/ Food & Drink, Health

Is hospital food packaging a problem?

yoghurt pot

Have you ever been in hospital and not been able to open a sandwich packet, pack of biscuits or drink carton? Or maybe you’ve seen an elderly patient, friend or relative give up and go hungry?

Difficult-to-open food packs are an annoyance at the best of times, but they become a much more serious problem when it’s patients in hospital who need to open them.

Shouldn’t we expect the NHS to encourage people in hospital to eat by providing them with easy-to-open food packaging?

Which? Conversation commenter Lessismore described the problem on a previous discussion:

‘It isn’t just the nutritional value of the food – it is the way it is served […]

‘This can include grated cheese and salad and flaked tuna in plastic tubs to go with the ubiquitous baked potatoes. The elderly need help to open these pots and help to open the fruit pots and help to open the packed sandwiches and help to open any salad cream or tomato sauce in a small plastic sachet. This is time consuming for the staff too.’

Food should be easy to access

Rica is a sister charity of Which? and specialises in working with disabled and older consumers. We’ve been testing the ease of opening food packaging with Marks & Spencer and Age UK to the new international ISO standard ‘Packaging accessible design – ease of opening’.

We believe that hospitals should be using this new standard to improve patients’ nutrition, independence, dignity and inclusion.

Patients can’t open their food

Helen’s experience demonstrates why this issue is so important:

‘I was unfortunate to end up in hospital last week. I was put on a ward where most of the patients were elderly women. One had previously had a stroke and had recently fallen (which was why she was in). Another clearly could not walk and had to be helped with all her basic needs. When it came to food, I was disgusted.

‘Not only was it packet breakfast cereal, but these poor women couldn’t even open the packet. I helped the lady who had had a stroke as no-one was available to help her.’

What do you think? Is hospital food packaging a problem? What are the worst types of hard-to-open food packages? And what do you think should be done?

This is a guest contribution by Caroline Jacobs, co-director of Rica (Research Institute for Consumer Affairs), Which?’s sister research charity, which focuses on older and disabled consumers. All opinions are Caroline’s own, not necessarily those of Which?


I find it difficult enough to open some packaging and I am not half prostrate and enfeebled as a result of an operation or illness. It must be tormenting to be stuck there with food in front of you and you can’t even open it. If patients’ food now comes in packets and sachets then somebody needs to go round to each bed and make sure that the patient can cope and open the packaging for them.

Considering how many people struggle with packaging when they are not in hospital, the answer must be for those delivering the food to ensure that packets etc. are opened for the patients. I’ve seen elderly people struggling to eat in hospital, so it’s important that help is available.

I am not sure about seeking help from Marks & Spencer. I nominate their plastic tubs of ‘fresh’ soup as the most challenging food packaging I have encountered recently.

I have had that problem with ‘fresh’ soup and also with tubs of fruit pieces. Even getting the protective cap off before you get to the thin seal is an effort. Things where you have to break a tab off are another difficulty and I still have the wounds to prove it. Opening small bottles of orange juice is almost impossible because the caps have been put on and sealed under pressure by machine and there is not enough to get hold of in order to twist the cap off.

I had some toothpaste recently where the inner seal over the tube outlet had lost its tab and I had to stab it to make an opening.

It’s best to leave the surgery to the surgeons but it might be handy to have some instruments to hand when going into hospital. “Scalpel . . . forceps”.

These problems are familiar to me too, John. Missing tabs seems a very common problem.

Back with the challenges for patients, I have seen people struggling with cartons of protein drinks and straws. These are often given to people who are not eating an adequate diet.

I worked in a NHS hospital 45 yrs ago when there were auxiliary nurses to help the less able to eat ( well before excessive packaging) do these good people still exist or have they been deemed unnecessary by Govt. cutbacks?

Time to bring back Matron me thinks!

I agree with you Carole. Nursing was more continuous in those days. I remember when my mother was in hospital there were always several nurses and auxiliaries on the ward to look after the patients and a staff nurse to supervise.

I am not quite sure, given the immense [and rising] resources poured into the NHS every year, whether it is fair to attribute staffing shortages to government cuts or a desire to keep extending services to more and more expensive treatments and procedures than the system was designed for. The principal hospital in Norfolk has over 7,000 staff, carries out 153 operations a day, and serves 2,250 meals a day to patients, as well as providing a huge range of out-patient services and dealing with 260 daily in A&E. It also relies on 600 volunteers to support the permanent establishment. Over the last few decades there has been an explosion of demand for hospital services and cutting back on some ancillary functions has been an inevitable consequence. Despite the massive financial provision represented by the statistics they still want more.

I quite agree about Marks and Spencer’s packets of sandwiches , I am elderly but not disabled and I find it almost impossible to open packets without using scissors. So do not use them as a good example!

Presumably many hospitals buy in their food and it thus needs the protection of packaging. However, why when it is dispensed it is not simply opened for patients is beyond me.
The quality of some of the food that is pre-packaged is questionable. I’d be more than happy if I was in hospital to be given M&S food. As they clearly show an interest their own packaging may well improve and we’ll find it easier to break off the tab and lift the lid on soup.

