1. Hospital catering
Mark Butler
July 2013

2. Contents Research Methodology Research Methodology
Key Facts and NHS Media Spotlight
Eating Concerns and Preferences
Hospital Catering Comparisons
Food Preferences – Eating Habits
Attitudes Towards Hospital Food
General Food Preferences
Eating Concerns and Preferences
Research Methodology
Key Facts and NHS Media Spotlight
Eating Concerns and Preferences
Hospital Catering Comparisons
Food Preferences – Eating Habits
Attitudes Towards Hospital Food
General Food Preferences

3. Research Methodology
For this study, YouGov SixthSense commissioned a survey among YouGov’s online panel, drawing on a sample of 2,092 people who had eaten or purchased hospital food as patients or as visitors in the last five years.
Of these hospital foodservice users, 716 were hospital patients in the last two years, and 840 were hospital patients in the last three to five years. (NB: those in the latter group may also have been patients more recently.)
Purpose of Report - Update to the previous 2011 report to understand how perceptions have changed over the last few years as well as what is key for patient feeding – plus any new findings.

4. NHS Promoting Healthy Eating
The issue of food in hospitals forms just part of the current and past debate on the NHS, which finds itself in the full glare of the media spotlight of stories around hospital patients suffering from an apparent lack of care.

5. Hospital Food Continues to be Seen in a Bad Light
Fewer users of hospital foodservices think that hospital food has shown improvement in recent years than was the case in 2011.
Leading doctors call for ban on junk
food and fizzy drinks in hospitals
Vending machines can be the easiest way to get food in hospitals
But doctors say hospitals should take a stance against selling junk food
Source: MailOnline 27 June 2013
Key facts in 2013
85% of hospital foodservice users eat a freshly prepared hot dinner in the evenings.
69% of hospital foodservice users agree that more nutritious food will help patients’ recovery.
63% of hospital foodservice users think hospital food for patients should be more nutritious.
51% of hospital foodservice users prefer a home-prepared cold snack for lunch.
47% of hospital foodservice users think hospital food is generally much better than it was in 2011.
35% of hospital foodservice users think hospital food is not healthy enough
19% of hospital foodservice users gave ‘The food was generally of a low quality’

6. Comparisons between hospital and other foodservices!
Cost-effective catering on a large scale is a constant challenge for foodservice provides
“Comparing hospital caterers with the catering for other large-scale operations, such as sports and other large venues, do you agree or disagree with the following statements?”
30% of hospital food users believe that hospital caterers are more mindful of nutrition.
46% think that hospital food is more bland than that found at other large-scale catering venues.
43% think hospitals cannot afford to pay more for meals.

7. Food Preferences – Eating Habits
Eating habits in 2013
Eating habits in 2011
Convenience, take-away and fast foods have grown noticeably from 2011
In Base: 1,918 nationally representative UK adults aged 16+ (Figure 2)
In Base: 2,092 hospital foodservice users age 18+ (Figure 2)

8. Attitudes Towards Hospital Food
Comparing 2011 with Over a third agree, one in 10 strongly, that hospital food is not healthy enough
In 2013 – 7 in 10 of those who have eaten hospital food as private patients in NHS hospitals agree it should be more nutritious.

9. General Food Preferences – Breakfast
Breakfast if often touted as the most important meal of the day, here we look at what consumers eat:
Cereal is the most popular breakfast choice, with around two-thirds eating it during the week. But toast takes over at the weekend.
Students are the biggest fans of cereals – nearly three-quarters eat cereal during the week and they are more likely than average to eat it at weekends too.
Almost half (47%) liked cooked breakfast as a weekend choice.
Breakfast biscuits is relatively new at only 24%.
Fresh fruit is eaten at breakfast time by over half of respondents during the week more so by ABC1 socio-economic groups.

10. Eating Concerns and Preferences
Fat content is still the biggest concern to hospital foodservice users.
52% of hospital foodservice users say they make sure they eat healthily.
49% try and eat five pieces of fruit or vegetables per day.
16% say they eat a lot of convenience food.
47% eat a cooked breakfast at the weekend.
64% of hospital foodservice users eat cereal for breakfast during the week.
Majority of hospital still going for ‘traditional’ tastes - chicken still the old favourite.

11. Food Checklists – 2011 vs. 2013
“When shopping for food or choosing what to eat when eating out, which of the following do you check for, if any?”
Around half of all respondents check fat content, rising to six in 10 women over 55
This question was also asked in September 2011:
Fat content was then, as now!
Salt replaced by sugar
Red tractor logo and ‘organic’ more concern now
Fairtrade not changed
In 2011, salt was a major concern, this has been replaced with sugar in 2013
London and the South East are also more likely than those in other regions to check whether their food is ethically farmed.

