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Literature Review of the UK Hospital System

Home Free essays Literature Literature Review of the UK Hospital System

The situation with the provision of catering and food services in British hospitals, both public and private, has been characterized as rather problematic by a number of observers. Such problems as hospital malnutrition (McWhirter & Pennington 1994; Lean & Wiseman 2008), food quality management (Fenton et al 1995), or insufficient and interrupted patients’ food and fluid intake (Edwards & Nash 1999; Holland et al 1991) may be viewed as some of the most serious problems that have to be confronted in the context of the UK healthcare institutions. Furthermore, the significant differences among the private hospitals and the NHS institutions with respect to menu planning and similar arrangements would need to be considered as important components of the general situation of the UK healthcare system. With this in mind, it is necessary to present a coherent analysis of the catering practices in both public and private sectors of the UK hospital system, so that a lasting comparison between them may be convincingly attested.

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Problems of Patient Malnourishment: NHS vs. Private Facilities

Several major studies of the UK hospital system demonstrate that the malnutrition problem still retains its relevance for both the actors and the policy makers. For instance, “as many as one in three adult patients” were found to be suffering from malnutrition of various degrees in accordance with the 2011 Welsh hospital survey (Wales Audit Office 2011, p.9). Similarly, the English hospital surveys would attest to the approximately the same situation, with more than 140,000 patients (about 20% of the total number) having been diagnosed with malnutrition in 2006-2007 (This Is London 2008). Finally, in Scotland, 110 deaths resulting from hospital malnutrition were registered in 2009 alone, highlighting the potentially dismal consequences of the neglect of this extremely important issue (Gardham 2009). The  financial costs of hospital malnutrition should not be underestimated either, as, according to O’Flynn et al (2005), in 1992 alone, the NHS expenditures connected with the patients’ undernourishment problems totalled %u20A4266 million in excess annual expenses (O’Flynn 2005, p.1079).  According to Cross and MacDonald (2009, p.160), this figure rose to %u20A47.3 billion in the late 2000s, indicating that the problem of patients’ undernourishment proved to be a chronic one. This would point at the substantial negative impact of hospital malnutrition upon the NHS hospital system.

Given the progressive commercialization of the UK hospital services (Cumming 1992; Chahal & Eldabi 2011), it is worth noting that no specific studies with regard to the comparative differences among NHS and privately run hospitals’ patients’ malnourishment levels have been carried out so far. While this would without doubt significantly limit the precision of this research, one could still surmise the differences in question when making use of appropriate secondary sources.

The statistics of the undernourishment in the NHS hospitals is scarcely traceable due to the persistent neglect of this problem by the respective officials (McWhirter & Pennington 1994). It was actually only in 1985 that the true extent of the hospital malnutrition issues was for the first time brought to light by the interested researchers (Pinchcofsky & Kaminsky Jr. 1985). Subsequently, several important studies of the empirical problems engendered by this situation in the NHS hospitals have been carried out.

In particular, O’Flynn et al (2005) implemented three consecutive cross-sectional studies of the malnutrition range changes at the Hammersmith NHS Hospital, with each of the surveys having been connected with the dietary care improvements that were instituted by the Hammersmith NHS Trust authorities between 1998 and 2003. While at the time of initial survey (1998) 23.5% of the examined inpatients were diagnosed with the visible symptoms of malnutrition, this number was reduced to 20.4% in 2000, and further to 19.1% as of 2003. The malnutrition risk ratio reduction was even more prominent, with 33% fall between 2000 and 2003 (O’Flynn et al 2005). While the authors attribute such reduction to the catering practices’ improvements, as well as to the improved staff education with regard to nutritional matters, the level of malnutrition decreases at the Hammersmith NHS Hospital would still be insufficient when the problem of hospital malnutrition is viewed in a more systemic dimension. Moreover, as observed by Age Concern (2006), the role of age factor in the development of malnutrition phenomena may not be disregarded, as more than 60% of the hospital patients aged 60 or higher would be at the risk of undernourishment in the NHS hospitals. Thus, as O’Flynn et al’s (2005) study included all groups of patients aged 16 or higher, it should not be considered as encompassing all aspects of the patients’ hospital malnutrition.

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Russell and Capezuti (2012) emphasize the need for enhanced patients’ eating screening by the nurse workers at the respective hospitals. In particular, such programmes as ageWISE, which affirm the need for a more comprehensive integration of the needs of the elderly patients in the NHS institutions’ nutritional practices, may be of great use there (Russell and Capezuti 2012). Nevertheless, such measures may not be viewed as conducive to the all-encompassing alleviation of the problems inherent in the treatment of the elderly patients’ nutritional needs, due to their mainly technical nature (e.g. the introduction of a “red tray” system (Russell and Capezuti 2012, p.399), etc.). Hence, the more coherent reorganization of the NHS elderly patients’ catering system may be needed in this respect.

The situation with the privately run hospitals concerning the issues of patients’ undernourishment would appear to be less problematic. For instance, Which? (2006) conducted a national survey of the nutritional experiences of 833 patients, with 75% having been to the NHS hospitals, while 25% were at private medical facilities. Subsequently, a significant bias in favour of private hospitals was made evident, with only 4% of the respondents who were placed at private hospitals affirming that they were still in need of further nutrition after taking their meals (Which? 2006). This would stand in a sharp contrast with the respective figures for the NHS hospitals, where as many as 29% of patients would be exposed to the negative impact of undernourishment (Which? 2006).