I have read that a considerable amount of hospital food is not eaten. Inevitably, some patients will not have much of an appetite but I wonder how much the challenges of packaging and the difficulty of eating without help contributes to this waste.

ISO 17480:2015 specifies requirements and recommendations for the accessible design for packaging with a focus on ease of opening.
Key areas include “Consumers, Ergonomics, Old people”. However there will be people who are still unable to open packages. Those with arthritis and other hand disorders for example or poor coordination. There will always be a conflict between the need for packaging to protect the contents and the ease of opening. So in the particular case of hospitals staff must surely always be aware of the need to help. Packaging will never solve the problem for all.

RICA, I understand, with Age UK undertook research for M&S on improving packaging for the elderly. Seems a proactive approach to me.

I encounter problems with packs of biscuits and boxed cakes (“pull here”); somehow I still often have to cut across the biscuit pack with a knife, and rip the cake box to pieces.

Unfortunately, standards are not freely available to the general public. This has to change, in my view. The public could provide valuable input about whether certain standards are being complied with. They are not all highly technical.

Standards cost a lot of money to produce but equally cost a lot of money to buy – this one is £212 to non-members (of BSI) – because many have a relatively small circulation. However they contain information that some “outsiders”, who look seriously at topics, would find very useful. Once upon a time (central) libraries used to keep copies in their reference sections, but doubt if that is now the case.

I wonder how many Standards Which? have, or can access?

How do you make such documents available for reference by the public? A non-printable view-only version on line perhaps? Those in the business of using standards would still no doubt buy paper copies for constant reference.

Many standards – this ISO for example – give a preview of the scope and contents. It also lists references used to help generate the standard, which might be as useful, if not more, than the standard itself.

This is off-topic – sorry.

I would still ask the basic question: why do hospital staff not. as a matter of course, open any packaging for patients and present the food properly? Is it not in their job description?

It was the cost of obtaining a copy that prompted my comment. Universities make use of the document supply service of the British Library to obtain copies of journal articles (electronic or photocopies), book loans, etc. It’s a wonderful service that I’ve used thousands of times. I have never ordered copies for private use but it looks as if the public can purchase photocopies of articles for about £12 and DRM-protected pdf versions for around £5. From memory you could print one copy of an article but not retain a usable pdf. Having said that, I don’t know if BL supply or even hold Standards. It would be interesting to continue the discussion but as you say, it’s off-topic. 🙁

I wonder if the NHS has standards for ensuring that hospital patients are properly fed, which obviously would include access to their food.

One of my friends was in hospital for months recovering from Guillain-Barré syndrome, which had caused extensive paralysis. She was not receiving the help she needed. After an argument her husband was allowed to spend time in the hospital and look after feeding her, etc. That went on for two months, possibly longer, because even after she was able to walk her hands were still affected by paralysis.

Off topic I know but IMO important.

10 yrs ago my husband was having chemo, he was also diabetic & it was considered necessary that he had a sandwich at suppertime to keep him balanced. The sandwich was put in the ward fridge to keep it safe( I checked it was there) but he never ever was given it. Where did it go? Staff supper?

For years we had child-resistant packaging for prescription and over-the-counter medicines, which often posed a problem for the elderly, though not necessarily for children. My impression is that most pills come in foil-backed plastic strips these days. These can be much easier for the elderly, but obviously care is needed if children are around.

Thankfully, hospitals still help ensure that patients get the appropriate dose of medicines and I have never seen anyone struggling to take their medication.

Thanks for raising this subject, and I M O it’s deserving of its own Thread – Please may one be started if there isn’t one in existence already.
I’m on a daily dose of 7 tabs, at night, every night.
I have a daily dose plastic container which is great.
Getting the tablets out of their foil packaging is becoming increasingly difficult, because my hands are increasingly less able to pop out the seeming smaller and smaller pills from their bubbles.
Such is the effort needed to release some, that they fly off to freedom and hide.
All comments, suggestions, hints, home-made release tools, etc will be recognized with a +1 vote.
PLEASE may we have a Thread on this general, Medical item, aspect of access

My FIL who was losing his sight (and whose fingers didn’t work as well as they used to) used to very methodically work his way through the boxes of pills taking one out of an ice cream box of pill boxes and putting each box to the other side as he went. He counted them in and counted them out.

He held them over a large black plastic bowl saved from a ready-meal so he could see and hear the pill when it landed and find it.

He found that the ones that the pharmacy supply (and the carers prefer) ready-filled didn’t work for him. They were to fiddly to open, pills stuck to the see-through top, and it was easy to drop a pill. If you dropped one pill from a group of pills together it was impossible to tell which one it was that you had lost. So the one by one approach from each pack in turn worked best.

Some plastic pill boxes that you fill yourself start with Sunday and some with Monday. Some are impossible to open with old and not very sensitive or strong fingers. We needed to put a lump of blutack on the first day to show which way up/where to start.