12. Food for Life - Wastage in Hospitals vs. Fresh Ingredients
Number of uneaten meals served in NHS hospitals rose above 9 million in at a cost to the NHS of £27 million!
Source: SSentif Ltd– published Jan 13
Key facts
83% of hospital foodservice users say that hospitals should use fresh ingredients.
72% say that hospitals should source as much food locally as possible.
24% of patients believe their food is freshly prepared and cooked in the hospital kitchen.
In 2013, the Soil Association extended its Catering Mark to hospitals, with 17 UK hospitals working to include more local and seasonal products on their menus. The Food for Life campaign has 90 organic and non-organic suppliers signed up to the Catering Mark’s assured supplier scheme.
They highlighted a hospital could saved £6 million a year by cooking with fresh and local ingredients.

13. What do Hospital Patients Believe
Fewer described hospital food as ‘inedible’ in 2013 than in 2011 and more as ‘well balanced’ and healthier.
42% of patients in 2011 said they though the food was processed, compared to only 33% in suggesting there may have been some improvements here.

14. View of Hospital Foods
 “Thinking about the last time you or a close relative stayed in hospital, which ONE of these fits best with your overall view of the food?”
1 in 5 felt hospital food is generally seen as low quality
By region, those in the North and Midlands were less likely than average to think it was tastier than they anticipated.
Very few respondents selected the option that the food seemed fresh, and presentation scored even lower.

15. Views of Hospital Food, by Region
North
Midlands
East
London
South
Wales
Scotland
Northern Ireland
Base
2,092
500
310
196
316
463
109
146 52
The food was generally of a low quality
19%
18%
20%
21%
12%
23%
The food was tastier than I thought it would be
10% 7%
14%
13%
15%
The food was tasteless
11% 8%
25%
A good choice of dishes on the menus
The portions were too small 9% 4% 6%
The food appeared well cooked 2%
There was not enough fresh food on the menu
The food seemed healthy 5%
The food seemed fresh 3% 1%
The food was well presented
The portions were too big 0%
Other
Don't know

16. View of Hospital Food Sources
Over half agree that they should avoid all processed foods.
The vast majority also agree that hospitals should try to source as much food locally as possible.
The theme of fresh ingredients runs throughout this report: 51% agree that hospitals should use more.
Agree a lot
Agree
Neither agree nor disagree
Disagree
Disagree a lot
Hospitals should use fresh ingredients
32%
51%
12% 2% 1%
Hospitals should try and source as much food locally as possible
27%
45%
19% 5%
Hospitals should not use processed meats
24%
39%
26% 8%
Hospitals should avoid all processed foods
21%
30%
Hospitals should use ethically farmed meat and fish
18%
35%
33%
Hospitals should serve organic food 7%
16%
22%
I don’t mind where hospitals source their food from
36%
15%
6 in 10 agree that hospitals should not use processed meats.
35% agree that hospitals should use ethically farmed meat and fish.

17. Willingness to pay for better hospital food
Key facts
Half of hospital foodservice users would pay something for food with higher nutritional value and an increase in fresh ingredients.
44% agree that children’s meals should be exempt from any kind of payment and 34% believe payment should be voluntary.
42% suggest a sum of £1-£2 would be a reasonable amount to pay for better hospital food.
The future
Nutrition comes out tops for hospital foodservice users, priorities for the future: food training / fresh / locally or ethically sourced food.
Importance of vitamins and minerals (the nutritional content of food): half of those surveyed agree that vitamin and mineral supplements should be given to those who cannot eat proper meals.
4 in 10 think hospitals should act as centres of excellence for healthy eating.
Just over a third agree that they would like to see a ban on foods high in fats, sugars and salts.

18. Food as Medicine - Level of Agreement
Figure 36: Base: 2,092 hospital foodservice users age 18+
“Thinking now about how hospitals can improve their attitudes towards food, which of the following, if any, do you agree with? Hospitals should…”
6 in 10 selected the option ‘Make sure all ward staff are educated on the importance of nutrition for patients’, reflecting perhaps awareness and media coverage incidences of a lack of care.
C2DEs are more likely to want hot food counters near wards where they can buy food for patients as well as themselves.
34% want a ban on all fast type
foods from being brought in.

19. Discussion Points
Nutritious and appetising hospital food and drink are essential.
Patients should get a choice from a varied menu – including meals suitable for religious needs.
All patients should have access to fresh drinking water at all times, unless it contradicts clinical advice.
Food and drink should be available at all times, not just planned mealtimes.
Hospitals should promote healthy diets to staff and visitors.
Substitutes of hospital meals – hospital café.
The Government Buying Standards for Food should be adopted as standard whenever possible.
Hospitals should regularly evaluate their foodservice and act on feedback from patients.