Diet of facts and fallacies

Signs from a Dunedin Public Hospital workers' protest in the Octagon in March. Photo by Peter...
Signs from a Dunedin Public Hospital workers' protest in the Octagon in March. Photo by Peter McIntosh.
Southern District Health Board member Richard Thomson addresses what he sees as the myths, misunderstandings and dilemmas over planned changes to board food services.

I heard the other night on talkback radio how much the food had deteriorated at Dunedin Hospital since they started trucking ''frozen mush'' from Auckland to Dunedin.

That was probably the worst example of misinformation I have heard around this debate but it is far from the only one.

If I talk to most people in Otago-Southland they will tell me that the proposal is to ''truck frozen meals from Auckland to feed Dunedin and Invercargill hospital patients''.

So what are the key elements of the proposal:

• Meals on Wheels will source snap-frozen meals from an Auckland-based company that specialises in these.

The savings come from the bulk buying for most of the country.

The advantages are that there is the potential for more options and users can have a choice of receiving the meal heated or frozen.

This means people do not have to have their dinner at lunch time if they don't want to and can save it till the evening or, indeed, the weekend.

The disadvantages are that once you take Meals on Wheels out of the hospital kitchens you increase the cost of preparing all the other meals as you still have all the overheads.

• Hospital meals will still be prepared on site in the hospital kitchens but from a mix of locally and nationally sourced fresh food and bulk pre-prepared frozen options.

The majority of the latter are the red meat dishes (stews, etc).

The majority of hospital food will still be sourced locally except for red meat dishes, which will only be about 22% locally sourced.

The advantages of this are that you can make savings on the bulk pre-prepared as there is less staffing involved in the meal preparation, and national contracts to supply most DHBs mean that better prices can be achieved.

The disadvantages are that you reduce the total number of food services staff required (by about 20% at worst case), and you lose some elements of local sourcing, which will impact on those supplying the DHB.

That will be offset, to a degree, as some local firms will have contracts to supply the whole country and their sales will go up.

So there will be winners and losers.

• Wider choices for patients.

The options being offered will increase and the timing of patient orders will make it more likely patients will get what they want to actually eat.

Orders are taken now in a paper format, well ahead of when patients will eat the food.

Under the proposal, new software will allow patients to choose what they want much closer to the meal time.

Using a tablet format, the order will go back to the kitchen and be made up.

The food can be as nutritious as you like but it only benefits the patient if they eat it.

For me, I can't see a down-side to this component of the plan.

So what do I think some of the misunderstandings are?

• Frozen meals will not be nutritious.

The snap frozen method used for Meals on Wheels is not what most of us think freezing food is about.

At home we get frozen moisture crystals in the meal, and the food we freeze degrades over time.

The snap frozen method results in instant freezing and there is no nutritional degradation.

• We will not be able to feed people if the motorway is closed.

The DHB will keep two weeks' supply of frozen meals and bulk pre-prepared foods, and there will be more locally in distribution centres.

The hospital kitchens still operate.

• Compass will benefit from the free labour of Meals-on-Wheels drivers.

The DHB, in not adequately engaging in this debate, has failed to recognise health services are more than just what we pay for.

They include the volunteers who entertain in old people's homes, the fundraisers who keep the hospice and any number of other organisations going, the people who are now fundraising to keep the physio pool open for the public, and they include Meals-on-Wheels drivers.

Some now question whether they would be working for the public health system, or a multinational corporation, and the answer to that question is important to them.

The DHB's contract with Compass is only for the meal and having it ready to deliver.

If voluntary drivers were no longer available, the DHB would have to pay for the cost of an alternative delivery.

It would not come out of the proposed meal cost.

We would either have to pay Compass more to offset the cost of the delivery or pay someone else to do the delivery.

That would end up as a cost to either the DHB or the recipients and probably both.

Either way, there would be less money to spend on health services.

Ironically, if we had to pay Compass to deliver the meals, it would presumably include a profit margin on that and its profit would go up if the volunteer service ceased.

• The meals will be less nutritious.

The standards for the meals have been determined by a panel of DHB nutritionists and then peer-reviewed by two external agencies.

They stipulate what must be provided and, not withstanding the high standards our staff maintain in Dunedin, the proposal requires Compass to exceed what we are offering.

If quality deteriorates, there are outs that would allow us to walk away.

• The savings are small.

The figure of $7 million over 15 years is repeatedly used.

What is not understood is that this is the ''NPV'', not the dollar savings.

There is not space here to explain the differences but the savings per annum are in the vicinity of a million dollars on the conservative figures.

So that's the proposal I am having to make a decision on.

I have also heard lots of people say, ''it's all about the money'' usually in a derogatory sense. But it is all about the money.

If we spend more on non-clinical things then we have less to spend on clinical things and that weighs heavy on my mind.

On the other hand, I need to be convinced the contract is sound (15 years is a long time), that we have given adequate consideration to alternative ways of making savings without outsourcing, and that there will not be unintended consequences that have not been thought through, and I have to decide whether the impact on staff and local suppliers (whether winners or losers) is justified.

• The board votes on the proposal on Thursday.

Mr Thomson is also a former board chairman and is a Dunedin city councillor. These are his ''personal'' views.

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