If this is successfully “staffed” it seems a pretty comprehensive way of dealing with it. I wonder whether this is a central NHS procedure and how many Trusts have adopted it? http://www.icid.salisbury.nhs.uk/CLINICALMANAGEMENT/ELDERLYCARE/Pages/VolunteersAssistingandFeedingPatientsatMealTimes.aspx

The use of intending university students in the NHS as a quid quo pro for cheaper courses would seem to be a form of “National Service [Health]” where everyone benefits. Could it happen? Well if one views it as a war situation of course it can happen. And the collapse of the NHS surely must be a looming threat.

The government might well believe capitalism cures all but if the US is anything to go by this is not a panacea for the UK.

O/t As to the on-line provision of BSI and other Standards surely that would be a cause that pretty much the entire nation would support Which?. I am sure somewhere there is the echo of a slogan .. “the knowledge economy”

Is an excellent site to browse and indeed support as it provides very thorough articles despite minuscule staff numbers. I have browsed it for mobility scooters and stair-lifts. It is hugely better then Which? on mobility scooters. And better than Age Concern [?] on stair-lifts.

I think the Consumers’ Association [Which?] should certainly increase the £75,000 a year it donates.

I would argue that hospital food packaging isn’t the problem, but staff not helping those who need it sometimes is. A different matter altogether.

Over the past 3 years I have had to be treated in our local hospital several times. At breakfast time we were asked what we wanted and the food was delivered to us ready to eat and we did not have the problem of having to open packaged food. Surely, as well, individually packaged serials must be more expensive for the health service.

The problems with food packaging are not restricted to being in hospital. I frequently have to resort to a pair of scissors to open things & I have yet to draw my state pension! How do the our Golden Oldies cope? Could packaging be one of the reasons why many elderly people are underweight?

The problem is not the packaging, it is no worse in hospital than elsewhere .
It is the organisation in the hospital, no staff have time to help the patients .
There should be someone given the responsibility and time to ensure that each patient has the support to eat the food they want and need whilst it is in a good condition. How often do you see a plateful of what was hot food congeal and inedible because the patient is unable to hold a knife and fork and needs someone to help them using a spoon. or even worse they need food in liquid form and need a straw to drink all liquids.
I am sure there will be some good hospitals but I have seen it often as I have been in hospitals recently.
Part of the problem will have been outsourcing catering without outsourcing the care to ensure people are able to consume the food

Diet and nutrition are important aspects of recuperation and convalescence. Helping patients get the correct food and drink intakes is a vital part of medical care. It seems to be that, as treatments have become more complex and technological, the simple and basic aspects of being in hospital have been allowed to deteriorate. That is not necessarily progress.

I was in hospital for some time 7yrs ago &to be honest the food was so revolting it was a relief it couldnt be opened!

If you couldn’t open it…… how did you sample it to know that it was ”so revolting”…. or did you get a Food taster to do it for you?

D Morris says:
24 November 2015

I was at the Westmorland Hospital in Kendal for day surgery. I was given after surgery some wonderfully tasty sandwiches on a plate (no packaging) and ample mugs of coffee. Food standards could not be bettered and the service was most attentive with jolly smiles. During my 90 years I have experienced all kinds of foodstuffs in many location s and situations and still hugely enjoy my food.
I also was an EHO specialising in food quality and hygiene for 30 odd years and do quickly identify poor food: this was not and the Westmorland Hospital in Kendal must be praised for reaching its high standard.

If only more hospitals could learn from your experience. I hope the quality of the food and the care and attention given to you aided your recovery

When my Mother-in-law was in our local hospital 10+ Years ago we use to go in at teatime with a pair of scissors and help all the patients open the packaging from biscuits, cheese, sandwiches etc. I sat with one elderly lady one day, it took all of 5 minutes and she ate everything in front of her, when the nurses saw what she had eaten they were shocked as it was the first time she had done that! Why can’t they have volunteers to help at meal times if the staff cannot do it? surely eating is all part of getting well again?! My dad has just left hospital and I have to say things were not so bad, there was hardly any packaging, other than those silly sugar packets, couldn’t there be dispensers for these like the saccharin pills?
Each patient could have their own while in hospital with sugar in them, not every patient would want them as many people don’t have sugar these days. The biscuits which came in packaging were always duly opened for him, but, this was often a waste as he did not always want them! My dad, like my mother-in-law,
were lucky that we were allowed to be there at meal times to help with such things, many are not so lucky. I think on the whole though the hospitals are beginning to realise this is a problem, better late than never!

It should of course be part of the assessment of each in-patient whether or not they can manage the food delivery or will need assistance just as it is necessary to find out in advance who can go to the toilet on their own or not. It’s an essential part of the care. It does seem that standards around the country differ widely. It seems to me that most hospitals couldn’t function fully without a lot volunteers. It makes you wonder at what number of additional billions of pounds the NHS would say “That’s enough”. I suspect it is infinite. Given that resource allocation is therefore a fundamental aspect of hospital care I just hope that the decisions are made by clinicians rather than administrators.

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