Why is NHS hospital food so bad?

Though it rarely gets much airtime in broadsheet columns and Westminster debates alike, procurement provides a bedrock for bad suppliers to get close to the government. As the COVID inquiry publishes its damning findings on the systematic failures of procurement processes, it seems that revolving-door relationships between government and private contractors are slowly eroding our NHS.

A visit to Wythenshawe Hospital

On the second day of his two-week hospital stay, I visited my father on the cardiology ward. This first visit into the heart of Wythenshawe Hospital, one of the largest hospitals in the UK, was confusing and stressful not just because I was worried about navigating the hospital’s labyrinthian routes marked out by different colours and numbers, but also because entering a hospital almost always feels like a departure from everyday life.

There is something disconcerting about navigating the complex systems of the NHS when you have been thrust towards disaster unexpectedly. Even when problems are mundane, routine, easily fixed, and labelled with all the synonyms for “don’t worry, you’re fine” that a doctor can throw at you, a hospital nevertheless feels like a place you go to be outside of routine and time and whatever else structures our daily lives. Navigating into the belly of the beast to visit a loved one takes you out of the regular rhythms of 9-5 breakfast lunch dinner to think about what is really important.

My father had been admitted for the removal of a benign tumour that was found by chance. He was not unwell at first, despite the medical paraphernalia surrounding his neat little corner of the ward often making him seem that way. On the wall above his bed, a thought-bubble reminded us that “Steve cares about family”.

Wards are awkward places to be if you’re not a nurse and you’re not ill. We were in the way, squeezing ourselves to one side as a flushed nurse jogged past us with food or medicine or both. The walls were covered with a laminated sheen of information, encouragement or, more alarmingly, posters imploring patients and visitors not to verbally or racially abuse staff.

One of the first things that became apparent during his stay was the almost cliched refrain from my father and the patients surrounding him that, “the food here is shit”. Over the phone, he would describe to me the contents of his mealtimes: a wet-looking beige piece of quiche, barely edible, or a yellowed and sickly omelette, each meal reminding us all of the synthetic sliminess of school dinners.

Whatever we hear about the NHS on the news, that it’s failing, that it’s overused and underfunded, that there are terrible terminal staff shortages, that it’s totally on the verge of collapse, it remains clear that the standard of healthcare is astonishing. My father was pampered, checked on, reassured, and eventually operated on by a well-oiled and efficient machine. Maybe it’s because I was born in the early 2000s and have never known the power of a large state that seamlessly provides its citizens with work, housing and healthcare, but the NHS seems to be an almost total anomaly in a country wrecked by the cost of living: not only can you get open heart surgery completely for free, but you can get it done by the best surgeons in the country.

Where does NHS food come from?

But this amazing standard of care is undoubtedly undermined by the poor diet patients are fed by private suppliers who have long-term and lucrative catering contracts. Why, in one of the UK’s leading cardiology units where patients may be unwell due to previous problems with poor diet and lifestyle, do unhealthy meals populate NHS menus? This is especially concerning considering NHS-authored research findings that proper nutrition can reduce hospital stays, improve recovery and alleviate strain on the health service.

Throughout Wythenshawe Hospital, the name Sodexo is branded across friendly and informative posters about nutrition and the services that they provide as a catering supplier to the NHS. But despite their attempts to cultivate a friendly, local image for Wythenshawe’s inmates, Sodexo is a French company that provides a mixture of catering and security to large, usually public sector institutions, such as hospitals, schools and prisons.

Notwithstanding the several controversies that the parent company Sodexo prisons have found themselves entangled in in recent years, (in particular, the several controversies around prisons run by Sodexo Justice Services, like the mother whose child died after she was forced to give birth alone in a cell without medical assistance ), the food that they supply to NHS England hospitals is often low-quality and lacking in nutritional content. Talking to ex-patients and those currently staying at Wythenshawe, many say they have been surprised by the poor standard of catering and the unhealthy or unvaried meal options.

