Episode 4 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!

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

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 starting my campaign to transform hospital food, I've been

shocked at the reality of what some patients are being given every day.

Just look at that. What the hell is that?

The e-mails and pictures you've sent me have highlighted

an extraordinary disparity in standards across the UK's hospitals

and given me a real sense of the good, the bad

and the unidentifiable.

It inspires you to sort of get in there and to work hard

and improve it.

And now, rather than bring about change in just a handful of places,

I've come up with a plan to help the entire hospital catering

industry, making all my ideas and recipes freely available online.

This website actually seemed like a good idea at the time

and I still think it is.

But it's a logistical nightmare.

As well as sorting out all that,

I'm continuing to work directly with certain hospitals around

the country to implement those ideas to benefit patients right now.

-High-five!

-Hiya, you all right?

-Good to see you, Andy.

At the Royal Oldham, I've delivered nutritious versions

of the kinds of food that kids really want to eat in hospitals.

Best pizza ever!

In Chesterfield, I'm helping to develop a food service

for patients after they've been discharged.

-We want to provide the patients some kind of grocery pack.

-Yeah.

-Do you think it's a good idea?

-I think it's a marvellous idea.

And at the Princess Alexandra in Harlow, where

the catering department has a sizeable debt, I'm hoping that

the ideas I'm working on with the team will be enough

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.

Today is roll out day at Harlow for the new one-week menu I've

planning with the team and the pressure is on to get it right.

Well, today is a massive day.

Not only do they have to streamline the menu,

doing so, this is the first time we're going to put a weekly

menu on, but also the same dishes the patients eat are going to be

the same dishes we serve in the restaurant.

So, hopefully, if we do all that, it's going to cut the costs

and streamline everything and make it really nice.

The Princess Alexandra is £15 million in debt,

so chief exec, Melanie Walker, is looking closely at the future

of the onsite catering operation with a view to reducing costs.

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.

One solution being considered would be to close the kitchen

and switch to a cook chill food system,

the most common type of hospital catering in the country.

It means the food is made off-site, bought in, and reheated.

Andy from the Princess Alexandra hospital with

the order for tomorrow for you.

If Catering Manager Andy and the team is to avoid that, they need to

turn round their £19,000 deficit and become cost effective quickly.

Can you drop that in tomorrow for us?

Yeah, please, that would be brilliant.

The change to a one-week menu cycle will help.

By ditching half of the meals they're currently making,

it should instantly cut the money the team spends on ingredients.

So, ten of these and ten like that. Yeah?

Walking into the kitchen today there's a real

feeling of nervous energy in the air.

Chefs like Yvonne and Neil are having to adjust to doing

things differently.

We'll see on the feedback today because it's the first

time these recipes are actually going on the wards.

So we'll find out today what's what.

I can't see why the patients can't have the same

as what the visitors or the nurses or everyone else is having.

Continuity, that's what you need. It's much more exciting, yeah.

There's been a bit of a buzz about the place.

So far, kitchen boss, Andy, seems to be keeping calm.

Try that, John. Try a bit. It's lovely.

The idea about the one-week menu cycle,

I'm almost sure will bring dividends.

I'm hopeful that it'll actually reduce our costs and,

at the same time, hopefully push up quality a bit as well.

This is big change.

You may not think it, going down to a weekly menu,

but it's fantastic to see all the guys really embracing that

and I think a lot of that was down to the fact that they

now know what pressure Andy has been under and he continues to be under.

They really want to rally around and support him even more

and what I've seen today is the perfect example of that, really.

And, of course, there's another reason for the chefs to want the new

menu to be a success.

If the department continues to lose money

they could all be out of a job.

There's nothing worse than the morale going down

because you don't know if you've got a job at the end of the month.

I retire in a couple of years, but these are young lads.

It's their livelihoods. They've got families and kids.

They don't want to be looking elsewhere. Oh, yeah, awful.

With the clock ticking down to lunchtime, there are just

a few frantic minutes remaining for the team to

finish off the first meal they'll serve as part of the one-week cycle.

With everything finally ready, it's time for the kitchen's

second-in-command, Jonathan, and I to head up to the wards to see

if the new menu will prove a hit with the patients.

