Published: 06/02/2003, Volume II3, No. 5841 Page 20

'Do you like hospital food?' The deepest, most fundamental problem with the NHS must be the food served in its hospitals.

It has got to be, since it is a subject which appears time and time again as the top gripe in patient surveys.

Forget about ugly nurses with moustaches, managers without ties and 'lost' surgical instruments; what every inpatient inevitably takes note of is the quality of the food. That is a reflection of the fact that, though few of us know much about the technical 'ologies', administrative complexities and managerial minefields which make the modern hospital, all of us are qualified to comment on the food.

Now I must confess that my experience of hospital food as an inpatient is limited to a nine-day stay some decades ago. One of my two concerns then was that breakfast was served at, what was for me, an unbelievably early hour.My other concern was the unwelcome skin on my tomato soup, an event which occurred at 12.15pm on Tuesday 23 March 1965 - a moment forever etched on my memory.

But although I may not have much experience as a patient, as a former NHS manager I have eaten in many canteens - and I have usually found the food excellent.

Until food critic Loyd Grossman got hold of the menu, that is.

Not that I blame Mr Grossman personally for foisting his fancy food onto patients.Health secretary Alan Milburn must shoulder the blame and the shame, though no doubt there is some eminence grise at the Department of Health hiding in Mr Milburn's shadow who was the originator of the multimillion pound Better Food for Patients scheme.

One can almost hear that obsequious sycophant saying: 'Wouldn't it be marvellous PR, minister, if we could announce that NHS meals will be designed by chefs from the Savoy and the Ivy?'

What an attractive thought - at least to those gastro-gnomes whose palates and pockets allow them to regularly exercise their slavering jaws in London's more expensive epicurean eateries. But it is, of course, nonsense.

Parsley dumplings and Arborio risotto rice may be the staple fare among the upper echelons of government and the Department of Health, but such offerings hardly represent the normal diet of the average man or woman.

And what folk want when they are in hospital is the comfort of familiar food, the sort they normally get at home.

Plain folk - and that means the vast majority of us - want plain food. And I do not mean pigs trotters and eel pie; but I do mean real, thick-cut chips, and mashed potato that has been mashed not rehydrated. It means Heinz baked beans, not basted Bolivian badger in a sesame seed sauce, nor any other mysterious delicacy which those with expensively educated palates think we will enjoy.

Trying to foist fancy food on plain folk who just want plain food is the height of condescension. Thank goodness the Grossman scheme now seems to be faltering. Let's hope the end is in sight for the kind of pretentious drivel found on the NHS Estates website, which tells us that 'NHS food... is not simply a means of satisfying hunger but a token of exchange between hospital and patient'.

I have been happy to read that fewer than half of our hospitals are managing to meet the government's target to provide at least three meals a day from the Better Food menu. And the good news is that the number reaching the target has fallen by 10 per cent over the course of 2002. I would like to say 'well done' to all the managers responsible for commissioning catering services.

Well, I really would like to be able to give them a hearty slap on the back, except it is not quite so simple.On the face of it, the real reason seems to be that the£500m annual budget for providing 300 million meals a year is not large enough to allow too many ofMessrs Grossman and co's fancier items to be provided. Even so, I would like to think that somewhere out there are managers pursuing their own guerrilla war on behalf of the poor and downtrodden masses - men and women who are secretly doing their best to give people what they actually want.

And it surely is what people want: no-one ever asked for meals of the kind normally available only in the best hotels.

The Better Food website says that 'robust research' revealed that patients complained about complicated menus, the time food took to arrive, presentation, temperature and small portions - but there doesn't seem to be any mention of complaints about menu content.That is just a fantasy cooked up in the dining rooms of Belgravia.

Food is surely one area at least where pandering to the lowest common denominator is a damn fine thing. So let's chuck Better Food in the bin. In the coming months, let's have toad-in-thehole, not taramasalata, offer roast beef, not ratatouille, and celebrate good old fish and chips, not guacamole.

Steve Ainsworth is a former primary care manager.