The true cost of empowerment

The quality of food served by our hospitals has come under the microscope this week. In our modern world where technology rules the day, patients have become empowered by their all conquering mobile phones. Cases have come to light in which patients in hospital beds have taken to ringing the ward desk on their ward if they don’t receive a response when ringing their emergency bell. Patients have also started to take photographs of their food to share with others. Mostly this is done to highlight perceived inadequacies. Occasionally this is done to highlight the merit of their meal. Either way, the patient has seldom had more power than he has today. Although this might be no bad thing, it may also bring as many problems as it solves. At Medical School, doctors are trained in patient centred care. Here, the ideal is to take decisions in the best interests of the patient rather than in the best interests of the doctor. The Francis Report in the aftermath of the inquiry in to Stafford Hospital only served to highlight what many people had already seen at hospitals the length and breadth of the country. In some ways, Stafford was needed because it was potentially the catalyst to change. Change, of course, won’t happen overnight because it never does. What the report does bring though is an aspiration for patient care. Aspiration is the first step. Just as members of the medical profession can rightly expect to be placed under the microscope with regard to their own behaviour and performance by their mobile phone wielding patients, the patients also have their own part to play. A recent case in North Wales highlighted the sad story of a lady who was sent to her local Cottage Hospital where she witnessed sub standard levels of personal hygiene by the staff and patients around her. As per the recommendations of the Francis Report, she voiced her concerns to the Ward Sister but nothing was done. The point I make here is that care actually begins with the most basic things such as hand washing. The most revealing aspect of this story is that this lady complained but was not listened to. It is all very well encouraging a new culture in which people are encouraged to complain but such a culture will never take off if people can see that it gets them nowhere. The lady in this case subsequently died from a hospital acquired infection which the coroner deemed accidental. Up the road at Glan Clwyd Hospital, they have divulged that they oversaw 96 cases of Clostridium difficile between January and May of this year. Could do better. But back to the food. When people find themselves out of work and seek unemployment benefit, they are often surprised to see how little they are expected to live on for a week. When the NHS claims to be “free at the point of access to every man, woman and child”, free does not imply that the food can do justice to a Michelin star. Even a Michelin starred restaurant would struggle to maintain high quality food provision with a restricted budget to feed many hundreds of patients. I do not excuse poor quality food but rather seek to put in to context the challenges facing the caterers at our main hospitals. It is true that no national guideline currently exists for the quality of food served up in the NHS. In an era where a national guideline seems in place for just about everything else, this is at best surprising. In my previous role in the wholesale food industry, I worked for the company which supplies food to the NHS. Lots of it was frozen and in multi portion ready meals. Question. Why would you want to buy in frozen ready meals when you have fully stocked and staffed catering kitchens capable of making such meals fresh in house? Answer: Money. Put simply, the cost of employing the staff to prepare and cook the food costs far more than just buying it in cheap from a company which is mass producing it. It is simply an economy of scales. It is a sad reality of life in the NHS that such a low value is attached to the nutrition of the patients who we seek to make better. Granted, the NHS is under increasing strain financially as the demand upon it increases and the money made available barely keeps up with inflation. That said, it seems counter intuitive to compromise on one of the aspects of patient care which best contributes to their recovery. Aside from the extra employment it would bring, increasing the catering operations at our hospitals could have a dramatic impact on patient outcomes. Dare I say, there might even be instances of local pride in which hospitals actually vie with each other for greater standards of culinary excellence. Why not? I’m told there is a TV programme which follows the progress of Junior Doctors as they embark on the first steps in their medical careers. With the photographic and video capability of mobile phones, every patient is now a potential film director on hand to capture the latest scandal for the public to feast on. But what about these mobile phones? Where is the catch? The catch is that they all represent one of the most obvious infection risks in the entire hospital. When a patient is admitted now they are swabbed for MRSA as standard. Why are their phones not swabbed likewise? Perhaps this would constitute an assault on patient rights. Seriously though, it makes sense to me to start looking more closely at everything which comes through the door if we are to take hospital infections more seriously. If the NHS is to remain free at the point of access, much needs to be done. If the NHS budget was allocated more in line with Maslow’s hierarchy, the end results would arguably be more fruitful!