The latest initiative to improve hospital food caught the headlines with its 'celeb chefs', but can it succeed where others haven't, asks Lyn Whitfield

Dine at the Savoy's River Restaurant and you can savour a starter of 'langoustines in their pyjamas with mango and basil dip'.

You didn't know shellfish wore pyjamas? Obviously you are not the sort of person the hotel expects to enjoy 'elegant dining in luxurious surroundings'. Yet the Savoy's maitre chef des cuisines, Anton Edelmann, is one of the 'celebrity chefs' called in by the government to improve food for another group of pyjama wearers - NHS patients.

The gulf between Mr Edelmann's domain - where the langoustines cost£19 - and the NHS - where feeding a patient for a day costs in the region of£2.70 - was neatly captured by Sun columnist Richard Littlejohn. He described the chefs as 'the sort of people who spend the whole of Saturday disembowelling a kiwi fruit and using it to garnish a pan-seared penguin's beak in cactus jus'.

If they tried offering 'this muck' to Holby City they would get it 'straight back in their faces', he added - which more or less chimes with the experience of Guy's and St Thomas' trust in London.

Guy's responded to a Guild of Food Writers' campaign for better food in institutions by inviting a number of well known cooks to help revamp its menus in 1997.

Head of facilities Mel Rankine says: 'Some people thought the food was very good but some people felt it was far too 'foreign'. They wanted their pie and mash.'

On the other hand, 'it got lots of publicity, the head chef was on the Good Food Programme and it made staff feel as if people were interested.'

The trust has now gone over to cook-chill food, but some recipes have been retained in the national database of its supplier, Anglia Crown.

The present initiative has also given a welcome boost to hospital catering. But work on a national menu for the NHS was underway before the chefs became involved. A national group including caterers, dietitians and nurses started work in October.

NHS Estates stresses that the idea is 'not to have all trusts serving the same meals on the same day'. Instead, a menu framework and some standard recipes are being developed that must be implemented by the end of the year. However, hospitals that are already providing better quality will be encouraged to maintain it.

Chris Gray, managing director of Medirest (formerly Granada Healthcare and the Bateman Group) says the concept of 'designing menus with customers - patients - in mind' is one that 'comes naturally to caterers'. In the past a focus on the technology of food production has at times 'overwhelmed the details of what patients require'.

John Hughes, catering manager at Nottingham City Hospitals trust, hopes that if all hospitals have to meet minimum standards 'you can push up from there'.

There is agreement among caterers that the new menus must take account of the age profile of patients, cultural and regional differences.

As Mr Rankine says:

'Despite being a Scotsman, I cannot imagine putting on haggis and I do not suppose jellied eels would go down well in Aberdeen.'

Regional differences will also have to be taken into account in implementing a 24-hour catering service across the NHS. The NHS plan suggests hospitals will have to provide continental breakfast, cold drinks and snacks mid-morning and afternoon, 'light lunchtime meals' and a two-course evening dinner. But this is a southern pattern of eating.

Rob Pinsent, facilities director for the Glenfield Hospitals division of University Hospitals of Leicester trust, says: 'Most patients in the north would want their main meal around midday.'

Wilson Barrie, managing director, healthcare, for Sodexho, welcomes the move as 'good for patients' if it means people admitted outside normal hospital mealtimes no longer have to wait hours for food. But he doubts it will lead to NHS kitchens working around the clock. It is more likely to mean basic meals, like sandwiches impossible to change the menus. What you cannot change is the total envelope of money you are working with.'

The plan promises an extra£10m a year for all these improvements. A much quoted figure is that this works out at about 4p per meal.

But the money has to fund other improvements, such as an extension of the ward housekeeper scheme.

The government hopes a reduction in waste will add to the pot. Mr Hughes describes this as 'the biggest red herring ever' - though his trust's ward and fruit, soup and a roll or airline-style food that can be 'regenerated', he believes.

Four pilots have been running to examine the precise details. Pam Miller, national chair of the Hospital Caterers' Association, whose own hospital in Bradford is piloting 24-hour catering on the maternity unit and acute elderly admissions ward, says the initiative is 'excellent'.

'Initially, a lot of us were worried about minimum standards, but now there is a recognition that we need to talk about enhancing standards, ' she says.

The NHS plan also says a 'national franchise' for NHS catering will be examined.

NHS Estates has brought in consultants to conduct a 'scoping' exercise. Several major catering contractors have been asked to respond.

Mr Barrie doubts that a single company could deliver food to the whole NHS, when some hospitals want cookchill and others want fresh ingredients delivered to cook on-site. Even if the 'national franchise' is awarded on a regional basis, he points out, contractors will have a wide range of 'asset bases' to cope with at different trusts. He also queries how existing private finance initiative deals will be unpicked, believing 'it might take primary legislation'.

Mr Gray believes that while some contracts will need to be rejigged, this will not present too many problems. 'None of our contracts is set in stone to the point where it is waitress scheme was praised for reducing waste by 40 per cent in the NHS plan (see box).

'If food costs as little as£2.70 per patient per day, then wastage of 40 per cent is pennies off that, ' he says.

The Association of Community Health Councils for England and Wales, which produced the Hungry in Hospital report, also wants to get back to basics. Senior policy officer Angeline Burke says:

'The guidance goes back years.

They should work out why it has not worked before they try another fancy initiative.'

Those celebrity chefs in full:

Loyd Grossman TV presenter and restaurant critic for Harpers and Queen magazine.

Eugene McCoy Joint owner of the Tontine restaurant in Cleveland.

Shaun Hill Restaurateur in Ludlow.

Mark Hix Head chef of the group that runs The Ivy and Le Caprice, London.

Anton Edelmann Maitre chef des cuisines at the Savoy, London.

Michael Caines Chef at Gidleigh Park restaurant in Chagford, Devon.

John Benson-Smith Head chef at Hazlewood Castle, North Yorkshire.

Food in the NHS plan By 2001:

a 24-hour catering service and an NHS menu will exist;

a national catering franchise for the NHS will be examined;

dietitians will advise and check on hospital food nutrition;

the performance assessment framework will measure patients' views.

And by 2004: half of hospitals will use the ward housekeeper system.