The results of Which? (2006) study may be taken as a starting point for the evaluation of the relative state of the malnourishment problem in private as opposed to the NHS hospitals. However, in order to examine the situation in the broader context, it is necessary to review the more general issue of food quality in both the NHS and privately run facilities, so as to make some inference with regard to their systemic differences.

Food Quality

The proper definition of food quality/waste, especially in the context of the hospitals’ food procurement systems, would depend upon the number of factors. The concept of food waste may take one of the important places in this respect. In particular, Sonnino and McWilliam (2011) point toward great levels of food waste that would significantly exceed the levels officially defined or acknowledged by the NHS regulations, with general food waste rates averaging between 19% and 66% per meal service at the hospitals that were put under inquiry (Sonnino & McWilliam 2011, p.826). The authors attribute such situation to the lack of proper monitoring, restrictions inherent in frozen food transportation and storage systems that are generally utilized by the NHS hospitals, and the lack of the staff’s proper training (Sonnino & McWilliam 2011, p.827). The conclusions proffered by these authors may be further substantiated by the results of such studies as Hong and Kirk’s (1995), with its emphasis upon labour productivity as a key factor defining the comparative efficiency of hospital food service systems, or Williams and Walton’s (2011), which would likewise focus on the food waste issues.

The situation with the private hospitals’ food quality and food satisfaction would appear to be much better than in the case of the NHS hospitals. The aforementioned Which? (2006) survey’s results seem to testify to that fact, with 86% of private hospital inpatients mentioning that they have always had an access to their menu, as opposed to 59% for the NHS hospitals, and 43% of the NHS patients complaining that their meals were of insufficient variety (Which? 2006). As these findings would seem to be substantiated by the data provided by Boyd (2007), they may be relevant to the issue of comparative evaluation of public and private hospital facilities in the United Kingdom. The challenges inherent in the proper provision of the high-quality food services were highlighted by Rose et al (2004) in their discussion of the managerial challenges that both public and private hospitals have to face. It was found that service quality perception was overwhelmingly connected with the provider’s establishment of the more personal links with the patients it serves, emphasizing the better capacity of private providers to face such kind of challenges. This conclusion may be supplemented by Hartwell, Edwards and Symonds’ (2006) observation that it is the differences in food presentation that may often lead to higher customer satisfaction in the hospital catering circumstances.

According to Hartwell and Edwards (2003), the greater rate of customer satisfaction at the private hospitals may be partially explained by the introduction of trolley food delivery system, as opposed to the more conventional plate delivery, with the former having been found to result in 93% of the patients’ food intake satisfaction, as opposed to 76% observed in the cases of plate delivery. Subsequently, the private hospitals’ greater reliance on trolley systems might partially explain their patients’ higher food satisfaction levels.

Patient Bedding Quality

Finally, the issues of patient bedding need to be reviewed here. As asserted by Hepple, Kipps, and Thomson (1990), the concept of hospitality would be applicable to the hospitals’ circumstances as well, opening the possibility of evaluating the provision of bed services to the inpatients as a specific kind of hospitality activities. Thus, it is necessary to review and compare evaluations of the hospitality efficiency of both the NHS and private hospitals.

The situation with respect to the NHS hospitals would appear to be rather strained, as the NHS has been in the state of acute ‘bed crisis’ since at least the late 2000s (Fallon 2010). Due to both the cuts in numbers of nurse workers employed at the NHS and the steady increases in applicants’ numbers, the NHS hospital facilities would seem to be incapable of accommodating the new numbers of inpatients, which found its expression in the more than 22% fall in bed availability rates at public hospitals, as the 2011 Royal College of Nursing (RCN) survey demonstrated (Huffington Post 2012). Taken together, these worrying trends signify the persistent in the NHS hospitality potential.

On the other hand, the private hospitals have been experiencing a steady growth in number of various care homes and similar institutions aimed at accommodating the needs of geriatric and otherwise vulnerable patients (Wattis 2011). As observed by Greener (2008), these hospitals and care houses are progressively taking upon the consumerist character, with some private hospital rooms being effectively modelled after the hotel-style accommodation. While such type of hospitals undoubtedly belongs to the more expensive category of healthcare accommodation, its emergence would still point at the tendency towards the development of a more consumer-driven model of medical hospitality, as opposed to the previous NHS one.


A brief critical review of some portions of the extant professional literature on the distinctions between the NHS and private hospitals’ catering and hospitality situations would enable the researchers to offer some preliminary conclusions on their significance and relative importance. These would in turn contribute to the further theoretical elaboration of some major themes of the current research.

First, the problems of patients’ undernourishment/malnutrition would appear to be more efficiently tackled by the private hospitals’ operators than by the NHS ones. While exact factors underlying this situation need to be yet explored and verified, it might be inferred that a correlation may exist between the development of user-financed private healthcare facilities and the relative decreases in patients’ malnourishment. However, this problem would still necessitate a more profound elaboration.

Second, the food quality differences between public and private hospital facilities may likewise be analyzed through the lens of the alleged higher quality of the privately run catering services. This would in turn lead to the more systemic discussion of the catering / hospitality benefits provided by the private facilities as opposed to the NHS ones.

Finally, the analysis of bed management quality in the context of both NHS and private hospital facilities would point at the relative superiority of the private providers in this respect as well. Hence, one should turn to the determining of the factors having an impact upon the private hospitals’ service quality, so as to present a coherent cause-and-effect framework of their functioning as superior hospitality/catering providers.

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