Running any big kitchen is a challenge. It is often like being a plate spinner in a circus ring - lots of things to keep moving and nothing can be allowed to fall off. Chefs will always argue which sector of the industry has the most challenges on a daily basis for a kitchen team, but hospital catering must be near the top of the list.
While food production relies on good control rather than adrenaline, there is a fundamental difference between hospital catering and any other sector of the catering industry. The customers mostly wish they didn't have to eat in the dining environment, they may be too ill to have any appetite, they can have very strict dietary requirements and are often clinically malnourished on admission to hospital.
One other big headache for hospital caterers - food cost for patients - is often nailed down to around £2.50 a day, from which sum catering managers are expected to deliver three meals a day, with menu choices and on-demand drinks and snacks around the clock.
Yet if it takes management skill to achieve patient satisfaction with those constraints, it is even harder when you add in the additional factor of catering at a very special type of hospital - Broadmoor in Berkshire.
Peter Foster, facilities manager at this secure hospital for those who are often regarded by society as mad and bad rather than sick, rises to the challenge with enthusiasm: "I know what the stereotypical images are out there of the type of person who comes into Broadmoor, but they are my customers, my clients; just as if they were in an acute hospital. It's about getting it in your mind that they are ill. Even if their illness has made them commit some awful crimes."
The names of current and past patients at Broadmoor are not part of a story about the catering operation at the hospital, but it is in the public domain that Broadmoor has some notorious patients, such as Ian Brady and Peter Sutcliffe.
Broadmoor is part of a national network of high security hospitals which includes Rampton in Nottinghamshire, Ashworth in Liverpool and Carstairs, south of Glasgow.
Foster came to Broadmoor in 1992 after working for Compass Group locally as a chef. It was the need for a new challenge that brought about this seemingly high-stepping career change, he says. Living locally to Broadmoor, Foster was well aware of the nature of the patients, but had previous insight into the true working of the kitchen and the catering service through a friend who at that time was working for the hospital.
Following on from his first job as sous chef at Broadmoor, Foster has risen over the past 14 years to his current position of facilities manager, which involves responsibility not just for catering at Broadmoor, but also for portering and building maintenance.
The catering operation is remarkably similar to any central production kitchen found in most acute general hospitals. Broadmoor operates a cook-serve system for its patients, whose number vary between 250 and 300. Breakfast is a cold service, lunch arrives on wards at 12.15pm, tea at 5pm with the option of a drink and a light snack later in the evening.
While 5pm seems early for the last meal of the day, patient surveys have shown that is the preferred time, as it gives longer for recreation in the evening.
While food temperature at the point of service is an issue in acute hospitals using the cook-serve system, Foster says he is happy with food temperatures. Given the choice of re-planning the whole catering operation he would stay with cook-serve.
He says: "I know what people say about cook-chill being as good as cooking food fresh and serving it hot, but there has got to be a taste and texture difference in favour of cook-serve."
As with any hospital, there are patients in Broadmoor with special dietary needs. The menu options routinely include vegetarian choices, but vegan and halal menus are also available. The ordered portions for each ward are made up together for a "family-style" service on the ward.
While malnutrition is a big problem in acute hospital admissions, it is not a problem in Broadmoor. The reverse is true. Rather than trying to get more calories and nutrition into Broadmoor patients, Foster and his kitchen team are sometimes concerned that patients consume too many calories. One cause of obesity problems in Broadmoor is the medication that some patients are on, which can lead to weight gain.
The Better Hospital Food Programme has been adapted for this reason. They have included some of the special recipes that were developed, but have taken out some of the fat content.
The pre-ordering system has the week's menus posted on the wall of wards at the start of the week. Daily tick cards are sent down to the kitchen about one and a half days before meal service and the kitchen collates what each of the wards has selected into the production run. This may soon change as the hospital is looking at a more computerised system of ward ordering where the computer software can capture food ordering from each ward and produce a meal-time production sheet.
Because the hospital is long-stay, rather than short stay like an acute hospital, menu cycles are longer in Broadmoor than the normal one- to two-week cycle. The cycle is a four-week one and the whole menu changes every six months. Food cost allowance for patients is similar to acute hospitals at £2.30 a day.
There is not a snackbox service in Broadmoor as is now widespread in acute NHS hospitals, but depending on the ward, there are tea-making facilities and there is a ward budget for buying extra snacks.
Another difference to acute hospitals wards is that patients at Broadmoor are dressed rather than being in bed at mealtimes. The food is transported into the wards by catering staff, but then it is the nursing staff that are responsible for service to patients. The nursing staff have a record of the patient meal ordering to assist in delivering the choice.
Serving hand over
The loss of control on meal times as catering staff hand over the food to nursing staff for serving is an area Foster is looking at. The option of catering staff not only cooking and delivering the food on to wards, but also serving it to ensure it is served hot is what a chef ideally desires.
There is a history of Broadmoor patients working in the kitchen and being paid for it. That practice is based on a prison regime rather than a hospital one and it was ended two years ago for security reasons. A review by the security team at Broadmoor on the ratio of how many kitchen staff should be trained in restraint procedures to the number of patients working in the kitchen found it had reached the point where it did not make good financial sense.
There are regular meetings between Broadmoor staff and patients to assess customer satisfaction and hear of changes the patients suggest.
Broadmoor is located in an affluent and busy area of the South-east of England where there is a wide choice of employment opportunities. Yet staff recruitment and retention is not a problem, according to Foster. The hospital serves its 300 patients with a kitchen team of four chefs, a supervisor and four porters on each shift. Pay rates to kitchen staff are slightly higher than an NHS acute hospital and staff turnover is low.
Staff receive training on how to interact with patients, what to do if there is a disturbance and the importance of personal safety and security issues.
Foster deals with the other great urban myth surrounding secure hospitals: how does he make up meals for patients who are being force-fed?
He says it is a situation dealt with by clinical staff in a secure hospital using nutrient supplements. It is not handled by catering staff. Also, in the 14 years he has worked in the kitchens of Broadmoor he has only heard of one occasion when a patient was force-fed.
Broadmoor sample daily menu
Lunch main course options
Seafood pasta with dill and Parmesan
Beef and onion pie
Soya mince chilli
Cheese and tomato omelette
Ham and mustard sandwich
Chocolate sponge with chocolate sauce
Tea main course options
Maryland pork steaks
Egg and tomato baguette
Prawn pasta salad
Apple and cinnamon cake
Broadmoor history and structure Broadmoor is situated in the affluent Thames Valley area close to Bracknell and Ascot.
It is one of a number of hospitals and health centres operated by the West London Mental Health NHS Trust.
The original institution was built in 1863 when understanding of mental health was poor. While conceived as a prison for the criminally insane, it is now run by the National Health Service as a hospital for people who are ill.
The wards are classified according to the level of care and security patients need, but catering staff have access to all wards.
High walls, high wire fencing and padlocks on gates and doors are part of the security system. This includes access into the kitchen area.
The average patient stay is around seven years, though some patients may stay for life if they fail to recover.