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Making a meal of it

Thursday, 26 January 2017

Making a meal of it

It is the sort of story you’ve become used to reading in the annals of NHS Blithering, a tale worthy of the fictional CCG’s sultan of spin Martin Plackard. We’re talking about the biggest PR coup so far this year, which was pulled off by Shrewsbury and Telford Hospitals.

Sandwichgate has been covered by the BBC, Telegraph and HSJ, to name a few. In the unlikely event you missed the story it concerns the decision by a catering firm to stop supplying sandwiches after a Shropshire trust asked all of its suppliers to accept new deferred payment terms.             

In a memo leaked to the press, the trust explained that with a deficit of £5.9m and growing it had been forced to take drastic action. As the catering firm had declined the new terms, “we will be unable to provide sandwiches and salads for patients or in our commercial outlets,” staff were told.

This was a stroke of genius. By focusing on the impact of NHS cuts on the hospitals’ ability to provide chicken wraps, the trust created just the right blend of bathos, drama and comedy. With stories of impending NHS disaster reaching saturation point, appealing to the public’s affection for the sandwich was the perfect way to break through the din about multi-million pound deficits, patients languishing on trolleys, overcrowded A&E departments and exhausted staff.

The hospitals will continue to function without sandwiches. The egg mayonnaise deficit poses no imminent threat to life. As the memo went on to make clear, “during this time, a wide range of alternatives will be available”, including “jacket potatoes with a choice of fillings… toast as well as cheese and biscuits, yoghurts and fruit”.

But this was barely reported. No self-respecting news editor was going to spoil a good story by acknowledging that the catering department had a contingency plan. The inference was clear: if there were no sandwiches today, what would be next to go? X-ray machines, anaesthetic, nurses?

The media laid it on thick. “Sandwiches withdrawn from trust with cashflow problems”, blared the HSJ headline, conjuring an image of bailiffs going in to recover as many cheese rolls as they could before the inevitable crash.

The BBC reported to that the trust was “struggling to pay its sandwich bill” using quotation marks to make it clear that when the trust said it was a "temporary issue" and that "at no time have any patients not had access to meals", what it really meant was that hospitals had run out of food completely and that it was only a matter of time before the first shocking acts of cannibalism came to light.

Struggling to find anyone sensible to interview, the BBC turned to social media. One man refused to blame the sandwich firm: “They have to pay their suppliers, staff and overheads for running business,” he tweeted matter-of-factly.

Another ordinary member of the public declared: “This makes me so sad,” but was unclear about whether her tears were for the decline of the NHS, the prospect of endless jacket potatoes or both.

The Telegraph saw the sandwich cuts as just the latest example of an NHS trust making a “desperate bid” to manage its finances. The paper’s health editor took a mere paragraph or two to link local ham salad issues to, as it were, the bigger pickle. “Last year the health service declared the worst deficit in its history - at £2.45bn - and the current winter crisis is fuelling extra spending on agency staff,” she wrote, leaving readers in no doubt that the underlying cause of the NHS’s problems is a shortage of baguettes.

Coming in the same week that the health police launched an assault on chips, toast and roast potatoes (all carcinogenic, apparently), the threat to the hospital sandwich is almost too much to bear.                                    

But before we wallow in self-pity, let’s pause to congratulate the resourceful chief executive of Shrewsbury and Telford Hospitals Simon Wright and his brilliant comms team. They have a knack for breaking the NHS stories people really care about.

Catering editor: Julian Patterson


Andrew Rix
Andrew Rix says:
Jan 26, 2017 09:06 PM

A toast to toast

Following the news that toast carries a ‘health risk’ independent advice was commissioned at vast expense on what to eat for breakfast .

