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Improve hospital food 1

Hospital changing the way it works.

"We need to start moving from a deficit position to break even or a surplus in the way we have done for the past 10 years." [Suzanne Tracey, quoted in the article, has been the Royal Devon & Exeter Hospital's director of finance and business development for all most seven years]

That means radically rethinking the way the RD&E is run by creating a new model of care for the future.

"At the moment we are treating people in a system that's at least 20 to 30 years old," explained Suzanne. "The best example is the Internet and the way people now do business. We are still not there in health so we have to look at how we make better use of technology. It will require some investment but it will change the way we deliver services. Developing a new model of care for the future will be quite radical.

"At the moment the focus is on treating a person with an illness or symptoms. What we actually need to do is look at ways of prolonging health and keeping people well."

She added: "The important thing is how we work with the people of Exeter and East and Mid Devon to make a change in a positive way and it's about how we engage with the public to do that."

When asked whether she is confident the fortunes of the RD&E can be turned around, Suzanne said: "What I am confident about is that we are not just sitting back and expecting to continue running things the way we always have done"

"I am confident we have been brave enough as an organisation to face up to the reality of what the national picture means to us. We have a really clear plan and we need to start implementing it.

Extracted from Express & Echo 9/7/15 p15


Action Plan to Improve Hospital Food

Background - 
Veggie Hospital
Vegan menus - 
Improve Hospital Food & The James Martin Formula - 
Action Plan - 

February 2014. My interest in hospital food began with an emergency admission to the Royal Devon & Exeter Hospital. I was an inpatient for ten weeks. I don't remember my first sight of the patients' menu. I knew it would not provide adequate nutrition for a vegetarian in the long term, but for a week or so I would come to no harm. By the end of my extended stay I was experiencing problems related to the food.
The discharge social worker (who was excellent) was a vegan. She told me of the problems vegans, whether patient or staff, have obtaining suitable food in the hospital. I resolved to do something to improve the lot of vegetarians and vegans. Oh how naive I was!

Back home, I wrote a few emails to the hospital and soon realised that was a waste of time. I was told about James Martin's programmes "Operation Hospital Food". The latest in the series had been shown when I was in hospital. I discovered there are campaigns to improve hospital food. I should have been completely discouraged, but thought if Jews and Muslims have their own hospital menus why can't Veggies. So Veggie Hospital went to Twitter and Facebook. It was not long before I was hearing comments from meat eaters about the need to improve all hospital food.

The European Court of human rights say vegans are a recognised group. Thus, they are entitled to have a vegan menu in hospitals. Such menus should be available in all hospitals by Summer 2015. Most vegetarians would be happy to eat a good vegan diet (perhaps supplemented by dairy and egg options) while in hospital. So there is a solution for veggies in hospital if the hospital is providing good food.
Now Veggie Hospital is about improving hospital food for everybody.

I analysed as much of the James Martin's programmes I could access and looked at the programme's website. I realised James Martin had provided the formula to improve hospital food, all that was missing was the support of a large number of the people living in a hospital's catchment area. Hopefully that support will motivate the authorities at each hospital to implement The James Martin Formula, build on what they already do well and ensure their patients receive tasty nourishing food, and staff and public can benefit from profitable onsite restaurants and snack bars.

1. Gather public support to back implementing The James Martin Formula at the hospital.
2. Approach the hospital catering managers to discuss the good and the not so good about the food.
3. Approach the Hospital Catering Association (HCA), The British Dietetic Association, The Vegan Society and the Vegetarian Society and enlist their support and advice.
4. Consider a plant based core menu with meat, fish, dairy, egg, legume and nut protein options.

Why Veggie Hospital?

In 2014 I spent ten weeks in hospital. It was the first time I'd been in hospital and the first time since I'd left school, more than forty years earlier, I hadn't had control over what I ate. Had my hospital stay only been a week, eating from the hospital menus might not have affected my digestion and health, but after a month I was struggling.