-James, good to see you.

-Good to see you too.

Knee by the looks of things. Is that right?

Yep. This one 18 months ago and this one this week.

Well, what do you think of the food so far, because this is the boss?

-Be as honest as you like.

-The food we've had here has been excellent.

-Is there enough for you?

-There's enough here.

They come up reasonable portions. It's not skimpy.

Fantastic. Well, good luck. Look after yourself.

-Thank you very much.

-Thank you very much.

Don't come in for another one, because you've used two already.

-I've used them up now.

-Nice to see you.

-What did you have for lunch?

-I had the vegetable pasta bake.

-And you enjoyed it?

-Yeah.

-How many hospitals have you been in, in your life?

-Three.

-About three different ones?

-Yeah.

-Yeah? And how does this compare?

-It's good.

-There you go.

My head's getting bigger. I'm really pleased.

-You've got a friend, anyway.

-I've got a friend, yeah.

-Get better soon.

-OK.

-How you doing, Robert?

-Very good.

-You're diving into that.

-I am.

-Yeah, you like it?

-Very nice.

And filling as well, is it?

It is because I'm just thinking to myself,

I hope he goes in a minute because I won't be able to get all this in.

And what about... I've got an idea about putting a little recipe

bank together so all the other hospitals can use it.

-Yeah.

-As you're diving into this everybody around the UK

-could also have some.

-Yeah, I would recommend it.

Yeah? Out of ten?

Oh, I'd give it a nine.

The meal options from the new menu have been given a thumbs up

by the patients, and Jonathan seems pretty pleased with the reaction.

We got very good feedback from the wards

regarding the food today.

I think we've got a good team here. It's just a case of moving forward.

Sometimes you can get a bit stuck in a rut

and basically do the same thing every day.

It's nice to have a fresh input by someone else giving you ideas

and suggestions.

But success with the patients is only half the story today.

For my new menu to be as cost effective as possible,

I want it rolled out in the restaurant as well as on the wards.

-Soup to take away?

-Yes, please.

If the hospital staff that eat here are as enthusiastic as the patients

then it should result in major cost savings as the team can bulk

buy the same ingredients to cover both the wards and the restaurant.

It's nice to have something that's warm and filling

when you've only got a short snippet of time to eat

and often we don't get regular breaks.

So, sometimes it's just a quick five minutes.

Something like a soup and a roll you can have and carry on.

It's nice that it's all home cooked, as well.

It's not been brought in pre-packaged.

When I see a patient eating something on the wards,

sometimes I really think, oh, yeah actually I'd quite like that.

So it would be nice to come down here and get that.

It's been an encouraging start for the team.

So have I got anything coming in on the prep side tomorrow at all?

And if they can keep it up, they now have every

chance of cancelling out the department's deficit.

Amazing job. Thank you very much, guys.

I think great appreciation on the wards as well.

-Yeah, that went very well.

-Yeah, went really well, didn't it?

-Definitely.

-The first day has gone very well for us

and I like to think that through the rest of the week, it'll carry on

being as successful as well.

And, as you saw in here today, we we're all working together for that.

We'd like to see an increase in revenue from the restaurant.

What we want to make sure we can do, is put the ideas that James

has actually brought to us with his salad ideas and grab-and-go

ideas that he's brought to us and that's really what it's about.

But this success needs to be sustainable to convince

the hospital trust to stick with the traditional kitchen here,

rather than cutting jobs with a switch to a different system.

Thank you!

The Princess Alexandra isn't the only hospital I've

worked at facing that threat.

York Trust, which runs the hospital where all this began,

Scarborough General, is also considering the future

of its kitchens.

It's already announced the closure of its traditional set up

in Bridlington.

It looks from this that Bridlington is going cook chill.

And Scarborough, where catering manager Pat Bell

and I first proved that it is possible to give patients

better food at no extra cost, could be next.

York Trust is my home county. I'm very proud of that place.

I'm very proud of the people that it represents

and the people that it serves. I felt honoured, to be honest.

A local boy goes back home and helps out the local hospital.

It was really everything that I ever wished for.

With York Trust offering few assurances over

the future of the kitchen at Scarborough, it looks as

though this may be a battle that I've lost.

