Tackling food waste
Food waste

The Hospital Caterers Association looks at how much hospital food is wasted and what can be done to prevent this

The Hospital Caterers Association looks at how much hospital food is wasted and what can be done to prevent thisAccording to NHS Data, the total cost of providing inpatient food for 2022/23 was £0.8 billion, with the food budget representing £241 million. The Independent Review of NHS hospital food, published in 2020, calculated that food waste in NHS England alone represented 39 per cent, but is this as bad as some would think?

While some hospitals record their food waste under 10 per cent, The Soil Association’s Food for Life calculate that the real picture is over 60 per cent. Meanwhile, WRAP, the global environmental action NGO, consider the waste levels in the NHS to be a more conservative 18 per cent, acknowledging that some 4.5 per cent of this is unavoidable.

These figures can only be considered as estimates, so more effort needs to be made to establish the true position, and then effect change for a significant reduction.

The Environment Act 2021 places a further obligation on hospitals (and other food waste producers) to present all food waste separately for collection. It also makes it illegal to put food waste into drains using macerators or liquidising digesters (which turn food waste into a slurry with enzymes and hot water before flushing into the sewers).

Whilst it cannot be denied that change is needed, we also have to understand the reasons for such diverse admissions.

Food waste defined

In the NHS, food waste is defined as food purchased, prepared, delivered and intended to be eaten by patients but that remains un-served or uneaten. Food not eaten by patients in hospital not only represents an unnecessary cost but may also imply that patients are not receiving sufficient nutritional support. Malnourished patients are almost four times more likely to be readmitted within seven days of discharge.

Hospitals produce substantial amounts of food waste, which can be due to a number of factors, including patient-related issues, food service models, and the hospital environment.

Patient-related issues

The first, and obvious reason for the patient not eating their food is that they simply do not feel well enough to consume it. Poor appetite is common when you are unwell. Things like infections, autoimmune disease, and other inflammatory conditions can cause taste changes, food might taste like metal, too sweet, bitter, or salty. After critical illness, the patient may also experience a complete loss of taste or smell; difficulties with swallowing may also be experienced, such as a dry mouth, dysphagia, tiredness and fatigue when eating.

Portion sizes

It is traditional within the UK to offer three main meals per day. Wastage would be reduced considerably if the NHS were able to offer a single menu, the ‘take it or leave it’ approach. This was quickly dismissed by the Independent Review. Because of the range of patients, and their localities, it is impossible to offer a simple choice of food, the hospital caterer must deal with a complex range of therapeutic and nutritional requirements as well as those requesting pescatarian, vegetarian and vegan menus.

Many hospital contract standards demand that each patient is offered a choice. By its nature, this demand may also lead to waste as additional portions could remain once the final choice has been made. Dependant on factors with the ordering of meals technology helps to reduce this, also allowing patients to choose closer to the next mealtime rather than the day before.

Food service models

There are a number of food delivery methods adopted widely across the NHS: A ‘traditional’ service will see the food produced from fresh ingredients in a conventional kitchen. This style of service will also see the bulk of unavoidable waste being recorded, such as vegetable trimmings, animal bones, etc. It is the style of choice but depends on the ability to recruit and retain larger numbers of well-trained professional caterers.

Cook Chill services see the meals being produced in a central production unit, usually off site and often by commercial operations. On the surface, this style of production keeps most of the unavoidable waste away from the service point but because the product has only been chilled (and not frozen), it has a short shelf life of only up to five days.

Cook Freeze operations are similar to the Cook Chill with the exception that these products are frozen and will have a considerably longer shelf life. Any over production can easily be stored rather than going to waste.

All models can avoid waste by maintaining accurate historical data to help predict demand on choices and aid production plans.

Each model has benefits and some hospitals adopt a hybrid approach, looking to make the most for their own particular needs, however the situation is also compounded when you consider the method of delivery to the bedside. Some wards receive their meals in bulk and the food is served from a trolley according to the patient’s preference. Others receive a plated or trayed meal service where the patient’s full menu choice has been prepared elsewhere and, at ward level, the tray is simply placed at the bedside.

Hospital environment

Despite most hospitals following protected and assisted mealtimes, interruptions may still be unavoidable for treatment of care for a patient, for example, some patients may not be in or by their bed at meal service times, i.e. attending physiotherapy or X-ray, and general expectations about the food quality and quantity of the food can also lead to wastage.

Offering different size portions can also help to encourage the patient to eat what they need, without over facing them, whilst reducing unnecessary waste.

Addressing the challenges: Avoiding food waste

Unused, or unwanted food in other establishments may be shared with the community or food banks but with the nature of a hospital environment this presents challenges, so it has to be disposed of. This may be considered as unavoidable but the hospital caterer needs support to help hospitals find ways to manage this better.

Interventions can include behavioural changes, e.g. avoiding the preparation and ordering of unnecessary just in case meals. Training of catering and other healthcare professionals will help drive fundamental changes. Ensuring a sensible number of options based on engagement with staff and patients is an easy change for NHS organisations to make.

The HCA has adopted a process called ‘The Last Nine Yards’, an initiative that includes the Royal College of Nursing, dietetics, NHS England, caterers, and speech and language therapists and the wider facilities teams. It considers the distance from the corridor to patients’ bedside, the area where unavoidable waste is most likely to occur.

Use of technology

Electronic ordering systems are now widely available and can reduce the time between ordering and meal service significantly. Modern tablets can also show the patient what the dish should look like and what its nutritional content is before they order. Technology can also identify trends and help measure and monitor food waste.

Reducing food waste can save money through the avoided purchase of ingredients or meals, lower kitchen utility bills, more efficient use of staff time and lower waste disposal costs. Achievable savings should be allowed to be reinvested, allowing the caterer to offer even better service to its main customers, the patients.

The Hospital Caterers Association

encompasses the single largest group of healthcare catering providers within the NHS and is the recognised voice of hospital catering. It represents catering managers who provide a wide range of food and other services for patients, visitors and staff in NHS hospitals and healthcare facilities. The HCA is a national organisation, with fifteen branches throughout England, Wales, Scotland and Northern Ireland, and more than 250 hospitals represented in its membership.