Episode 1 Operation Hospital Food with James Martin

Over the last decade £50 million has been spent trying

to improve the quality of our hospital food.

What is that? You don't know.

So far, though, there's been little sign that change

on a national level has been achieved.

That's the reality of the food that's served in the NHS.

In fact, a recent study revealed that over a third of hospital food

is still considered unacceptable by patients.

Just horrible.

It's not appetising.

It was inedible, cold. It was vile.

That's why for the last four years I've been working with NHS kitchens

to prove that serving good food IS possible.

30 seconds. Come on, come on, come on!

-You guys have made it.

-Thank you!

-Phew!

Together, we've demonstrated patients CAN have tasty,

nutritious food, without it costing any more money.

What motivates me more now is the public's perception of the good that we've done.

That means a lot.

But it won't be feasible to bring about real change by tackling

just one hospital at a time.

People deserve decent food in the NHS. It's not a big ask.

So, now my aim is to introduce a lasting improvement

to hospital food for every patient throughout the UK.

Mmm! Yummy!

Yeah. It's lovely!

I'm massively passionate about food in hospitals.

Change can be achieved.

Since 2011 I've made it my personal mission to improve the food

served to NHS patients.

-The food's awful.

-Bland.

-Tasteless.

-Atrocious.

It all began at Scarborough General in Yorkshire

where we transformed the menu, delivering meals to the wards

that were both great tasting and healthy,

whilst staying within tight budgets.

We're getting the price what we want it to be, and it's under £3.49.

HE MOUTHS

The results were hard won, but we highlighted that change really is possible.

-I think the food's excellent.

-The soups now are brilliant.

It's such great food.

Next on my campaign trail was Birmingham Royal Orthopaedic.

The biggest problem there was wastage,

with over £20,000 worth of food being binned.

365 days a year, this is waste.

There was more than this. This was going to go in the swill.

Wow!

I also found a demoralised team, resistant to change.

Do you have a recipe for ten litres of custard?

No.

But with hard graft and perseverance,

we saved the kitchen staff's jobs

and gave patients food to get excited about.

-We got exactly what I wanted. I have enjoyed it.

-Good.

-Absolutely delicious.

-It was gorgeous.

In order to roll out my changes, I roped in a group of chef mates

to take on hospitals in their own areas.

-I need you guys!

-HE LAUGHS

Cos I can't do it on my own.

I don't know whether they realise what they've let themselves in for.

What we managed to achieve in Cornwall, Norfolk and London was fantastic.

And one year on in Birmingham, the kitchen continues to thrive.

I was hoping for seconds.

I'd stop in a bit longer if they'd let me.

After decades of failed initiatives,

I've proved that we can really improve the quality of hospital food,

and at no extra cost. But to make a real difference,

my strategy needs to be rolled out on a much larger scale.

What I'm hoping to achieve this time is a bigger voice.

For me, this project has never been about a TV programme.

It's been about trying to make a difference.

I'm hoping to progress this forward.

Standards of hospital catering continue to make the news.

Since the last series it's been revealed that

until recently hospitals were responsible for rating

the quality of their own food.

It's a business where the customers - the patients -

have had little or no voice.

So this time round I want to put that right

and give patients the chance to say what they really make of

what's being dished up to them on the wards.

I think with the invention of social media, internet,

there's got to be something that can be accessible for patients to get involved in.

I'm hoping that bringing together the power of many voices,

and not just mine, will be the first step in finding a way

to bring about lasting change throughout the NHS,

and massively improve the food served to people when they're at their lowest ebb.

For my plan to work, I need my battle to go nationwide.

So I've arranged some big interviews that should spread the word.

I'm quite confident we can do good things out of this,

and I'm confident that if we give the patients the opportunity

to have a voice, then we can really see what the food's like.

We can start to build up a great picture of the food that's

served in the NHS in the UK.

And then do something about it.

James, we can bring you in now.

-We're doing a call-out, so that's why I've come on, as well.

-The call-out being what?

The call-out being that every hospital thinks the food's great.

I don't believe it, and certainly from the experience

over the past four years, I don't believe it is.

I think good food is quite sporadic in terms of some hospitals.

So, the idea is to give patients a voice and people can e-mail

their experiences, but also pictures,

because if we can get a food map of Britain we can actually understand

and try and change things and make hospitals accountable for it.