Here is a summary of the report:

Given that the definition of toast seems to include more or less anything that involves cereal and cooking this was always going to be a difficult one. Traditional ‘full fry’ options are obviously out (fat, salt, meat ) as is anything processed or flavor enhanced (beans, ) or remotely dairy connected (yogurt and cheese). Eggs – highly nutritious, (no fat or salt) but unsafe due to their method of delivery and in any event difficult to eat without the aforesaid toast. Trying to find out what you should eat for breakfast turns out to be a lot harder than finding out what you shouldn’t – a sad refection on the way food research is carried out and more importantly presented to the public.

The threshold for concern adopted by the experts and others seems to have been reduced from
• demonstrated over a long time on a lot of people to cause a specific medical condition
• suspected/possibly linked to the development of a component that is present in something or other which, along with a lot of other things, might pose a risk if you are daft enough to consume it in large quantities, along with said other things, for a very long time to the exclusion of anything else

We decided to look at foods that had both
a) positive evidence of benefit from consumption and
b) evidence of harm from non-consumption.

Applying this two-way test to the vast literature at our disposal (the combined wisdom of Google and the Daily Mail) we found three ‘safe’ consumables:-

1. Fruits and berries 2. Nuts and 3. Water

Be aware that ‘safe’ is a relative term – and assumes consumption within our recommended guidelines. Fruit should be eaten in moderation but great variety, nuts only when freshly extracted from their shells and water only in accordance with the best before date or with evidence of no animal or human interference within two miles up stream and with a flow speed of > 5mph.

In the true spirit of academic partnership we shared our findings with fellow academics including anthropologists and business economists. The latter group informed us that we had just reinvented muesli and the former that we had rediscovered the diet of nomadic hunter gatherers (vegan section).

Phase two of our research involved a qualitative study of users of our safe diet using current and historical data collection methods. Our choice of method was influenced by the work of Dr Betts of Bath University and his research finding that there was in fact no evidence at all of the benefit of eating breakfast, or for that matter, any other meal. Three meals a day, and four if you can get them, is a social phenomenon, not a biological need, as any ecologist will tell you. Steady browsing serves ruminants well, while half a cow every two or three months keeps the lion’s nose cool and moist and the coat shiny (or is that dogs?) The biological message is - if you must eat, don’t make a meal of it.

There is no shortage of clinical data about muesli eaters, and, although admittedly it comes mainly from self-reports of bowel movement obsessed hypochondriacs, it is both meticulous and long on detail. The data mainly demonstrates the advantages of drying the components of the diet and mixing them together in different proportions to produce apparent variety in the diet of those with little else to talk about. In health terms, they lead long lives – too long in the view of non-muesli eating groups. In social terms it has little going for it (muesli dinner parties tend to be rather dry affairs) and in evolutionary terms it is a dead end.

Hunter-gatherers present an altogether different research challenge as they left very little behind by way of records, other than a few cave-drawings and their often fatally damaged skeletons. Also, it appears that the vegan section fizzled out quite quickly or was at least subsumed into the group that learned that the pointed stick was the way to the top of the food chain. Once at the top, they never looked back: skills in domesticating animals and growing food, including cereals soon followed. The ability to preserve food and combine ingredients and cook them, led to choices in what they ate and when they did so. Eating may be a biological necessity but it also has social value. One of the choices was to transform grain into our daily bread and the leftovers into toast early the following day.

In contrast to the muesli eaters, adapting their diet had huge social and cultural benefits. Freed from the need to find a nut or berry every few seconds of the waking day, homo sapiens developed linguistic and social skills and ways of reducing risks to health, including housing and sanitation. Abandoning the fruit and nut diet led to a steady increase in the longevity of the population and the quality of the life it enjoys to this day. In evolutionary terms it has proved a huge success. While eating toast may pose an individual risk, at a population level it is a necessity.

Going back to a diet abandoned by the most successful evolutionary group ever poses far greater risks than toast: our very civilization depends on it.

AR 21 Jan 2016

1. Fruits and berries

Julian Patterson
Julian Patterson says:
Jan 26, 2017 09:54 PM

Andrew, thanks for the longest and best ever comment on this page. Just so you know, I despise berries.