I tried raising vegetarian and vegan menus with the hospital, but as an individual I had no influence. So I started this initiative as Veggie Hospital. I soon discovered others would like to see the hospital offering its patient better meals. And my ideas grew when I learnt about the work James Martin did over 4 years with the BBC and the website, Operation Hospital Food.  Judith Morrison.

James Martin & Operation Hospital Food

Did you see the TV series, Operation Hospital Food, with James Martin? He spent four years committed to improving hospital food. The TV programmes are not available now, but two full programmes are on YouTube as is a short clip showing him talking with a local grower. Watching these programmes show that, with persistence and co-operation, and expert help, changes can be made.

Operation Hospital Food with James Martin on YouTube.
1. A short clip at a farmers' marke
2. An episode of Operation Hospital Food 
3. Another episode of Operation Hospital Food 

The Operation Hospital Food with JAMES MARTIN website has interesting information, including:-
James Martin's Hospital Blueprint
Selection of clips from the TV programmes
Gallery - Your hospital food horrors 

Analysis of Vegetarian Menu for Patients at R&DE 2014


A. Menu structure

B. List of the Vegetarian Options for Soups, Main Courses, Salads and Sandwiches
C. Vegetarian Lunch & Supper Main Courses daily Menu Options - 2 week menu cycle

(Menu information taken from RDE publication " Food and Drink" Edition 9 2014)

A. Menu structure
There wasn't a separate vegetarian menu. The vegetarian options were mixed in with the meat options on the daily menu card. I was also given the Halal, Kosher and Gluten-free menus. Some days I had three menus cards to complete. That caused a bit of confusion when the cards went to the catering staff, and was stopped.

The ordinary vegetarian options were based on dairy, cheese, eggs, jacket potatoes and sandwiches. My usual diet was grain based (rice, millet, oats and quinoa) with legumes and vegetables, and of course, fruit. I limited my milk and wheat intake, and did not eat bread. 

The Halal menu had a number of rice and lentil dishes, but the menu did not indicate which were vegetarian. The ward catering manager wrote out the ingredients so I only ordered vegetarian ones, but the full range was not available as the call on the Halal menu was limited and the whole range was not stocked. The meals I tried were dry and I was frequently choking on the rice.

The Kosher Menu did not indicate which meals were vegetarian, but added the options of tomato omelette and spaghetti neapolitan at lunch and supper.

The gluten-free menu added the option of Spanish omelette with chips and peas at both meals, but served with cheese and side salad at lunchtime.

A daily Menu Card had four sections, i) Lunch, ii)Supper and iii) Sweets and iv) Something for Later.

Orange juice OR some days Soup
Main course* with choice of 1 from 2 types of potatoes and 2 set vegetables dishes
and sometimes gravy (The Menu Card did not say if the gravy was vegetarian).
Choice of 1 from 3 Sweets with custard or ice cream

Orange juice OR some days Soup
Main course* from choice of 2-4 with 1 set vegetable dish
Choice of 3 Sweets with custard or ice cream


iv) SOMETHING for later
Choice of 1 from 4 items, cheese & biscuits, apple or banana, cake, scone/shortbread.
*Main courses options include the sandwiches and salads.

The detail of the choices at any one meal are shown in Section C below. Most days there were 4 choices, but on Week 1 for Tuesday and Thursday lunches and Week 2 for Friday lunch there were only 2 choices that were vegetarian.

B. List of the Vegetarian Options for i) Soups, ii) Main Courses, iii) Salads and iv) Sandwiches

i) ORANGE JUICE every meal or (some nights) SOUP with supper (vegetarian 6 out of 14 nights).
Tomato x 2 nights
Vegetable x 2

ii) The range of VEGETARIAN MAIN COURSES available, served with potatoes & 1 vegetable, and the option of gravy (sometimes) and Yorkshire pudding for Sunday lunch.