But around 60% of UK hospitals now serve cook chill food or

other types of off-site catering.

If I really want to make a difference on a national scale,

I can't ignore that.

Up to now, I've never seen exactly how food made off-site is produced.

But finally that's about to change.

We've talked a lot about cook chill

and the effect that it has on catering units that I've been

working with over the last sort of two-to-three years.

But thankfully, after those years have passed, the NHS have

allowed me to come here.

This is there own Central Production Unit in Wolverhampton

and they want me to work with them on stuff they're serving

in the hospital right next door, so I'm looking forward to today.

This isn't your typical cook chill production unit.

For starters, it's a little unusual for one to be based

so close to a hospital.

Plus, it's run by the NHS, rather than a private company,

as many of them are,

although the patients are split on what they make of the food.

It's a bit bland.

-I'm quite happy.

-It's vile.

These meals are prepared in a central facility like this one,

blast chilled in large fridges then transported to

hospitals in the surrounding area.

When the food finally reaches the wards, it's reheated using

a special serving trolley.

What is that? You don't know.

I've always believed that the majority

of off-site hospital catering is of a poorer quality

than meals cooked in a traditional kitchen.

Fetching, I know. But there's a lot goes on here.

I'm here at the unit today, though, with an open mind.

And Catering Production Manager, Gene, has pledged that he'll

take on board my ideas and suggestions.

But first, I need to see exactly how a place like this operates.

What are we looking at in terms of production?

What's the average amount that you do a day?

1,000 lunches, 1,000 suppers, so 2,000 meals on a normal

production day.

We do a double production day on a Tuesday,

so that would be 4,000.

The unit here caters for three hospitals in the local area.

But producing 4,000 meals on a busy day is pretty staggering.

Compare that to the kitchen I've been working in, in Harlow,

which gets through around 900 meals daily,

and you begin to get a sense of the scale of this operation.

In my book, mass catering doesn't usually result in quality food,

but there's no doubt that there are some aspects of the way

this unit is run, which I wasn't expecting.

This is the decant area.

So you can see all our raw meat has come through.

It's interesting that you use fresh chicken because a lot of these

much bigger units than what you've got here, might be using, well,

it could be frozen boneless chicken, it could be anything really.

We don't use any frozen meat at all. Everything is fresh.

All fresh. OK.

That's not the only working practice I'm in favour of.

There's also close attention paid to the way dishes are produced,

sometimes with obvious benefits.

-Each one of these trolleys is basically a recipe, then.

-Yes.

So you basically standardise the recipe exact?

The recipes have to be standardised because they're all agreed with

the dieticians.

So it keeps our dieticians happy.

It keeps the finance people happy,

so we know exactly how much we're spending.

We have a very strict budget to stick to

and it also cuts down on waste.

If we're cooking 385 portions of cottage pie,

we order exactly the right amount of ingredients to cook that amount.

Sounds good.

Now this is more like it. Some serious pans.

You feel a bit more at home in here, then?

Yeah. I've never seen equipment like this.

I don't know what these cost, but they are not cheap.

They're not cheap. However, we do make savings.

When you're cooking in bulk like this, you need less staff.

-What are they? Three, four?

-Yeah. I was really surprised.

-It's not many, is it?

-No. And it works, James.

So, I'm intrigued to know what you're cooking today,

-so can we go and have a look?

-OK.

With only four chefs making up to 4,000 meals a day, it's

clear that the unit have bulk production down to a fine art.

But how the food actually tastes is what really counts.

Home-made soup.

-Home-made vegetable soup.

-Home-made soup.

If you think it's too salty, you can work on the recipe with us!

There's pros and cons with everything, really.

I can see, really, why they do it.

The negative side, is you don't get any variety, really.

There is work that we can help them with, absolutely,

in terms of the soups and the tastes and everything else.

But the basis of everything is there.

It's just there's a little bit more frozen veg than I'd want.

Try and get fresh veg on because they've got fresh meat on.

You know, most of the time with the NHS, you're fighting for equipment.

You've got it all. You could have a bath in there, look.

Albeit a hot one.

I can see it's a very professional set up here.

