with ready-made meals – ‘high in sugar, high in salt, high in fat’ – and is less than keen on greenwash. One supplier – an award-winning organic bacon producer – was shown the door when Mike discovered it was sending its pigs to Germany to be killed and having the meat shipped back to Britain.

But it’s Mike’s love of giving people high quality food that pervades everything he does. ‘If a patient is happy after having a meal they will be more receptive to treatment,’ he says. ‘Furthermore, food is part of their recovery – for a start, I know that if you were given fresh fruit and bananas you wouldn’t want vitamin C tablets and potassium.’

Once he manages to find it, Mike passes me the menu that was in use when he arrived at the Royal Brompton. It reads like an uninspiring list of school-dinner fodder circa 1975, right up to the jam roly-poly. The new one, by contrast, sports in-season vegetables and even exotica such as baked navarin of lamb. The kitchen also prepares its own soups which contain 50-60 per cent food content (‘Heinz Chicken Soup is only 4 per cent chicken’). The Patient Environment Team Audit has duly awarded the menu three stars, its highest rating. Not bad considering it’s all done on a budget of £3 to £3.50 per person per day, and that’s including mid-afternoon tea and cake and even the occasional ‘naughty’ portion of chips (‘lets not forget that food should be fun sometimes, too’).

Unsurprisingly, patients have reacted very positively. In a national survey, the Royal Brompton scored 71 per cent for its meals (the national average is 52 per cent) rising to a ripping 94 per cent when patients were asked whether they were offered a choice of meal they liked. The staff seem pretty happy too, with retention up and absenteeism down – both of which have been attributed in some measure to the excellent staff canteen.

Mike Duckett’s influence has long since spread beyond the confines of his hospital, however. In 2004, he was involved with Sustain (the alliance for better food and farming) and the Soil Association in running the two-year Hospital Food Project, in which four London hospitals took part. At its close, the project – aimed at increasing hospital take-up of local and organic food – broadened into a scheme called Good Food on the Public Plate, which encompassed schools, care homes and yet more hospitals. Organisations flocking to his door to profit from his expertise include the Hospital Caterers Association, the Royal College of Nursing, the Greater London Authority, the Royal Mail, the Institute of Hospitality and, naturally, other hospitals.

As for the future, it’s no surprise to find that Mike is buzzing with ideas. He wants menus printed on recycled paper, more low-calorie and organic food, and more ways of integrating the hospital into the local community.

‘When it comes down to it, I was just fed up with people saying hospital food was rubbish,’ he says. ‘When I can influence it, as I can now, I feel as though I have a moral responsibility. If I can do it here in a 300-bed hospital, imagine what the other 600 hospitals can do.’

Best of all, you don’t even need to come down with a serious disease to enjoy Mike’s food – the Royal Brompton’s street-front cafeteria is open every day to the public.

Dixe Wills is a freelance journalist

Want to get fresh, local food on your local hospital’s menu?

Ask the catering manager to download sustain’s hospital Food Project report (suggested donation £10) for more ideas than they can shake a stethoscope at. See www.sustainweb.org/publications/info/146 Alternatively, they can contact the royal Brompton hospital (www.rbht.nhs.uk).

Other UK hospitals with similar initiatives

Ealing general, Bethlem Royal (Beckenham and Lambeth) and St George’s Hospital all participated in the hospital Food Project.

This article first appeared in the Ecologist November 2008

 

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