Broccoli & herb quiche x 1
Cauliflower cheese x 1
Cauliflower in cheese sauce x 1
Cauliflower & broccoli pasta in cream sauce x 3
Jacket potato/baked beans x 7
Jacket potato/cottage cheese x 2
Jacket potato/low fat cheddar x 8
Leek, cheese & egg pie x 1
Macaroni cheese x 3
Pasta shells in cheese sauce x 2
Pasta mushroom & leek moray x 2
Plain omelette x 13  Picture of a Cook/freeze omelette
Tomato onion Gruyere and basil quiche x 1
Potato, leek & cheese bake x 2
Vegetable & bean cottage pie x 2
Vegetable crumble x 2
Vegetable lasagna x 2
Vegetable pie, baked x 2
Vegetable pie, potato topped x 2
Vegetable quiche x 1

Cottage cheese x 2
Cheese x 2
Cheddar cheese x 1
Egg & cress x 3
Egg mayonnaise x 2
Ploughman's x 1
Quiche x 2

Cheese & cucumber x 2
Cheese & pickle x 3
Cheese & onion x 2
Cheese salad x 1
Egg & cress x 2
Egg mayonnaise x 3


C. Vegetarian Lunch & Supper Main Courses Menu Options
The menus were on a 2 week cycle, but many of the dishes were repeated in the second week but on a different day.

Week 1. Vegetarian main courses menu options

Monday lunch   Macaroni cheese, cheese salad, Jacket potato with grated low fat cheddar cheese topping and side salad

Monday supper Mixed vegetables with mashed potato topping, White egg and cress sandwich, Plain omelette, Jacket potato with a baked bean topping and side salad

Tuesday lunch   Tomato, onion, grey and basil quiche (in a savoury egg custard pastry case), wholemeal cheese and onion sandwich

Tuesday supper   Pasta, mushroom and leak morning (in cheese sauce), egg and cress salad, plain omelette, Jacket potato with a low fat cheddar cheese topping and side salad

Wednesday lunch   Cauliflower cheese, cottage cheese salad, Jacket potato with a baked bean topping and a side salad

Wednesday supper   Baked leek, cheese and egg pie with pastry topping, wholemeal cheese salad sandwich, plain omelette

Thursday lunch   Vegetable lasagna (pasta sheets layered with vegetables and white sauce), White cheese and pickle sandwich

Thursday supper   Vegetable & bean cottage pie (mixed beans and vegetables with mashed potato top), cheese salad, plain omelette, Jacket potato with a low fat cheddar cheese topping and side salad

Friday lunch   Potato topped vegetable pie, quiche salad, Jacket potato with cottage cheese topping and a side salad

Friday supper Broccoli and herb quiche (savoury egg custard in a pastry case), wholemeal egg mayonnaise sandwich, plain omelette

Saturday lunch   Vegetable crumble (vegetables with savoury crumble topping), Wholemeal egg mayonnaise sandwich, Jacket potato with a grated low fat cheddar cheese topping and a side salad
Saturday supper   Potato cheese and leak bake (in white sauce), Ploughman's salad, Plain omelette, Jacket potato with a baked bean topping and side salad
Sunday lunch   Cauliflower and broccoli pasta (in cream sauce), Egg and cress salad, Jacket potato with a baked bean topping and side salad

Sunday supper  Pasta shells in cheese sauce, Wholemeal Cheese and pickle sandwich, Plain omelette

Week 2. Vegetarian main courses menu options

Monday lunch   Vegetable lasagna (pasta sheets lad with vegetables and white sauce), Cottage cheese salad, Jacket potato with a grated low fat cheddar cheese topping and a side salad

Monday supper   Macaroni cheese (pasta in a cheese sauce), White cheese and cucumber sandwich, Plain omelette

Tuesday lunch   Cauliflower in Cheese sauce, Wholemeal cheese and onion sandwich

Tuesday supper   Vegetable and bean cottage pie, Egg and cress salad, Plain omelette, Jacket potato with a low fat cheddar cheese topping and side salad

Wednesday lunch Vegetable quiche, Egg mayonnaise salad, Jacket potato with a baked bean topping and a side salad