-Pictures of hospital food.

-Exactly.

-Nice to see you here.

-Thank you very much.

That's it, people are now aware of what we're up to.

Fingers crossed it'll be a success and we'll get a response from it.

There's more to do as well, cos right now I'm off to my mate Chris Evans for his radio show.

JINGLE: # The Chris Evans Breakfast Show Good morning! #

-CHRIS EVANS:

-22 minutes to nine o'clock, BBC Radio 2, here.

James Martin is live from Manchester.

He couldn't be with us this morning. Why are you on this programme this morning?

I need the help of the public, really.

What I'm asking people to do is either e-mail or send

via my Twitter a selection of photographs and information on

the meals you're currently having in hospitals at the moment,

and over the next four to five months

I'm going to try and change the food in hospitals.

We can then hopefully try and make a difference.

All right, we'll tweet those addresses and we'll put them on our Facebook as well,

-and we'll put a link on our website. So no problems.

-Thank you, buddy. Cheers. Bye.

Well, that went really well, it's great to pull in favours

from a guy that's got one of the biggest radio stations and radio

programmes in the UK, and already literally after about three or four minutes,

I'm already starting to get tweets coming in,

so I'm looking forward to seeing the e-mails, so fingers crossed.

While I'm waiting to see what response I get from the public,

I'm off to the Princess Alexandra Hospital in Harlow, Essex.

I've heard the food there is decent,

but they're currently busting their very small budget.

The kitchen is a traditional on-site catering operation

cooking over 6,000 meals a week.

But like many other hospitals,

it faces the threat of transferring to a system called cook chill.

That means the hospital buys in meals from an external supplier

then heats them up before serving.

If that's introduced here, the majority of the staff face losing their jobs.

So I'm here to meet Senior Catering Manager Andy,

and second-in-command Jonathan, to hear what issues they're facing.

-How we doing, Jonathan?

-James.

-Good to see you, Andy.

-Snazzy kitchen.

-This is our main kitchen.

-How old is this, then?

-The hospital was built in 1967, I think it was.

So, how long have you been here as catering manager?

-Well, I came over here in '87.

-And you're about to retire, is that right?

I retire next year. I've actually worked in the NHS

since I actually was 20.

-So, are you taking over, Jonathan?

-I'm taking over.

As someone who's worked in the NHS that long,

what's changed over the years?

-It's been a continuous driving costs down, unfortunately.

-Yeah.

We're working off £2.72 a day,

to provide a patient with everything they eat and drink in that day.

To keep it within budget is extremely difficult.

The fact that Andy has just £2.72 per day to spend on food

for each patient is a real shock.

This is the smallest budget of any hospital I've come across.

Cost-wise for this, are we on budget in this department?

Well, we get about £330,000 a year food budget...

-Yep.

-And you will be doing in excess of 150,000 patients through a year.

-Yeah.

-So, it's very tight, and at the moment I'm slightly overspending.

By a lot?

At the moment I'm about £7,000 overspent on my budget,

which is, what, six months of the year gone?

So, realistically, difficult to pull that back, to some extent.

£2.72 is not a lot of money! THEY LAUGH

The Trust is under huge pressure to reduce costs in the hospital

and they think ready-made meals may help them save money.

But in my experience, using a cook chill system not only leads to

poorer food for patients, it can also mean job losses -

so that could spell disaster for Andy and his kitchen staff.

The common theme I've learnt from the last four years doing this is

once you go down the route of cook chill, there's no going back.

You get rid of your brigade and a lot of the kitchen is mothballed or used for other things,

so, consequently, it's not easy to put that back in.

How do you feel about that as a legacy for you?

While you're wondering round the golf course, what will you be thinking?

All I want to really walk out of here with is

at least I've left it in a good state.

We're still giving a very good quality of food to the patients,

which is important to me, but what comes in the future, I don't know.

Andy wants his final few months at the helm of his kitchen to make a difference.

He wants help to reverse the overspend and potentially

lift the threat of job losses to his staff.

He has the backing of his head chef John and chefs Neil and Yvonne

who believe in the patients' right to good, nutritious meals.

It's very rewarding, isn't it, doing this job?

Yeah, it is. I'm totally dedicated to the NHS.

It really is something I'm passionate about as an organisation.

So, you get a bit of something more

cos you're doing something for patients.

What about the team here? Cos I think you've got a fantastic team.

