It used to be the butt of tired jokes. But as the Millennium approaches hospital food produces few laughs, as we now recognise it to be the great hidden scandal of our national health service.

To many it's still incomprehensible that patients in our hospitals end up in a state of near starvation.

What is beyond question, is the role of nutition expert Prof Simon Allison in making Britain face up to the cold fact that hospital food not only impedes patient recovery, it actually leaves thousands of them suffering from malnutrition.

This week the professor was in defiant mood as he served up uncomfortable truths to the catering manager of the John Radcliffe Hospital in Oxford, and nurses and nutritionists from across the UK.

Prof Allison was at Oxford Brookes University on Wednesday to address a seminar, five months after his controversial report Hospital Food as Treatment caused a national outcry. Hospital caterers shifted uneasily as Prof Allision told them that the cost of wasted hospital food now stands at £144m a year. He estimated that the figure for the John Radcliffe alone could be as great as £200,000.

"If you had a manufacturer who saw 40 per cent of his production being thrown away, he would soon go bust, said the professor. "If this problem of waste was looked at, the money could be diverted into doing a better job for the patients."

But his greatest concern was the fate of undernourished sick patients and the consequences of malnutrition - impaired recovery, higher risk of surgical complications and increased mortality.

And it inevitably led to longer hospital stays at a time of chronic hospital bed shortages. "What it would cost to improve the situation is nothing to what it is costing us now," said Prof Allison, whose father Philip was Oxford University's Nuffield Professor of Surgery up until 1973. "Menus are designed for general institutional catering like you would find in prisons and universities. The system is not being designed to meet the need of the sick, like Florence Nightingale said it should.

"But I am afraid that we've not made any progress in the last 150 years, though it's never too late. The Millennium is perhaps the opportunity to do so."

Prof Allison, consultant physician at Queen's Medical Centre, Nottingham, said there had been only limited improvements since his report.

He feared unappetising food was still being put on plastic trays and sent to wards on cold trolleys, where it's left to go cold and then patients were given insufficient time to eat it. He unveiled a whole series of measures that could be taken by hospital managers. He urged hospitals to:

*Start with the needs of patients and work backwards. Greater care should be taken with the presentation of food

*Assess the nutritional needs of individual patients and design menus to meet requirements of different groups. The needs of elderly patients clearly differ from those of young accident victims, for example

*Recognise that the tastes of patients change when they are sick. Avoid the disruption of meal times by ward rounds or tests. Be aware of ward environment and the fact other patients' medical conditions can put people off eating

*If there are nursing shortages, employ ward hostesses to ensure patients are eating. Over-worked nurses may fail to identify patients who need help *Ensure regular consultation with dieticians.

Michael Head, who as catering manager is responsible for the 1,650 meals a day served to the 550 patients at the John Radcliffe, left with lots of food for thought.

He said he had noted the professor's advice on the need to increase the energy density of food for the elderly, while reducing portions. New research showed that older patients often were put off by the size of portions. Food is bought in at the JR from outside suppliers and Mr Head said waste levels were carefully checked. They presently stand at between ten and 15 per cent.

Story date: Saturday 06 November

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