Wednesday supper   Baked vegetable pie, White cheese and pickle sandwich, Plain omelette

Thursday lunch   Pasta shells in cheese sauce, White cheese and cucumber sandwich, Jacket potato with cottage cheese topping and side salad

Thursday supper   Potato, cheese and leak bake (in white sauce), Cheddar cheese salad, Jacket potato with a low fat cheddar cheese topping and side salad

Friday lunch   Macaroni cheese, Cheese salad

Friday supper  Cauliflower and broccoli pasta in cream sauce, Wholemeal egg mayonnaise sandwich, Plain omelette

Saturday lunch   Vegetable crumble, Wholemeal egg mayonnaise sandwich, Jacket potato with a grated low fat cheddar cheese topping and side salad

Saturday supper   Baked vegetable pie, Plain omelette, Jacket potato with a baked bean topping and side salad

Sunday lunch   Cauliflower and broccoli pasta, Quiche salad, Jacket potato with a baked bean topping and side salad

Sunday supper   Pasta mushroom and leak morning (in cheese sauce), White egg and cress sandwich, Plain omelette

By Judith Morrison Mar '15  

Meat/Fish Options on Patient Menu at RDE Hospital

(Menu information taken from RDE publication " Food and Drink" Edition 9 2014) 




Hospital Catering Association

"Hospital food is an essential part of patient care. Good food can encourage patients to eat well, giving them the nutrients they need to recover from surgery or illness."

The aims and objectives of the Association are the promotion, development and improvement of the standards of catering in hospitals and healthcare establishments in Great Britain, Northern Ireland and elsewhere; the education and training of persons in health care catering services, and the provision and improvement of the professional interests and status of those engaged in health care catering services.

Local Procurement

"Better Hospital Food contains best practice guidance, resources and background information to support the delivery of food in NHS healthcare facilities."

The Vegetarian Society

Catering for Vegetarians – a two day course for Professional chefs i

Serving Vegetarians - A Guide for the Catering Industry

Vegan Society

Vegan Recipes

NHS Hospital Food Standards
"The quality of food provided in hospitals is important to patients, and hospitals should cater for your personal dietary needs. If you need a particular type of food (kosher, halal, vegetarian or vegan), inform the staff."

Vegetarian Guidance Notes for Hospital Caterers

Vegetarians in the Hospital: How to make the most of you stay with the nutrition you need. Article with useful tips from The Vegetarian Resource Group. (USA)

Nil by Mouth  -Vegan Food in Hospital

Campagning to fix hospital food for good

And James Martin & Operation Hospital Food

What the RDE Hospital website says about Catering and Patient Meals

Extracts from RDE Hospital website  Accssed 8/3/15 (Italics below mine)
1. Catering
2, Patient Meals


Thank you for taking the time to visit the website of the Catering Department of the Royal Devon and Exeter Hospital. We hope your tour around the site will be both enlightening and informative.

During your tour you will be introduced to the various sections and the people who help to provide this unique catering service. Everyday we provide our patients with a multi-choice menu that is delivered to their bedside. Staff and visitors are also offered the same high class service with food served in surroundings that are pleasant and welcoming.

The Catering service is an 'In-House NHS Operation' and operates 15 hours per day, 365 days of the year. The service provides meals on the Royal Devon and Exeter Hospital Wonford and Heavitree sites as well as to Mardon House, Sycamore Resource Centre, Vranch House School and Centre and to Meals on Wheels.

The service consists of 3 departments, Kitchen, Patient Meals Service and Restaurant/Retail Services. The service employs some 100 full and part-time staff. It serves approximately 14,000 meals a week.

The Catering Department is at the forefront of implementing the NHS Plan for Better Hospital Food and we are committed in ensuring that the food we provide is appetising, nutritious and wholesome.

We have one restaurant and a number of snack bars. There are also a number of food and drink vending machines around the hospital.

Patient Meals Service
In April 2007 the cook-freeze system was introduced for the Patient Meals Service.