They're a very good team. Very good team. I think we're pretty well organised.

Everyone knows what they're doing.

You're looking after ill people, and you've got to get it right.

You've got to get that food right for the wards.

If the food's not right for the wards, phone doesn't stop ringing.

Speaking to the kitchen staff and watching them cook,

I can see they're a really well-organised bunch

who, on the whole, know what they're doing -

something I've not always found in the other hospitals I've visited.

What's also impressed me is that they've already got some

vital procedures in place that I've had to introduce elsewhere.

These are all the lists of everything people want on each

individual ward, basically like an order, really.

This little piece of paper reduces the waste down by so much.

Without this, or if this turns up late, the chefs are really making it up,

and I've found in hospitals where I've been working so far -

not this one, I might add - that they've been literally wasting

upwards of 50% of all the food that comes out of this trolley.

And I reckon doing it this way,

I reckon you're probably going to see between 8% and 10% waste

which is not very much at all.

I'm impressed by the professionalism of the kitchen staff,

but it's some of the near 500 patients in the hospital that I'm keen to hear from.

-Ah, Peter. Good to see you.

-Hello.

-Good to see you. How are you?

-Good afternoon.

-So what are you in for?

Spinal decompression and spinal fusion.

That sounds a little more complicated than just an in-and-out thing.

You haven't been suffering with the food, have you?

Food is OK. If you're here for a couple of days after you come in,

-you've got a choice.

-And what about at home?

What do you look forward to when you get back out of here?

-Me? Curry!

-Curry, is it?

-Yeah, I'm a curry freak.

Anyway, we'll leave you in peace.

-And I'll see you at a local curry house shortly.

-Yeah.

-All right? Take care.

-Thank you.

So, Joyce, looking at this paper, I take it you're in for a new bionic knee to help you.

Absolutely. THEY LAUGH

How's the food? Cos you've been in here for quite a while.

Yes, and it's excellent. I like plenty of vegetables and fruit,

and I find plenty of that to choose from.

I don't know if your fruit bowl is going to catch on, Joyce.

-And why not?

-I don't know. Is that, like, a sick bowl?

-LAUGHTER

So Janice, how are you?

-Yes, fine. Doing quite well.

-Doing quite well? On the mend?

Yes, just about. I mean, I've been in many times

and I've never complained about the food.

I had a sandwich today, a tuna sandwich, which was excellent.

The key problem in this hospital appears to be providing a menu

that fits within the tiny budget.

They've got a lot of basics right, but I'd like to replace the packet made soup with fresh alternatives.

What if somebody put a fresh soup on the menu for you?

That would be lovely. I make my own soup at home, you see.

-What's your favourite soup, then?

-I do a cauliflower soup.

-Really good with a little bit of curry powder and apple in it.

-No, I don't do that.

-I nicked that one off Jamie Oliver.

-Oh!

-HE LAUGHS

-I'm only joking. Good to see you.

-Thank you.

This great patient feedback and the sound organisation I've seen

in the kitchen is a credit to the main man here -

who I think will be a hard act to follow

once he's hung up his chef whites.

So, what are you going to do when you retire?

I shall probably take the phone off the hook for a start

so I don't get too many phone calls.

It's an amazing job that you're doing.

Amazing. Amazing. You should be very proud.

-It's the team, it's not me.

-Yeah, but you lead from the front.

You're only as good as your team, but you lead from the front.

That's because basically I'm a chef at heart,

and that's what I get a buzz out of.

Yeah. You're not going to let this go, are you?

I've told them I don't want anything big.

We'll go out for a curry when I go. That's basically it.

-But no, it's... It's good.

-It is.

-And I have to say,

I've enjoyed every year I've actually spent here.

-There's a little tear in your eye.

-Yeah.

-Anyway, carry on with lunch.

For me, seeing a good kitchen like this

facing the threat of closure is heartbreaking.

But "well run" means not only good food, but also staying on budget.

However tight money is, there's no escaping the fact that Andy is still spending too much.

If that's allowed to continue, then the threat of job losses will remain.

I think the key to balancing the books might lie

in the hospital restaurant that Andy is also responsible for.

A common problem I've come across in other hospitals

is that their restaurants can be short of customers, but that's definitely not an issue here.

This place is actually pretty busy,

and looking at the figures that they've got here,

this is a pretty busy restaurant.

