The NHS plan says half of all hospitals must have 'ward housekeepers' by 2004 to ensure food from the new menus is served hot and well presented and that patients can eat it.

Nottingham City Hospital trust is held up as an example of good practice for its ward waitress system.

Catering manager John Hughes says problems in nurse recruitment four years ago made the trust seek ways to reduce pressure.

Then the hospital formed a nutritional steering group to review practice and realised these people were the linchpin. 'If you cannot get food to the patient, or if you have someone delivering it who is not clued up or interested in what they are doing, you can have the best menu in the world and it is not going to make any difference.'

Initially, 75 per cent of directorates opted in. Now all of them want to use it.

The trust employs people from local industry as ward waitresses and has developed a three-day training course. Cooking is in the hospital's kitchens.

'I call it caveman catering, ' says Mr Hughes. But it delivers food that is 'fresh and hot', costing about£2.70 per patient per day or, with production added, about£4.