But amongst many of the people I've spoken to in hospitals,

not just chefs but dieticians, nurses and patients too,

the quality of cook chill food has a terrible reputation.

Gene believes the blame shouldn't lie with an NHS unit like this one,

but with the 35% of hospital catering that's sub-contracted

out to private firms.

I don't want to be disrespectful to these other big suppliers,

but they are profit driven.

They will have to buy the raw ingredient, produce it,

store it, transport it and make a profit.

We're an NHS unit.

We have a budget to stick to, like any other NHS unit.

So we spend well over a million on raw ingredients

and our recipes have all of that money put into the ingredients.

Yeah. If a meal costs four quid, you'll spend four quid

on the quality of the food.

Whereas I find difficult to believe, is a company would spend four

quid on food, they're not, they're going to spend, I don't know, £1.50?

We don't have to make a profit.

It all goes back into the patient experience.

Well, I've got to be honest with you, I didn't really know what to

expect when I came in here.

I was probably anticipating a lot more of a factory environment.

You know, this is NHS owned,

so they can control everything in terms of the cost.

It's kitted out how they want to kit it out, as well.

Whereas you just get the feeling in a cook chill unit that has to

make a profit, it doesn't really look as good as this.

Although I'm cautiously optimistic about what I've seen so far,

the real test of this food is how it goes down on the wards.

Bed 22, isn't it?

So I've come across the road to the New Cross hospital to see

some of it served to patients.

So, unlike conventional hospital wards where the food is

placed in a hot cabinet from the kitchen, wheeled to the wards

and then the button is pressed to be super-heated, these

have had probably a lot less time in an oven but on an exact temperature.

An armoury of waitressing team. Check that out.

Bed five, please.

Watching the food being served, there's one issue with it

that's immediately obvious to me.

What about portion size? Is it easy to portion up doing this?

Er, I try my best.

There's a portion of six on this tray here.

The unit produces trays with either six or three portions in them.

But as numbers haven't worked out perfectly today, there seems

to be quite a lot of waste left over in many of the trays.

And that's costly for any hospital.

-So has everybody eaten a main?

-Yep.

What happens to this, then?

-This all gets thrown in the bin, does it?

-Yes. Unfortunately.

When you're cooking in containers for three and six portions

and not individually, you're going to have huge amounts of waste.

They tell me at the hospital that they have 10% waste, but

based on what I've seen,

I imagine on some days it's probably a lot more.

Can I try a bit then, before anyone starts chucking it out.

-Chicken pie. What is this one?

-Beef hotpot.

Beef hotpot.

Chicken pie is better.

Of the food I've tasted, I would say some is good, some just OK.

And that's what many of the patients think too.

You've had experience of the food. Six weeks worth of food.

-Everything you wanted or...?

-It could be improved.

They offer you like jacket potato and cheese and I thought,

"Oh, that's nice." And I had it the first time and it was really nice

and then the next three times I've ordered it,

the potato's not cooked and you're like, "Urgh!"

Anything you'd like on the menu that's

not on the menu at the moment?

No. Because I think, to me, there's a choice of what I want.

You know, if I don't want it, it's up to me to say,

-no, I don't want that.

-And you're happy?

-I'm quite happy.

When they used to plate them up a million miles away,

put them on the things and bring them up in the flight trolley

and whatever, that was just disgusting.

The way it's presented is much better now, but there are some

issues with choice, particularly if you're on a restricted diet.

To improve that choice and raise standards overall,

Gene and his team will now start trialling some of the recipes

I'll be putting up on my website.

If that's a success, they'll start using them for good.

From what I've seen today, it's very different to what I've

seen on a bigger commercial scale being served in other hospitals.

The actual kitchen was a proper kitchen with proper

chefs in there and cooking real food.

Having said that, that's the benefit of being owned by the NHS.

Whether a hospital's meals are provided by an NHS unit or

a private catering company, I still believe most patients, given

the choice, would jump at the chance of having some fresher

food added to their menus.

The dinner hasn't been very nice.

That was certainly the case a year ago when I sent a couple

of my chef mates to work with a large cook chill hospital in London.

We're at the Royal Free in Hampstead.