Procurement and public health

The recent COVID inquiry findings provide one example of the ways in which a poor procurement process can be disastrous for public health. While the inquiry found “no evidence of cronyism or corruption”, there was evidence of a system that is “inherently biased towards those with connections to the UK government”. It is difficult to understand what else cronyism could be defined by other than a preferential treatment towards “those with connections” to government ministers and other officials. Procurement is such a well-oiled government machine, only hazily understood by those outside it, that it seems hard for even public inquiries to get to grips with the problems that cozy relationships and preferential treatment pose when dealing with essential services for healthcare, defence and other sectors.

Despite these findings in the COVID inquiry and the avoidance of the explicit suggestion that cozy relationships between ministers and private companies are damaging to procurement processes, Sodexo sits comfortably in the knowledge that they are unlikely to be booted out from their prime position as a “strategic supplier” to the NHS with a lucrative contract that they don’t seem to work all that hard at maintaining.

This is because of a new initiative from the Department of Health and Social Care that NHS England and Cabinet ministers have called the National Strategic Supplier Relationship Management programme. Beneath all the verbosity, this is a new procurement model that, as Sodexo helpfully explains on their website, marks a “shift in how the health system engages with its most critical suppliers – moving from traditional procurement approaches to a structured, collaborative model that emphasises relationship-building, long-term value creation and innovation”.

How will this new model of procurement work?

So away with “traditional procurement”, the process responsible for what we can now all acknowledge was the perilous response to PPE shortages during the coronavirus outbreak. Shockingly, this model of procurement is not streamlined enough for companies like Sodexo who want first access to huge public-sector contracts. Instead, the “collaborative model” introduced by the new initiative, in which strategic suppliers like Sodexo have direct access to decision-makers, allows for the fostering of close relationships which will speed up the process of tendering contracts. Naturally, speed is good for private providers who want to minimise regulation, oversight and scrutiny into the products they intend to provide.

This amounts to a structural problem in government, rather than the fault of individual parties in power. There is an underlying issue with the way any government, the Cabinet and the civil service relate to private companies who provide services or supplies to the public sector. The way these relationships between government and the private sector are streamlined is through Crown Representatives, individuals who ostensibly work for the Cabinet Office while at the same time representing the interests of a particular private provider. This creates more than just a conflict of interest: it is currently unclear who Sodexo’s new Crown Rep will actually work for. Their website describes Sodexo working with its own Cabinet Office Crown Representative, while the government website describes the role of Crown Reps as working on behalf of the taxpayer to engage with potential and existing government suppliers.

This is, yet again, a hazy definition of procurement. If Crown Reps engage with both “potential and existing” suppliers, then why are they assigned individual companies to represent? The gov.uk website lists 36 companies, each with an associated Crown Rep working with them or on their behalf. And, more importantly, if Crown Reps are designed to “help the government act as a single customer”, why are several of these 36 companies still allowed exclusive access to policymakers despite being notoriously bad suppliers? For instance, Fujitsu, the Japanese tech company responsible for faulty Horizon software supplied to the Post Office that resulted in several people wrongly convicted of theft and fraud, continues to be exclusively represented by Crown Rep Vincent Kelly. Fujitsu have retained their status as “strategic supplier” despite admitting that they knew all along that the IT systems they supplied were faulty. Additionally, BAE Systems, responsible for supplying poorly performing weapons to the Ministry of Defence that were both late to meet project deadlines and predicted to be around £11 billion over budget, are represented by Meryl Bushell, the same Crown Rep who also works on behalf of Sodexo.

While the creation of Crown Representatives by the 2011 Tory-Lib Dem coalition government is celebrated as a way of improving procurement efficiency, it is unclear whether such a tight-knit relationship between the state and private companies can offer transparency and oversight as efficiently as it offers speed. As the COVID inquiry has shown, procurement is more than just a logistics headache for civil servants: it is the bedrock for expensive, bad decisions that ultimately serve to undermine trust in public services and line the pockets of large, often global corporations looking for easy and long-term contracts.

In the case of Sodexo and their poor-quality NHS catering services, procurement allows a company that is not fit for purpose to sit right at the heart of government, lobbying for more money, more responsibility and a greater chunk of our public health sector. Under current procurement processes, Sodexo can increase its buying power and cultivate a close relationship with government ministers while overseeing the continual decline of our NHS hospital food.