Just picking a random day, 24th of this month,

you had 1,177 customers come through these doors.

With numbers like that, this place should be making a healthy profit.

But at the moment it's actually losing money.

It's already £7,000 in debt for this year so far.

That's on top of the overspend that already exists on patient food.

Speaking to the staff who use the restaurant, it looks to me

like Andy and his team are really missing a trick

when it comes to understanding what his customers actually want to buy.

Being a doctor, sometimes I will have five minutes, if that, for a lunch break,

so coming down to the canteen, queuing and then worrying about

what kind of quality the food is,

sometimes I'd rather just bring in my own lunch.

There's a short time for physicians, for doctors.

You are very in a hurry, and you need to

pick up something that is not junk food.

What I'm thinking of doing is grab-and-go.

We'll portion it up and you grab it and go.

-Absolutely.

-It's quicker for you.

-Absolutely, yes.

-Quick and easy.

-Quick and easy. Bang. Yeah.

The hospital staff's demand for fast and healthy food

is also backed up by the restaurant's own figures.

Out of nearly 1,200 people coming through the doors,

only just over 10% of them had hot meals.

They've got far more cold sales than hot,

which means they're much more grab-and-go, that sort of stuff.

People who work in the NHS, particularly on these wards,

want to be able to come down and grab something quite quickly

and then disappear.

At the moment, these take-out customers are catered for

in the restaurant with a huge range of bought-in sandwiches

Four...eight...

And when I say it's a huge range...

31, 32...

..I really mean it.

There's about 60 different types of sandwiches there.

I think I've found one reason the restaurant is losing money here.

Buying in so many different types of sandwiches

really eats into the profit margin. The answer is simple.

Andy and Jonathan should be making their own.

-You've got a lot of different choices here.

-Yeah.

-It's like a supermarket shelf here.

-Right.

-If we took this choice down a little bit,

and started to make some our own baguettes...

We have actually made our own baguettes in the past and they do go very well.

If we make sandwiches ourselves, we haven't got enough staff to make that selection.

-I reckon we can reduce... Whatever's the least selling one...

-Reduce those.

Get rid of it, make 30 baguettes up, and I reckon you sell them for £2.70.

-Oh, we would sell them, I know.

-There you go.

-We have done them in the past.

What keeps us back is the shortage of staff.

It takes ten minutes to make 30 baguettes.

Replacing costly bought-in sandwiches with more

made by themselves in the kitchen,

is one way the team can push up their profit margins.

But there are other ways for Andy and the team to maximise takings.

The key to this is turn this into a salad bar,

and then right next to your salad bar, impulse buy fruit.

I think you could make a lot of money out of this bit.

Hopefully if the restaurant can start to turn a profit,

the money generated will go far enough to balance the books

across Andy's whole catering operation,

including wiping out the overspend on patient food.

I think the key to this really is streamlining everything.

I think if we can put it back into profit then the Trust, they've got difficult questions to confront.

You know - why would you get rid of something

when it's making money in a hospital?

If we can get the Princess Alexandra catering department making money,

it could potentially stave off a switch to the cook chill system here at Harlow.

But if not, and the hospital decides to make that switch,

it would change everything for the team.

Rather than prepare the patients' meals here in the kitchen,

food would instead arrive at the hospital pre-made from a factory.

The only thing left to do for the kitchen staff would be to heat it up and get it out.

It's a very different system to the current operation,

but one that head chef John already has first-hand knowledge of.

-Now, you've had experience of this cook chill situation.

-Yep, yep.

Your previous place used to be freshly cooked food?

It was originally, and then after two or three years we went over to cook chill.

And out of the brigade that was in the kitchen,

I presume some of them lost their jobs, did they?

Yeah, there were vacancies and they just didn't get refilled.

Tell me about it.

Basically, I think it's a retrograde step, really,

because it's definitely using cheaper ingredients.

-And we used to get very few complaints when we were doing traditional...

-Yeah.

And then the complaints started to go up when we moved over to cook chill.

And it's very difficult to defend

if you're called up to a ward and they say, "This is rubbish."

You can't do anything about it, can you?

No. We've got no input at all apart from loading it into a trolley.

The spectre of moving to a cook chill system here

is unsettling other members of the team, too.

It's like a cloud hanging over you.

It's a real worry, and morale does get hit by it.

