45. Pay-As-You-Eat at Joyce Green Hospital

Key words/phrases: National Health Service, hospital dining rooms & waitresses, West Hill Hospital & Livingstone Hospital Dartford, the “pay as you eat” system, split-shifts, hospital cafeteria,

No. 45

If you were employed AND resident at Joyce Green Hospital prior to 1967- 68 the accommodation that you were given and the meals that you received were, like the National Health Service itself, “free at the point of receipt”.

Historically, charges for board and lodging within the British NHS had always been deducted at source, i.e. taken directly from the employee’s wages and so all resident members of staff - no matter what profession or trade the individual belonged to - simply enjoyed (if that’s the correct word !) the accommodation that they were given and the meals that they were served, “free” at the moment of use or consumption.

I say “served” in relation to their meals because some people reading this will be able to remember when meals were served to them in hospital dining rooms. I can certainly remember being ‘served’ meals by uniformed waitresses in the main dining rooms of both the West Hill Hospital and the Livingstone Hospital in Dartford although not at Joyce Green. In addition and by tradition ward sisters and medical staff had long had their meals served to them by waitresses in separate dining rooms.

However somewhere between 1967-68, a Government edict descended from on high dictating that this deductions-at-source approach to reimbursing the NHS for “meals taken” was going to be scrapped and a “pay as you eat” system introduced into all hospitals. This was done in an attempt to make staff accountable for exactly what they ate rather than deducting a one-price-for-all figure ffrom the salaries of all staff of the same grade and was aimed of course at reducing each hospital's catering budget.

Thus on the appointed day special, separate dining rooms for Ward Sisters and Medical staff were abolished and “Waitress Service” dining rooms arose in their place for those members of staff of any type or grade who wished to pay a small add-on charge for having an individual meal served to them.

Most people however continued to eat their meals in Joyce Green’s main dining room, but - and here was the rub - every item of food that they ate or beverage that they drank after Day 1 was individually priced and had to be paid for at a newly installed cashier’s till in the cafeteria immediately prior to it’s consumption, as in self-service cafeterias in the public domain.

For most employees, but particularly for resident staff, this was completely different to anything that many of us had been used to. Some of you reading this will be able to remember the shock of seeing the cost of the items on their lunch tray mounting up on the till roll ? “Meat x 1 portion = 1/-, portion of potatoes = 2d, portion of carrots = 2d, glass of orange squash = 2d, portion of treacle sponge and custard = 6d” and so on, right down to the halfpenny charged for a pat of butter for one’s slice of toast or slice of bread !

Not only were most staff totally unused to monitoring the cost of the dining room food that they were about to consume but many long-standing members of staff were also institutionalised to the extent that they were not used to handling money on a daily basis. In fact there were some older members of nursing staff “in post” to whom life and the ‘service’ that they rendered was something akin to living within a closed religious order, that is to say, they only left the hospital on rare occasions.

I can certainly remember dedicated ward sisters who seemed to spend most of their lives within the confines of the hospital and who frequently worked split-shifts on their wards (i.e. a morning and an evening shift in the same day) as a feature of their ‘calling’, who struggled to come to terms with the introduction of this new pay-as-you-go system because they were completely unused to budgeting and handling money.

Thus paying their bus or train fare in order to go and visit their family whilst taking a “day off” didn’t create a problem - because they were used to budgeting for this type of special, regular or occasional event – but having to calculate what the food that they had selected on their cafeteria tray was going to cost them and marshalling the necessary coins with which to pay for their meal was much more difficult for them in this brave new world, at least at the outset.

For us as students handling money and paying for food at the hospital cafeteria check-out wasn’t the problem. No our problem was that we didn’t earn very much and yet suddenly found ourselves having to control our appetites and our spending instead of eating to our heart’s content in the hospital dining room, as we had been used to doing up until then.

But here’s a question that I haven’t been able to answer yet. Prior to the arrival of the pay-as-you-eat system how did hospital authorities get back the cost of meals eaten in hospital dining rooms by non-resident staff ? Was a small sum of money routinely deducted from their wage packets as a contribution towards the costs of their meals whilst they were on-duty or were their meals a gift from the bosom of the NHS ? Maybe you can remember ?