A whopper of a hospital, very, very big one.

I asked Lawrence Keogh and Paul Merrett to work with

the team at the Royal Free to see how we could supplement

the hospital's off-site catering with simple fresh food.

And once they read the patient feedback forms, one dish stood

out again and again.

Soup! Soup! Soup!

Maybe that's an area we need to look at.

At the moment, just explain, the soup is made...

60 miles away in the production kitchens.

OK, wouldn't it be nice if every day there was a fresh, fresh,

-fresh soup?

-Yep.

It wasn't long before the boys and I got busy in the kitchen.

Right, come on, come on, Lawrence. Where are you?

Paul Merrett, can you please come to the diary room?

More soup.

We were making not just fresh soups but salads too.

And when we tested them out both on the wards and in the hospital

restaurant, the response was overwhelming.

I had the carrot and coriander soup and it was beautiful.

How does that compare with what you've had before?

Very tasty, yeah. Very good.

It's the best soup I've had down here, so it's really good.

Can you just say that again loudly?

-It's the best soup I've had down here.

-Excellent!

That's the batch I made.

It was great to see a hospital with this sort of system keen to

improve the quality and range of the meals they'd bought in.

And doing it actually saved them money.

When we left, the soups and salads had been introduced on three wards.

But Director of Facilities, Jeremy, had big plans to roll them

out across the whole building.

We've done the whole floor today.

We can start planning our menus around delivering

this across the whole hospital.

It'll be a bit of a challenge but we'll be able to do it

and it enhances the meal service we have now.

So, six months after their last visit, Lawrence and Paul went

back to the Royal Free to see how things had been working out

and if we'd managed to make a lasting difference

to the food there.

I'm really keen to know how the six months has gone, you know,

whether they've managed to maintain the momentum.

It's easy to turn up and do it over a short period but over six months?

Have they managed to achieve it daily? Have they expanded it?

Have they disbanded it? I don't know what to expect today.

I'm a little bit apprehensive.

The lads are meeting up with Jeremy

and the hospital's Chief Exec, David.

For us it's been fantastic.

It's been just a huge change, actually, to the way that we operate,

the way we eat, the way we do things.

Jeremy and his team have been out there.

We have. The soup has gone down a storm.

The salads have been absolutely fantastic in terms of patients

taking them on board

and it looks so much fresher and more tempting, it really does.

So the management are happy

and the word back from the staff on the wards is just as encouraging.

Patients have been really warm and receptive to the soups.

It's what they want to eat when they're not feeling very well.

There's a good variety of soups,

they're freshly prepared every day using really nice ingredients.

Best of all, both patients and restaurant customers

are really feeling the benefit of fresh food on their menu.

When you're sick, you need all the energy in the world to help

you to get well.

It's a number one priority.

We get the soup every day.

We come down here every day and it's just really, really nice.

-Healthy.

-Healthy.

You get your five-a-day packed in there.

So, it's quick, it's easy, quite nutritious and it fills you up.

There's no doubt from the management that the changes we introduced,

just by adding simple additions to the bought-in meals,

are here to stay.

The staff eating the same food as the patients makes a huge

difference in terms of the messages we're giving

to the organisation about what's important.

If it's not good enough for us, it's not good enough for the patients.

So, as yet, you haven't got it right the way through the hospital

-but that's going to happen very soon, right?

-It is.

There's a plan out there now at the moment.

All the soups have been rolled out throughout the whole hospital,

that's gone really well and we're now working down from the 11th floor

downwards doing all our fresh salads.

It's good work in six months, isn't it?

-You're ahead of the pack now.

-Benchmark.

-Brilliant.

That's good to hear.

They've done really well.

They're running it out throughout the whole hospital.

The feedback was good, the vibe was good

and they've maintained that level.

I tell you what it proves.

It proves that the model that we worked on here could probably

be replicated across every cook chill hospital.

Well, why not? What's preventing it? What's stopping it? Why can't it be?

Paul and Lawrence have a point.

Simple ideas like the ones we trialled at the Royal Free

could work in many hospitals with off-site catering.

We've done something right, mate. We've done something right.

It's initiatives like this I'm hoping more hospitals will

adopt once I've put them all down on my website.