Cos that must be quite depressing.

You know that any point in time, through no fault of your own,

you could get dragged in and all of you could lose your jobs.

Yeah. Which is frightening. Frightening.

I just don't think you've got the flexibility with cook chill,

-and we can tailor make our service for patients.

-Yeah.

And of course, also, you will invariably get rid of most of your catering staff

with cook chill, you will even probably get rid of your kitchen.

How do you feel about that? For someone who's been working in the NHS for as long as you have.

Do you think it's inevitable?

I think they think it's a way of actually reducing costs in the NHS,

and when you build new hospitals these days, invariably

they won't build a kitchen with it. They'll just go cook chill.

You can see when you speak to Andrew that the frustration

is in his voice, really. And all these years he's put in and all this work he's put in,

that to still have that cloud over him,

thinking it's going to be cook chill at any minute,

and this is happening all around the UK.

It's not just... He's not on his own here.

You've got a lot of people trying to do good in the NHS,

and then it gets taken away from them.

So it gives certainly Jonathan more incentive when he takes over

the reins to continue his legacy,

and also all the staff in the kitchen as well,

who have seen at first-hand exactly what cook chill can do.

It's clear there's determination to make the kitchen economically viable here.

But its fate lies with the hospital's key decision maker,

Chief Executive, Melanie Walker.

As a Chief Exec, I was thinking this was going to be a very

glamorous office and everything else. This is reality, though, isn't it?

It's one of the many myths about the life of an NHS Chief Exec, James.

-This particular hospital is struggling financially.

-Yeah.

It's been in the papers. Just how much is this place over budget?

So, we have got the dubious honour of being pronounced in the

Health Service Journal as being the Trust with the highest percentage deficit.

So our budget is about £173 million,

and we have a deficit of about £15 million.

-Which, by anybody's measure, is a lot, yeah.

-A lot.

-Yeah.

-And there comes a point where we've got to think very

differently about how we run the hospital.

And there isn't an easy answer to that.

So, I'm trying to narrow it down into the catering side of it.

Because you have this real black cloud over downstairs

-about this cook chill thing.

-Yeah.

I mean, the way you're nodding your head, this could be a distinct

possibility to save money, would that be the case?

The issue for me and for the board will be - which provides the better quality and value?

There will be a financial decision in that.

I'm not going to pretend that there wouldn't.

-That's going to be quite high up the list, the financial decision.

-Yeah.

Hearing that the hospital has a £15 million overspend,

it's clear that Melanie has to think very seriously about where she can make savings.

But I'm not sure that cook chill can be any cheaper for the hospital

than the great food the kitchen staff are already providing.

This is the lowest budget I've seen in terms of per patient per day for food.

-£2.72 is the lowest I know.

-OK, right.

Are you telling me you can actually get cook chill for the same amount of money?

I haven't seen the price, so I don't know if that's true or not,

but we had a piece of work done about a year ago

that initially indicated we could make significant savings on catering and the kitchens, etc.

-How can I help?

-What I'm looking for from the opportunity of you coming along

-is, can we improve the offering in the restaurant so we get more profit in?

-Absolutely, yeah.

Can we then use that profit to put into patient food?

Which helps in the situation where we haven't got huge amounts of additional money.

I can certainly help you with the restaurant being more profitable,

because 1,200 people come through those doors,

and I think there's a huge market for a grab-and-go sort of idea.

Fantastic.

And I'm clear that if we make it profitable,

that changes some of the debate, but then we can begin to put some of that money back into patient food.

Yeah. If we were to streamline the restaurant,

would this cloud that's going over them at the moment...?

Because you can imagine coming to work, you've got guys who've got kids and he doesn't know

whether he's going to jump ship or whether he's got a job next week.

Yeah. I'm very happy to have that conversation with them.

I've had that conversation with them before. We can have it again.

What they want is just security for 12 months to say,

"Right, if we're going to do this, let's focus on it before any decision is made, if any."

Yeah. If we can come up with a solution that is viable,

the executive team's preference is to retain the existing service.

I'm pretty positive that we can make it better for you. I think this could work.

-Brilliant.

-It was an absolute pleasure to meet you.

-Pleasure to meet you.

-I don't envy your job at all.

-But then, on Christmas day I don't envy yours!

-THEY LAUGH

The message from the top seems pretty clear to me:

turn round the catering department's overspend,

or face the introduction of cook chill food in the hospital.