Advances in food and systems technology makes cook-freeze ideal for hospitals and replaces the conventional plated meal system previously used by the RD&E catering service for over 15 years. About 2,000 patient meals are served daily.

Nationally cook-freeze is used in over 300 hospitals and companies providing this service provide menu planning and nutritional support. All meals have been nutritionally assessed following national guidelines.

Cook freeze offers the Trust the opportunity to offer a more extensive menu which can be easily changed to reflect local eating trends. Positive feedback from patients on two wards where cook-freeze was piloted before it was introduced Trust-wide included comments like “the food is much hotter, the presentation is nicer and the portion size is what you want.”

How the cook-freeze Patient Meals Service system works
Menu cards filled out by patients are scanned electronically to inform the catering service what frozen stock is needed. New purpose-built trolley ovens, crockery and non-slip trays are loaded with the meals which are then served directly to patients on the wards. The trolleys are taken from the kitchens out to wards where the meals are cooked in time for lunch and supper.

Why a good vegetarian diet is important to me

My mother went vegetarian when I was weaned. I do not know why she did that; she was a farmer's daughter, knew how beef was produced and would declare she liked beef even though she had not eaten any for 20 years. My father enjoyed food, was not a vegetarian, but restricted his meat consumption at home. But then we did have the best of home grown vegetables and home cooked and baked whole foods. I had a brief teenage rebellion and ate sausages, ham and tongue, but did not like them, and did not feel I was missing anything by not eating meat.

I had a spell in my forties when I ate small amounts of chicken and fish for health reasons. It was during the couple of years before I was diagnosed with MS. I did not know what was wrong with my health and wondered if there was something lacking in my diet. There wasn't, it was MS. I also ate chicken and fish occasional during the four years John was in my life in my fifties. He was a chef, loved top quality fish and knew how to cook it. I insisted the chicken came from Pipers Farm in Exeter as they have a "Slow Food" policy.

I do have ethical views about animal welfare, and increasingly, the green issues around meat production. There is growing awareness of the extra resources needed to produce animal feeds, the threat to rain forests and greenhouse gases.

Having studied Ayurveda's lifestyle principles I am aware of the pleasurable use of herbs and spices in food and their beneficial effects on digestion.     (Judith H Morrison)

Options for all

From Vegetarian Living

Hospital food has regularly come under fire for being tasteless or lacking in good nutrition and that's without even considering any individual dietary requirements.
'Some hospitals are already doing a great job, but often vegan patients face a depressing hospital food lottery,' Amanda Baker, senior advocacy officer at the Vegan Society, told Vegetarian Living. 'This is despite the general duty of care hospitals have for all patients, and the fact that being vegan is a protected philosophical belief under the European Convention on Human Rights.'
The good news is that's now set to change as part of a collaboration between the Vegan Society and the Hospital Caterers Association (HCA) which aims to revolutionise vegan-friendly food in hospitals across the UK. The Vegan Society is providing the HCA with a number of recipes which should start appearing on hospital menus this summer.
The move is the result of a Hospital Food Forum organised last September by Sustain, a registered charity and alliance representing around 100 national public interest organisations. Sustain has been campaigning for better standards in hospital food and last November published new figures showing the government spends more on nutritional supplements for hospital patients than on the food served to them.
Following the Forum, Andy Jones, national chair of the Hospital Caterers Association, approached the Vegan Society to start discussions. 'We want to get the message about appetising, nutritious vegan recipes out to all hospital caterers, and ultimately, to the patients we serve,' he explained. Amanda told Vegetarian Living that the Vegan Society have been impressed with the HCA's proactive approach, adding, 'As well as ensuring vegan needs are met, good vegan-friendly food can appeal to just about any diner, and can support recovery and healthy living.'
Until the new menus are rolled out, the Vegan Society recommends vegan patients get in touch with their hospital catering manager and registered dietitian. The Vegan Society and the HCA are also each in dialogue with the British Dietetic Association regarding hospital nutrition.

From Vegetarian Living