I want all the recipes and ideas that I've proved can work to

be available for every hospital to use.

It's the key to my goal of affecting change on a national level.

So I've enlisted the help of other organisations also

pushing for change, such as the Hospital Caterers Association

and the British Dietetic Association.

Well, when I thought about the idea of a website, it was really

important that we got organisations like the BDA involved in this,

because, really, they are at the forefront of nutrition

in the NHS and what they say more or less goes, really.

So when you're devising a recipe and you're devising menus

and stuff like that, without their really seal of approval,

it's very difficult to implement this on a larger scale.

To get that seal of approval, all the recipes

I plan to share on my website need to be thoroughly checked out.

So I've sent the details of nearly 60 of my dishes to top

nutritionists at the British Dietetic Association.

And now I'm waiting for the call from BDA dietician, Maxine Cartz,

to let me know whether I've got the go-ahead to describe the dishes

I'll be making available to all hospitals as nutritionally sound.

On the whole, everything OK?

On the whole they're great

and they certainly look like mouth-watering dishes.

They look like they're going to be really well received by patients.

You've got sticky toffee pudding and those soups look really great.

Great, all right, thanks for all your help on it.

-Cheers, James, no problem.

-Cheers. Thank you. Bye.

-Bye.

How good was that?

Often, really, when you try and implement change within the NHS,

they've all got their own sets of issues and rules and regulations.

And if Maxine says the recipes are great,

that is a massive leap forward.

Making available a database of dishes hospitals can be confident

are both tasty and nutritious, will be a real step forward.

Staggering as it sounds, there are no mandatory nutritional

standards laid down for all hospitals in the UK.

There are for prisons,

but hospital food has no such consistency or regulation,

or, at least, not in England.

There are nutritional standards set out for Scotland and Wales, though,

as I discovered last year when I was asked to help with a new initiative

from the Welsh Assembly.

Leslie, thanks for meeting us.

Welsh Minister, Leslie Griffiths, set me the task of helping create

dishes for a single menu set to be rolled out

across all 115 NHS hospitals in Wales.

From the end of this year, I'm bringing in the all-Wales menu,

which, again, I think is really important.

So the idea is just to have almost like a recipe bank of recipes

-that people can dive into and come out of?

-Absolutely.

I asked my chef friend Stephen Terry to help me out.

But when he arrived at a hospital kitchen in Abergavenny,

he made a discovery that shocked us both.

You've got a roast chicken dinner. Do you do lamb, beef, pork?

-We don't do lamb. We don't do beef.

-No lamb?

We do pork, chicken and turkey.

What has shocked me, really, is the fact, you know,

because it comes down to budget and cost,

here in Wales, in a Welsh hospital, we can't serve Welsh lamb.

I don't understand why that isn't possible.

Unbelievably, Stephen found the only lamb that most Welsh hospitals

could afford to buy was from New Zealand or Australia, not Wales.

Currently, what are they charging? Is it per kilo?

-£8.10 a kilo.

-£8.10 a kilo?

-Leg of lamb.

-And does it say where the lamb's from? Is it...

-New Zealand.

Red tape means Welsh hospitals can only buy from

their official suppliers.

None of whom appeared to be able to source local lamb

more cheaply than foreign imports.

We were shocked by that and quickly identified local farms

more than happy to offer a better price.

On Welsh lamb legs, what's the best price per kilo?

45 kilos once a week. £6.50 - £6.99.

£6.50 sounds the better of the two.

Welsh lamb is the obvious ingredient for the lamb pie Stephen was

determined to get on the all-Wales menu.

But without it,

hospitals would have to use meat from the other side of the world.

This one can go in just in the tinfoil because they're all right.

The hope for both of us

was that, in time, the cost of local lamb from the official Welsh supply

chain would be reduced, so that in future, these pies could be produced

with meat from Wales, giving a massive boost to the local economy.

150.

But first, all the dishes Steven and I suggested for the new menu,

including some of my soups, needed to get Leslie's official approval.

Smells gorgeous.

-Good enough?

-That's so good.

Now, one year on,

I want to know what progress has been made, both with the menu

overall, and in making local lamb affordable for Welsh hospital chefs.