It's a challenge that won't be easy on the team's budget,

but from what I've seen, there's an obvious route to recovery.

I think given the amount of people that come into this restaurant,

there's definitely scope that we can do quite a number of things in here

and definitely make it more profitable.

Here they reckon there's about 1,200 people per day, so...

Just little tweaks, but on the whole it looks pretty good so far.

What I'd see as little tweaks in one of my restaurants, though,

are often a very different matter in the NHS -

or so I've discovered in the past.

So the issue that's in front of us is where we're sat now, the restaurant.

-Restaurant. Yeah.

-We need to make this more profitable.

-That's exactly it, yeah.

I think you're in the unique position where you've got

a large number of people coming in here.

Mostly all those are staff,

so they're quick and go, grab on the hoof, sort of thing.

Watching those grab-and-go customers this morning

I wasn't too surprised to see that it was the fresh sandwiches

made by Andy's team that were the best sellers.

-Your sandwiches were the quickest thing to fly out of here this morning.

-Yeah.

-So Monday - double it.

-OK.

And then what I think we should do, from this moment forward,

on Monday, let's look at doing packs of salad that's already made.

And then I think soup needs to be on.

-Lunch and evening?

-Lunch and evening.

-OK, fine.

You see, 100 portions of soup at £1.50, that's £150,

it's cost you £25.

You've gone 15 grand shortfall to 15 grand profit,

and you've just made soup, you ain't done anything.

When you've got the 1,100, 1,200 and predominantly are staff,

then you've got to look at their eating habits.

Half an hour break, 85%, that's a big chunk, is going grab-and-go.

So let's aim at that for the moment.

It's a pretty simple plan,

but there's no doubting it will increase workload

for the kitchen, which may not go down well with everyone on the team.

I think the restaurant is the key point to our survival in staying traditional.

I think they're very good ideas, and obviously we'll give them a go.

The only thing I'm concerned about, some of the suggestions like making sandwiches,

we're quite short staffed, we're not the most staffed in the catering.

If a member were to go sick or we're short staffed,

it's very difficult to make everything in one day.

Jonathan might have concerns, but I believe making more of an effort

with some soups and other fresh foods to go

is a vital way of getting the restaurant to turn a profit.

There's also another cost-cutting measure I'd like to see them take on.

The kitchen is currently running a two-week menu cycle,

but the average stay in the hospital for a patient

is actually less than a week.

Halving the range of meals that the team makes for both the restaurant and the wards

would have major cost-saving benefits for the kitchen.

I know we've got this two-week menu cycle.

-I would do a one-week menu cycle.

-OK.

It's a massive change, it's a big ask, I know it is.

James has actually thought that a one-week menu cycle

would be more than adequate for patients. I don't have an issue with that at all.

You can't be just set in your ways, you've got to be open to change,

and that goes on constantly - change goes on all the time.

If every single NHS hospital had an Andrew,

we wouldn't be in this situation.

And I think without those guys being really passionate about what they do,

none of this would work and everything would become cook chill,

and unfortunately that's the way things are going.

How do you feel, honestly, about

walking out these doors in February?

As I say, apprehensive, I think.

All I want is to make sure when I do leave here,

John's going to take over and it will be left in a good state.

Which hopefully it is. Unfortunately, if I stayed on any longer,

they'd probably end up carrying me out! HE LAUGHS

I'm impressed with Andy's commitment to the kitchen,

and the team seems happy with my plan.

It's over to them now to implement some changes before my next visit.

If we can improve the profit margin in the restaurant,

and make it a lot more profitable, then I'm almost sure

the Trust will park cook chill and save traditional.

Hopefully when I leave, I'd like to come back in a year after that

and find it still intact.

If the team and I can turn round the problems at Harlow, it will be

a positive step. But I want much more than that.

My aim is to see an improvement across the NHS.

To get a greater understanding of the obstacles to that, I invited

you to share your experiences of hospital food with me.

Since calling for help, your stories and pictures have been

flooding into my inbox, and they make for some sorry reading.

Well, this is it, people are responding, and to be honest,

I'm pretty shocked at the amount of e-mails that we've had.

Nearly 300 at the moment and counting. This says it all, really.

"Having spent five nights in hospital in August,

"it was only on the fourth day I had something to eat.

