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'A hidden problem': Up to half of food provided to patients in Irish hospitals is not eaten

The HSE said it is working to implement guidelines in hospitals to address food waste.

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THE HSE HAS said it is committed to reducing food waste in Irish hospitals as research shows up to 49% of food provided to patients is not eaten.

The issue was highlighted by Sinn Féin’s health spokesperson Louise O’Reilly who recently asked the HSE about the amount of food wasted or thrown out from hospitals and whether any unused food from hospital kitchens is given away or donated to avoid waste.

The HSE told O’Reilly that research by the National Health Sustainability Office (NHSO) published at the end of last year included 30 detailed food waste surveys of both acute hospitals and community care facilities.

Based on the results, it is estimated that between 37% and 49% of food given to patients in Irish healthcare facilities is not eaten. The HSE told O’Reilly that the management of food waste is a matter for each individual hospital so it cannot provide detail on whether any of the unused food is donated.

“The scale of food waste in hospitals is largely a hidden problem and the reasons for such staggeringly high levels of food waste can be complex,” the Sinn Féin TD said. 

It is often reported that much of the food waste in hospitals is due to poor quality food, or the provision of unsuitable food – the Department of Health and the HSE need to examine if this is the case and ensure particular effort is made to improve the quality and type of food on offer to those in hospitals in order to reduce waste; but much more than that is needed.

“Uneaten food represents a lost nutritional opportunity, a financial loss to the health service, and is also environmentally damaging and wasteful.” 

Prepared food not served to patients

There are two main patient food delivery systems in Irish hospitals – bulk food systems and centrally plated systems.

Bulk food supply is where food is prepared in the main kitchen and sent, in bulk containers, to the wards, where it is plated. In a centrally plated system, food is prepared and plated in the main kitchen. It is then transferred to the different wards before serving.

The HSE told TheJournal.ie that research carried out in 15 acute hospitals found valuable food waste (excluding bones and other food waste that would not be eaten anyway) was divided into three categories:

  • Food prepared that is not served to patients. This accounts for 27% in bulk system and 24% in plated system.
  • Plated food that was never touched or consumed because a patient is absent from the ward for a procedure, a patient is discharged, or a patient refuses a tray as they are feeling unwell. This accounts for 4% in bulk system and 3% in plated system
  • Food remaining on plates after a meal is finished. This accounts for 18% in bulk system and 23% in plated system.

The main reason patients did not eat their food was that the portion size was too big.

The HSE said the Green Healthcare Programme (GHCP), the initiative which carried out these surveys, has produced detailed advice and guidance to address these issues.

The next phase of the GHCP initiative will focus on helping hospitals to implement those guidelines. 

The HSE has also recently published its food, nutrition and hydration policy for adult patients in acute hospitals. This new policy aims to ensure that patients in acute hospitals receive a patient-centred food and nutrition service.​​

Clinical guidelines on nutrition screening and nutrition support for adults in the acute hospital setting are currently in the final approval stages. These guidelines are designed to ensure that patients admitted to hospital are screened for risk of malnutrition.

Patients who are at risk of malnutrition are found to have a greater risk of surgical site infection, developing ulcers, readmission to hospital and a two-three times greater risk of dying.

While poor quality hospital food is not the cause of malnutrition in these patients, clinicians have said nutrition is even more important when these patients are sick.

The new screening system is aimed at providing appropriate nutritional treatment for these patients, whether that means a high protein diet plan and supplements, or a referral to a dietitian during their hospital stay.

How to reduce waste

Mayo General Hospital was found to have one of the lowest levels of food waste in a 2010 survey by the GHCP. Measures implemented by the hospital to keep food waste down included the provision of clear menus to patients meal size options.

The hospital also did not automatically provide condiments like butter or marmalade to avoid waste – patients could outline on their menus which condiments they wanted. 

St Michael’s Hospital in Dún Laoghaire also started a food waste reduction programme in 2011. 

Some of the measures it tried included:

  • Reducing the quantity of porridge provided at breakfast
  • Providing different sized portions for elderly male and female patients (the hospital found providing bigger portions actually resulted in the patient eating less)
  • Reduced quantity of milk provided in individual jugs. 

The hospital also began to place unused food from the canteen service into containers in a refrigerated vending machine that night staff could buy and heat up in a microwave. 

In one year the quantity of food waste generated in wards reduced by 40% and the volume of milk disposed of reduced by 44% in one example ward survey. 

Deputy O’Reilly said the volume of food waste “needs to be dramatically reduced” and hospitals should be engaged in a schemes aimed at donating and repurposing food.

She said “effective waste management in hospitals is required to ensure any waste there is disposed of in the most environmentally-sound, and cost effective way”.

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