Welsh lamb was all around us.

There are millions of sheep in Wales.

So, I've asked Stephen to get an update from dieticians Judith

and Jessica, both of whom have played a key role

in the developing the all-Wales menu.

We've got a number of recipes being implemented across Wales with

the standardised recipe and analysis that meets our standards.

-But it's still in progression.

-And how's the feedback been?

It's been great having some of the signature dishes from last

year's programme.

We had some James Martin soups and they've all gone down really well.

-We tried your lamb pie recipe.

-How was that?

Yeah, it was very good.

We need to tweak it a little bit in terms of the herbs.

It's quite difficult to use certain things like fresh bay leaves

and then remove it when you're doing mass catering.

-Sure.

-Once we finally tweak that, we'll be looking at putting

-that on the framework.

-Great. That was all about Welsh lamb, really.

It was one of those things that it seemed silly not to have Welsh lamb.

That conundrum is still not totally resolved.

While local lamb is available for Welsh hospitals to

buy from their approved suppliers, the cost of it is still

around £3 more expensive per kilo than overseas alternatives.

If I was a cash-strapped Welsh hospital chef,

I know exactly which choice I'd be making.

And although that's frustrating,

the rules on how a hospital sources its food, means simply

switching to a cheaper supplier isn't always straightforward.

How much of an issue for contract selection process is local produce?

Is that something that you're thinking about?

With the EU legislation, we can't favour somebody

because they're local but what we're trying to do is work with

local farmers to explain to them the NHS tendering process,

so then they can be in a best position to bid for the contracts.

They're in with a shout, then? They have an opportunity?

I mean that's what we're hoping. That they'll be in the best position

and they'll be able to submit the best product.

It sounds like steady progress is being made on the all-Wales menu

and it's great that they've kept faith with the dishes

we came up with.

But for Stephen, that's still not quite enough!

My wish is to get a Welsh lamb dish, you know, on the Wales food network.

It looks like if I want to move this issue forward, I need to go

back to the Welsh Assembly.

I've asked the new Health Minister, a guy called Mark Drakeford,

for an interview and this is the response, which is very much

a political response.

"I thank you for the progress update on the all-Wales patient menu.

"Unfortunately, the Minister has declined to be interviewed.

"The Minister has asked me to pass on his thanks for your interest

"in what we're doing in Wales and all the best for the next series."

So, in terms of a response, that's a firmly closed door, I think,

and which is the story, to be honest, of the NHS as a whole.

You know, you almost go one step forward in hospital

and five steps backwards

when you're trying to meet with people who make decisions happen.

And this is the problem that I'm having.

Nobody from the Welsh Government wants to speak to me.

When you're getting doors shut in front of you,

you can't do a lot more than doing what you're doing.

But if there's one thing I've learnt from trying to improve hospital

food, it's that while disappointments along the way

might be inevitable,

there are still plenty of issues on which I can make a difference.

-Nice to meet you.

-Hiya, you all right?

-Good to see you.

Recently, I was invited to the Chesterfield Royal Hospital

to hear about an initiative their Head of Retail, Kim, has come

up with to give patients some help with their food immediately

after they've been discharged.

-We want to provide some kind of grocery pack.

-Yeah.

The basics, you know, things that they can be discharged with

at a reasonable price.

This idea to extend food service beyond the hospital was

welcomed by the patients I talked to on the wards.

If you've got something sort of just bits of staples to go with,

then, you know, you'd be on a winner straightaway.

My contribution to Kim's idea was to come up with

suggestions for the essential items that would be included in the bags.

It's got to be bread. It's got to be eggs.

It's got to be milk.

Yeah. Absolutely. Yeah.

With only a short time

until I return to Chesterfield to launch the service, Kim is meeting

with Discharge Lounge Sister, Susan, to see what she makes of our plans.

Myself and James just got a list together of the things

that we thought.

OK. I don't know.

There's quite a lot on there that I don't think

-patients are really going to manage with.

-Really, what like?

You're expecting quite elderly people to be able to open the cans.

Most of the time, the patients I'm sending home would just want

the milk to make a cup of tea, perhaps the bread

and the cheese, so they can make themselves a sandwich.

