Nutrition experts have warned a government cost-cutting team that patients could suffer malnutrition or even death under plans for cheaper hospital food.
Their objections have forced a rethink on plans to reduce the amount of protein fed to patients, cut back on hot food, use plastic plates instead of crockery, remove small and large portion offerings and use lesser-quality ingredients.
Sandwiches were also on the chopping block — hospitals were told to give patients 10g of protein in each sandwich instead of 10g in the filling alone.
Alarm over the changes was sounded by an advisory group set up to give feedback over the plans. They said the cuts would save only 52c per patient a day.
The state-owned cost-cutting agency Health Benefits Ltd (HBL) has now ruled out plastic plates, removal of hot lunches and reducing portion choices.
But from next year, mince will be fattier, the 10g protein count for sandwiches will include bread, and the minimum protein delivered on a daily basis will drop from 90g to 80g.
The options were put forward through HBL by British-based company Compass, which has been selected to buy, prepare and provide food to all district health boards and is negotiating how much it will be paid.
HBL interim chief David Woods has rejected any impact on patients, saying hospital food will be as good as or better than ever and prepared under nationally consistent guidelines.
HBL also says the savings will be higher than the 52c identified by the nutrition experts. It expects to save $3 a day feeding each patient, bringing the cost of meals down to $27 and saving up to $120 million in 15 years.
Health Minister Tony Ryall created HBL to save $700 million in the health system by merging back-office functions and bulk-buying in non-clinical areas. It expects to start bringing in the food-delivery changes next February.
HBL formed the Food Nutrition Advisory Group of hospital dieticians and other health experts to give "robust" feedback on proposals before signing the contract with Compass.
In March, the hospitality operations manager of the Southern District Health Board, Justin Bellass — writing on behalf of the advisory group — said they felt "the focus for the provision of patient meal services appears to be on the benefits which can be achieved by reducing nutritional specifications as opposed to looking at the total picture".
The group said a third of hospital patients were malnourished and "food is cheap medicine" that should be "seen as a cost-saving measure rather than a 'nice to have' that should be cut".
Dieticians in the group warned that not using lean mince would create "fat separation" and "decreased customer satisfaction due to fatty mince mouth-feel and appearance".
They were also concerned removing a hot lunch overlooked the importance hot food had in delivering protein and restricted choices, leaving patients searching out alternative food sources.
"Research shows that DHBs will pay a larger price with malnutrition and poor food intake associated with prolonged hospital stay, frequent admissions and greater-in-hospital mortality".
The way food is prepared is also set to change. Auckland patients will be served packaged hot meals prepared under the Steamplicity system — which has received positive reviews in a British academic study.
Outside Auckland, the practice of cooking meals fresh at the hospital will end. Instead, components for the meals will be delivered to the hospital kitchens for cooking or heating before being put on plates according to patients' orders. Meals-On-Wheels recipients and others will get reheated frozen meals. Mr Wood, a former Treasury executive, said the debate over food was "pretty predictable" but unavoidable.
"If we find any adverse actions on patients, you can be sure we will address them. We have to be very mindful of what DHBs are spending, what they can actually afford."
David Page, who is leading the programme for HBL, said it had worked hard to address the concerns of the hospitals.
He acknowledged there were "strong words" in the advice from dieticians.
"They are a group of very passionate people, and very emotive too. You're going to get crockery and stainless steel. The debate is over."
Mr Page said the sandwiches produced under the new guidelines would be the same as those made now, but the guidelines would more accurately reflect the protein patients received.
Labour health spokeswoman Annette King said it was a "penny-pinching" project which would see patients swapping fresh food for chilled and frozen meals.
"Trying to save a few cents will end up costing them dollars in terms of long-term outcomes on patients."
Outsourcing will see the end of bulk food production in hospital kitchens, impacting on the jobs on 1,000 people around the country.
Public Service Association acting general secretary Glenn Barclay said morale had plummeted, with staff unsure of their futures.
He said the dieticians had raised legitimate health concerns.
"Any mistake carries consequences."
'Steamplicity' meals pass the taste test
The future of hospital food is here — and it's tasty. But it's only in Auckland, so if you're outside the Queen City, here's a taste of what you're missing out on.
Lunch was arriving for Trevor Crane, 64, as he was preparing to end an extremely positive visit to North Shore's elective surgery centre.
He is leaving for home after a two-day stay with a new hip and two "flash meals" he can't praise enough.
On Wednesday, Mr Crane came out of surgery hungry and ready for dinner. He found there was no need to wait for scheduled meal times — food was ready when it suited him, not the other way around.
"They rustled up a roast lamb meal for me. I was quite impressed."
Then there was the braised beef, served with "nice fresh vegetables", which was "beautiful".
Food is prepared on the ward in microwaves by HBL's selected national food provider Compass using its "Steamplicity" system.
A valve in the plastic pack containing the meal regulates the temperature, meaning the food is cooked (or heated) using the moisture of the ingredients. The bottom of the pack slides out onto the plate below and is served to the patient.
Studies abroad have recorded high levels of patient satisfaction with the system, which matches Mr Crane's enthusiastic response.
They are backed up by patient satisfaction surveys at the elective surgery centre which are also strongly supportive. One negative comment sits among a mass of positive feedback, reading: "Not into healthy food."
HBL says the elective surgery centre is a model example of how the new system should work.
But outside Auckland, perfection may be a little more distant.
The "Steamplicity" system isn't going into other hospitals when it rolls out in February. The food will be prepared in one central place, and getting it beyond the critical mass of Auckland is difficult.
Everybody else will get meals that will include components prepared somewhere other than in the kitchen of the hospital they are in. The food will then be reheated, and occasionally cooked.
About 80 per cent will be "Cook Chill" — raw, ready-to-cook and cooked products delivered chilled to the hospital for heating or cooking. For those who get Meals-on-Wheels, the future holds frozen dinners.
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