On 21st April 2017 Dr Kelly Reed, IFSTAL Education Coordinator at the University of Warwick attended a workshop which saw expert speakers and guests discuss the history of, and current policy around, diet and nutrition in institutions of care. They considered who makes the choices around food in institutions, and how and why those decisions might differ in terms of funding, quality, and source in different settings. The workshop particularly focused on hospitals and prisons. The event was organised in collaboration between the Cultural History of the NHS project and the History of Prisoner Health project, both at the University of Warwick. Read her thoughts on the event below.
Diet and Nutrition in Institutions of Care: History and Policy
Friday 21st April 2017, University of Warwick
“It’s time we stopped ignoring institutional food. It can’t be right that 40% of hospital patients leave hospital worse nourished than they went in, that prisoners eat their meals in their cells, that nurses eat “on the go” from vending machines. We need to identify the obstacles preventing caterers providing enjoyable nourishing food. I hope this conference will do exactly that and also inspire those with the power to do something about it to act.” Prue Leith CBE, the cook, caterer, business woman, and novelist, has campaigned tirelessly to improve standards in hospital and school food.
The day kicked off with a talk by Dr Ian Miller, Centre for the History of Medicine in Ireland, University of Ulster, on Eating and Starving to Death in Medical Care: Prisons, Food, Control and Choice. He explored issues around why the issues of hunger striking (and force-feeding) are so problematic in prisons and how strike management evolved. He looked at the 1909-14 suffragette hunger strikes and the ethics behind force feeding. Is it ethical to provide therapy (or food) against the will of a patient given that we all share a basic human right to be able to refuse medical treatment? Is food actually medicine? Are doctors being guided by political considerations rather than clinical needs?
In 1975 the Declaration of Tokyo states “Where a prisoner refuses nourishment and is considered by the doctor as capable of forming an unimpaired and rational judgement concerning the consequences of such voluntary refusal of nourishment, he or she shall not to be fed artificially. “
But artificial feeding in medical care has become far more complex, including issues around those who are comatose, suicidal, elderly, or anorexic.
Two further talks were given on the provisioning of food in modern prisons. Helen Sandwell and Victoria Williams from Food Matters presented a talk titled – Food Matters Inside & Out: A Project at Wandsworth Reform Prison. Non-profit organization. They discussed issues around how we can build food into prison rehabilitation and how food impacts not only physical but also mental health. In particular, they pointed out how it can be difficult to change canteen food menus as they have a huge amount of constraints stipulated by the government. Menu cycles have to be a minimum of four weeks and include religious and dietary requirements, minimum of one hot meal a day and guidelines on portion control. The whole prison system is also supplied by a single supplier restricting purchasing choice.
An-Sofie Vanhouche from the University of Brussels also discussed prison food in Belgium – Enjoying Your Prison Meal: Prisoners’ experience with self-perception in the framework of a self-catering project. This project saw the introduction of communal eating and the benefits of this type of system.
The second session of the day explored food in hospitals. Katharine Jenner, Campaign for Better Hospital Food, presented a talk titled – Hospital Food Can Be Improved Only By Legislation. This was followed by Philip Shelley, Hospital Caterers Association, who discussed The Role of the Hospital Caterer and the last 9 yards campaign which advocates adding food to w patient recovery plans, as well as trying to reduce food waste. The final talk was from Professor Jonathan Reinarz, Institute of Applied Health Research, Director of Medicine Unit, University of Birmingham. He dicussed Making choices, Constructing Communities: towards a history of hospital food.
The last session of the day kicked off with a great talk by Hugh McNeill, Project Manager of the Trussell Trust Coventry Food Bank, discussing Beyond Foodbanks: Looking at the implications for moving away from the food bank model. He shared some shocking facts, such as that the Coventry food bank had fed 85,000 people since they started in 2011; 15,300 in the last year (2016/17). They work with 332 support agencies who refer clients and have 17 food bank centres and 1 warehouse. But they are the first bank within the Trussell Trust to have seen a decrease in response to the programmes they are running for example providing employability skills in order to create independence and prevent dependency. McNeill also highlighted some of the main reasons why someone may need to use a food bank, for instance benefit delays, low income and debt.
The final speaker was Jennifer Jones-Rigby, Health Exchange, who presented a paper on- Breathe Well… Take Control – a bottom-up, participant-designed, assets-based approach to supporting those with COPD and their carers.
The day was exceptionally thought-provoking and highlighted the complexities of providing good and nutritious food within some of our national institutions.