It shocked me, actually, because I would automatically think

when you're poorly, tin of soup.

Yeah, that's because you're young and you can just open the can.

-Keep telling me that!

-You're young!

-All right, Lillian?

-Yeah.

-How's that cake?

-It's lovely.

-Is it nice?

-I'm enjoying it.

-Are you enjoying it?

-Yeah.

Susan may think our home food bag needs a few tweaks,

but she's in no doubt that this is an idea with obvious merits.

I think the service is so important.

It can potentially prevent readmission into hospital

for more vulnerable, frightened patients.

They may go home and feel less inclined to

ring for an ambulance because they're frightened.

They know they're supported in their own home.

They have got nutrition for the next few days

and an ongoing support service.

And with Susan's input, Kim can now rethink

the contents of our bag to better reflect what a discharged

patient might need after leaving hospital.

I was looking at it from a young, fit person.

So, semi-skimmed milk, brown bread, fruit, and I was told that

the older people prefer full fat milk, white bread, full fat cheese.

That kind of thing, so that was the main stumbling block.

The new system will be a reduced bag.

They can buy the pack at a discounted rate.

If they wanted any other items then the Discharge Lounge

and the Red Cross could facilitate that, using the shop at the Royal.

The British Red Cross has had its own scheme to help newly

discharged patients get the essentials they need.

But working more closely with the hospital on a combined system

will lead to a more streamlined and efficient service.

-Hi!

-Anything for the Red Cross today?

Yes, I've got this young lady that's gone home.

She's going to need a hand with her shopping for the next few weeks

while she recovers from her surgery.

Red Cross Service Manager, Chris,

has seen first-hand how more vulnerable patients need help

with their food when they first leave hospital.

In the first few days, people have a real problem

because they've lost probably everything that was

perishable in their fridge and they've got to get things going

and they don't need feeding up, they just need the basics.

Once they can get those things, then things start working out after that.

Susan and Chris believe the home food bags offer a great

opportunity for teamwork across the hospital, with a real

benefit for the more vulnerable patients in the Discharge Lounge.

If we can work collaboratively with the shop at the front

of the hospital, then the Red Cross could even visit

the patients on a weekly basis and work closely with them to

check that they are safe at home and are getting the nutrition they need.

I'm quite excited about this project.

For people who don't have very solid support networks, it could be

the difference between them staying at home or going back

into hospital again.

The more people that we've spoke to love the idea,

love the service, something so simple and nobody can understand

why it's never been done before, which is crazy really, isn't it?

But there's still plenty to be sorted yet for

when I return for the launch.

We've got to get the bags back from the printers.

We've got to get the leaflets back from the printers.

Really nervous, but I think it'll go well.

I hope it'll go well.

While Kim races to get things ready to be rolled out

in Chesterfield, her idea is another that I'm making sure

goes on my website so it can be adopted by other hospitals too.

Seeing the success of initiatives and improvements at all

the individual hospitals I've been to, is hugely satisfying.

But it's time now to make a bigger impact.

I think massive things can come because of this.

With the blueprint I've laid out on my website, I want to

bring about change across the entire hospital catering industry.

And to unveil what I've put together,

I'm organising a big launch event in London and invited

representatives from as many hospitals as are willing to come.

Boys, come on! Fudge, come on!

As the day of that approaches, my nerves are mounting

but I'm more determined than ever to make a difference.

I'm massively passionate about food in hospitals

and have been for so many years.

That's why I got involved in this project.

It is possible to implement change within the NHS.

It's going to be gradual.

It's going to be slow and it's going to be painful,

but change can be achieved.

And above all else, you can do it on budget, save money, save massive

amounts of waste and improve the hospital and patient's experience.

Well, that's what I believe.

Now, I just need to convince the rest of the industry.

Next time... I'm back in Chesterfield

to help launch the hospital's home food bag service.

-Should we get you home?

-Yeah, please.

There's a surprise for Andy at the Princess Alexandra.

What this? A guard of honour?

I said she'd stitch me up.

And as I get ready to launch my ideas for change to more

hospitals than ever, the pressure begins to mount.

Proper nervous. But here goes.