"There was a selection of food but a strange selection.

"This was one of them - jacket potato with a cheese and leek filling."

Slightly different, isn't it, really?

What is that?!

HE LAUGHS

Some pig died in vain. Look at that.

At least, I think it's sausages.

That is proper rubbish.

"This was supposed to be mash potato and minced beef served to me

"after a bowel operation.

"I couldn't even bear the smell. It was absolutely disgusting."

That's down to people who don't give a damn, which is annoying.

I mean, look at that. That looks like something that somebody's regurgitated.

Look at it! That's the reality of the food that's served in the NHS, and we're paying for this.

It inspires you to get in there and to work hard and improve it,

but a lot of these Trusts and a lot of these hospitals won't let you in.

And this is just a little insight into... I mean, just look at that!

What the hell is that?!

"I was given this the day after having a baby.

"Needless to say, I politely declined."

Not surprised!

"For your interest I attach a photo of the food that was

"served during his stay which looked and smelled disgusting.

"I even quizzed a member of the nursing staff

"and asked what it is, and she couldn't even tell me.

"Regards, Colin."

Colin, I can't tell you what it is,

and I've been in catering for 30 years.

And you can see people are really annoyed about it, because these

responses are not one line responses,

they're paragraphs and paragraphs.

Why do we have to put up with this rubbish?

If ever I needed a reminder as to why all this matters,

the e-mails and pictures flooding in have provided me

with plenty of ammunition.

Whatever the claims the NHS might make about the quality of their food,

the evidence from patients reveals the shocking extent of a very different story.

But the sheer scale of the problem is a stark reminder that

making improvements on a national scale is going to be a tall order.

All I wanted to do was make the food better for people in hospitals.

That's all I wanted to do, and it's all I still want to do.

How you achieve it isn't easy.

People have got to want to change, you know what I mean?

It's one of the most frustrating things in a business that

doesn't have to make money, you know?

Bringing about real and lasting change might be a tough ask,

but I'm still determined to give it a go.

And while saving individual hospital kitchens

and changing menus here and there is all great,

I believe the key to this is to make the fight a bigger one.

Getting into every hospital isn't feasible.

So I think I've hit upon an idea which should help - by enlisting

the support of hospital catering managers throughout the country.

I thought what I'd do is actually go through the back door of the hospitals,

and get the chefs to come down to my house and almost do like

an open house and get lectures from all the people that have been working with the NHS

that can explain to them what it is we're trying to do

and what it is we're trying to achieve to make things better.

If we get it right, and if I can get all the people talking to each other

and get their backing, more than anything else,

we can hopefully change things for the good.

This is probably going to be the hardest task yet,

to try and change people's opinions. Trust me.

So, if I can't get to all the hospitals,

the hospitals can come to me.

One organisation which could prove vital to the success

of my open house plan is the Hospital Caterers Association.

In the past, they've been reluctant to meet me,

probably as they felt I was knocking their work.

But now their chairman Andy Jones has offered to help out,

another sign that my ideas are starting to make inroads with the people who really count.

Now, you've been watching this from the sidelines over the last few years.

I certainly have, yes. I watched the first series and the second series,

and I've still got them on playback, actually.

What did you make of it in terms of what I was trying to do?

The first series, I think, as an association, we stepped back from it

because we've had celebrity chefs involved in the process before,

and we felt, "Is this another celebrity chef?"

But as the series went on, we decided

no - it was somebody different who really wanted to make a difference.

And the work that we believe that you're doing

will make it again part of the recovery plan.

A seal of approval from the association for what I'm trying to achieve is a real breakthrough.

With over 400 members, they're the major voice for the industry.

And now I've got them in my corner, I'm determined to make their support count.

I'm going to be honest with you, we had an awful problem

trying to get into a hospital in the first place.

Even continuing to do so. We're now three, four years into this project.

It's very difficult to get a hospital to respond to us, let alone let me in.

I've got an idea, all right? And that idea, rather than me

going around and trying to change each one individually,

if we do an open invitation, say, for one or two days,

I do a workshop. It's an open invitation

for anyone of your guys, your members,

to come down, I think we possibly could break new ground here.

Cos if we did that and gave them away

a pack of recipes and information,

they would then have their choice to go away and make a difference.

This is another way of doing it, but do it not via the back door,

but via the people that matter.

