Food, with care

More than just a nutrition strategy, 'Food, with Care' recognises the cultural, emotional, and sensory dimensions. Researchers and Co-production Champions - parents and caregivers - are working together to create a new approach to food in hospitals where everyone feels supported and nourished.

The aim is that “Food, with Care” becomes not just a blueprint for the Cambridge Children’s Hospital but a transformative initiative influencing how we perceive and prioritise food in hospitals, with potential implications for broader shifts within the NHS.

“Food, with Care“ is a collaboration between the University of Hertfordshire, NIHR Applied Research Collaboration (ARC) East of England, Cambridge University Hospitals, Cambridgeshire and Peterborough NHS Foundation Trust. It involves a team of multidisciplinary clinical professionals including dietitians, clinicians, psychologists, speech and language therapists and nurses.

The hospital’s perspective

The name ‘Food, with Care’ was settled on after lengthy discussions. Nancy Bostock, co-chair of the Cambridge Children’s Hospital food workstream and consultant paediatrician at The Croft Child and Family Unit, adds: “We needed to be careful with our language as, for some people, food isn’t good, happy, or positive. This felt like a compassionate and honest title.

“Working with children, young people and families, I’ve learned that food in hospital is so much more than ‘grabbing a bite to eat’. It’s about nourishment, coming together, feeling strong and able, as well as the cultural aspects of how food makes you feel.

“It can make you feel at home and, if the food is right, it can make you feel valued as an individual, not just a patient. The cost of food in hospital food courts across the country is also a massive issue for parents whose children are in hospital for longer periods of time.”

The academic perspective

Nutrition is very important, but food is never ‘just’ food. Rebecca O'Connell, Professor of Food, Families and Society, Centre for Research in Public Health and Community Care (CRIPACC), University of Hertfordshire, says: “The philosophy is about much more than just the food itself. It's about where and with whom it's shared, the environment in which it's consumed, and even the sensory aspects like taste, texture and smell. This holistic approach recognises that these elements are especially crucial for children, creating a positive and supportive atmosphere during their hospital stay.”

This project challenges the one-size-fits-all approach. Children with various physical or mental health conditions may have specific dietary requirements, making it essential to strike a balance in the hospital's food strategy. The philosophy is not about enforcing a singular definition of healthy eating but about understanding and accommodating individual needs. It’s about understanding the cultural significance of food and its multidimensional meaning in children’s and family lives.

The food philosophy also considers the varying lengths of hospital stays. One way in which children’s hospital experience is different from most adults is that they are often accompanied by parents or carers. The focus extends beyond the patients to their families, recognising the importance of providing comfort foods and familiar options, especially for those with children undergoing prolonged treatment.

The embedded researcher perspective

Millie Barnes, Research Assistant, University of Hertfordshire, is leading the work with Co-production Champions patients and families that have experienced long stays in hospital. Millie, as did her colleague Elena Neri, combines regular meetings with Co-Production Champions, and building relationships with them, with meeting and consulting with staff and reviewing published evidence. This is helping build the evidence base to inform decision-making today and the longer-term food strategy. The study creates a community of practice that continuously adapts to the evolving needs of the hospital.

“I'm actually learning more about someone's life through having tea and a biscuit and talking” says Millie. “These informal conversations are really important in this kind of research. You need to create a safe space, especially when you're talking about things that are quite sensitive or difficult. Co-production is about research, but it's also about looking after each other and checking in with each other.”

This unstructured approach is a challenge but also offers opportunities. Claire Thompson, Prevention and Early Detection in Health and Social Care Lead, ARC East of England, adds “When you look at the co-production literature, there's lots and lots about what you are supposed to achieve and what the underpinning philosophy is. But there is a lot less in the way of instructions because every project is a bit different. There is freedom in it, within ethics and guidelines. You meet a group of people and work with them in a way that fits the group and the project. The challenge is that more participatory approaches need a lot of time to allow for genuine collaborations to develop. That can be very difficult to plan for.”

The participant’s perspective

Celia Enderle is one of the twelve parent Co-production Champions involved. “When it comes to food and hospitals for us, we've had quite negative experiences and they're obviously the ones that leave the strongest memory” Celia says. “In the day ward, where there was no catering in the evening, all I could get for my son was from the ad hoc menu, the only thing he could eat on there was the all-day breakfast for a whole week.”

Celia's involvement in the project stems from her background in well-being, particularly her interest in how food in hospitals can impact overall health. She too emphasises the emotional aspect of hospital experiences, particularly regarding food. The lack of control over food choices, limited accessibility to suitable meals, and the negative impact on autonomy during hospital stays are key challenges.

There is one thing above many that Celia values in her relationship with researchers and that makes her feel valued; “Curiosity is really important, we've been talking about that in our family. It is more productive doing research in an environment where being curious about why people make decisions is more important than being judgmental. And researchers are naturally curious people.”

The NHS staff perspective

Hospital food services are not only about providing comforting and nutritious meals for patients but – vitally – they are also about ensuring that the staff has access to quality food. This includes considerations such as a variety of meal options, availability of hot meals, coffee services, and even 24-hour food services. Recognising that hospital staff may have varied schedules and demands, the goal of Food, with Care is to create an environment where everyone, from patients to staff members, feels supported and nourished.

The hope is that Food, with Care eventually informs not only the food strategy of the Cambridge Children’s hospital, but other hospitals too.

“One of the reasons for having this piece of work is to make sure that it doesn’t get lost in all the noise surrounding the construction of the new hospital”, says Rebecca O’Connell, “we are all learning about our different roles, how we work and how best to work together. For us as university researchers, building our understanding of the context of how hospitals work and how the NHS works is really important, but is also challenging, especially when the hospital is in the planning stages, and there are so many moving parts. Part of what we’re doing is keeping food on the radar.”

According to Elena Neri, formerly Senior Research Assistant University of Hertfordshire, “This is the first time that people from completely different backgrounds and expertise are coming together to create a food vision that really thinks of food from a holistic perspective, giving due importance to the social, cultural, environmental and educational dimensions of eating.”

This research is made possible through the different people and roles involved. There are many ways to make research part of your work. Learn more about different paths in research as part of our Shape the Future campaign.