And I get the feeling, if we can speak to the head chef, then we can make a huge difference.

-I don't know how you feel about it, but...

-I feel that's a really great idea.

As an association, we'd certainly welcome that.

In terms of the way we push this forward,

shall we put something together on a piece of paper for you to fire out

on your database to all your members and particularly the chefs?

-Yes.

-The key to this is getting the chefs involved in it.

Having the backing of the Hospital Caterers Association is huge,

and Andy is as good as his word

when it comes to letting his members know my plans.

He sends each of them

an invitation to the open house workshop that I'm planning.

And it's not long before e-mails from all over the UK begin to

pour in with requests to attend.

But they aren't the only responses filling my inbox.

As the days tick down to the cookery school,

shocking images of hospital food

sent to me by patients and their families continue to pour in -

a constant reminder of why all this is so vitally important.

And inviting round all those chefs is my chance to get

the message through to lots of hospitals - all in one go.

Well, this is it. It's the morning of the cooking school

and I'm getting set up.

I think what's going to be great about today is

I can't get round every single hospital, it's not possible,

and I've learnt, trust me, I've learnt by doing this,

that it's very difficult to change one let alone trying to change two.

I'm really pleased that we've got people who are currently

working in hospitals all around the UK coming down.

The whole idea of this is I'm going to teach them a couple of things that I've learnt.

I want them to tell me what they expect,

and what it's like for them, and whether or not we can help them.

But I think the effect that we could have on the NHS is massive, really.

If those hospitals go away and implement

just a small fraction of what they're going to learn today,

that will make a massive difference to patients all across the UK.

So, the key to this day is information, informal chat,

and having lunch, really.

But before the first of my guests have even turned up,

I get news of a major setback.

Word has reached me about the future of a hospital kitchen where an old friend works.

Well, as well as getting e-mails from people regarding

hospital food, this has just come up in the local newspaper.

It says here that the kitchen is set to close in Bridlington.

It looks from this that Bridlington is going cook chill.

Bridlington is one of two hospital kitchens managed by my old friend, Pat Bell.

-How are you doing?

-How are you?

-Nice to see you.

-Nice to see you.

As the catering manager at Scarborough General,

she helped me turn things around at the first hospital I visited

when I began this mission.

How much was the budget per patient?

Last year it worked out at £3.30 per patient.

-So, you're 19 pence under budget.

-Yeah.

The success we achieved at Scarborough led to Pat also

rolling out the same ideas at the hospital in nearby Bridlington,

part of the same Trust.

So, after everything she's done to turn the food around at both hospitals,

I expect the news that one of those kitchens is closing

will have hit her pretty hard.

Hi there, Pat. It's James here. How are you?

I've just read it. Tell me what's happened.

It's clear from the phone call that Pat is pretty shaken,

and doesn't want to say too much.

Chin up. Bye!

But with a bit of digging, I'm able to find out more about what's happened.

That's interesting.

York Trust are actually investing into a new kitchen,

a new development kitchen, a new restaurant all at York.

The fear is they're doing that to expand the cook chill enterprise

to be able to cater for Bridlington and Scarborough possibly,

and other hospitals that are round and about

that are going to be hoovered in into the main trust.

It seems ridiculous and makes me demoralised, to be honest,

and frustrates me, and actually makes me think, well, what's the point?

It makes you think you're fighting a losing battle, sometimes.

When you've got people as good as Pat running a catering department

and even she gets...dumped on.

And...I don't want that to happen, but I don't know how to stop it.

What more do you have to do?

It might be bad news, but I'm determined not to let this set back

my plans to roll out a workable and lasting template for change.

And right on cue, the people I think will be able to

carry on that fight are arriving to take my campaign to the next stage.

My cookery school kicks off and I soon discover

not everyone shares my views on the future of hospital catering.

There is a big black cloud over the NHS at the moment. Cook chill.

I disagree with that. Don't disrespect,

because cook chill is actually, I think, the better quality.

I visit a Lancashire hospital where I need to impress

some of the most plain-talking food critics I'm ever likely to cook for.

What cheese do you want on your pizza?

-The sprinkly one.

-The sprinkly one?

-Yeah.

And I turn up the heat on the team at Harlow by revealing

one of the steps I want them to take in the battle to save their jobs.

I don't want to put any more pressure on you,

but I want to go down to a one-week menu cycle.

The look on your face!