Hospital food and nutrition

hoSPitAl food StAndArdS: whAt do they reAlly meAn to you?

andy Jones Chairman of hospital Caterers association, iss facilities services (healthcare)

Andy has been a stalwart of patient catering for over 30 years, with the key influence being the delivery of a nutritious and wholesome food and hydration service at ward level. he has been one of the key leads in the nutritional and hydration weeks and currently sits on the Government-led hospital food Panel. Andy is also a member of the cost sector caterers’ top 20 public sector caterers.

the new hospital food standards only cover england, with the other three nations having their own standards currently in place or in the process of being reviewed. but what is so pleasing and different this time is that they have all involved those who are delivering the service, from nurses to dietitians to caterers.

However, to me it’s about not what we say but what we do that is more important. Let me explain what I mean by this. It’s great having the standards, but we have to ensure that they are followed and that we are all committed to them from bottom to top and vice versa, but above all, they must meet the NEEDS of the PATIENTS we serve.

Of course, the standards include areas which impact on the social welfare of the staff working within our Trusts and, of course, the patient’s visitors. This is a key area; as we all know, well-looked after and well-nourished staff members are better able to look after the patients.

the Key elements - RequiReD stanDaRDs patient catering eatinG foR GooD health • 10 key characteristics of good nutritional care, Nutrition Alliance • Nutrition and Hydration Digest, The

British Dietetic Association • Malnutrition Universal Screening

Tool or equivalent (BAPEN)

staff and visitor catering - healthy eatinG • Healthier and More Sustainable Catering – Nutrition Principles (Public

Health England)

all catering • Government Buying Standards for

Food and Catering Services, HMG standards developed by the Department of

Environment, Food and Rural Affairs

We all know that the standard of catering in hospitals is a very high priority and sadly, one of the things not reflected in the report is that food and drink is an integral part of the patient’s recovery plan and I will continue to campaign for this; after all, food is the best form of medicine. One area within the standard that we ALL have to ensure is in place, is a trust-wide Board-led FOOD and DRINK POLICY, which is essential and involves a multidisciplinary team including dietitians and caterers, but must be the responsibility of the Director of Nursing to ensure its delivery.

I am convinced that by working together in implementing this plan, we will succeed in the final outcome. Yes, there are issues and we understand that we will never be able to appease (or satisfy) everybody, but what we have to do is to get the basics right and I believe this standard incorporates the potential to do just that.

so What Can Dietitians Do? Nothing that they do not do already, i.e. work closely with the catering team and patients. After all, we all have our favourite foods when we’re not feeling well, whether it’s a bowl of soup or rice pudding; we naturally gravitate to comfort foods and that is what patients do when in hospital. Patients don’t come into hospital to be adventurous; they come in knowing that the progress of their recovery will be based around nutritious foods which will help them. The new Hospital Food Plan goes a

It is key that our menus and beverage choices meet and are suitable for the patient groups we serve, as well as being flexible in both their offering and adaptability.

long way in helping to achieve this, although we know that we have people out there who want nutritional standards made mandatory. The Plan incorporates this aspiration by using the powers of the mandatory NHS Contract and local commissioners.

I have often remarked that this is a base mandate to enable us to move forward, but be assured, this is only the beginning of the journey - not the end. In my view, clear and unequivocal standards for nutrition are in place in the British Dietitians Association’s Nutrition and Hydration Digest, developed by Food Counts Specialist BDA Group along with HCA, and these clearly give us caterers our nutritional standards. These are the standards which every NHS caterer in the UK is to achieve in all the menus they provide and when I say the UK, I do mean the four Nations who are covered by this. So, when people call for mandatory standards, just take a step back and think; we already have them, so what we don’t need is more standards, we just need to ensure that people adhere to the standards we have already.

How do we do this? We do it by working and listening to the patients we serve with the menus and dishes they want to eat. We must remember that one size does not fit all; we must also look at the names we use in the menus. I believe that in some areas we have become ‘too posh to nosh’ and it’s not about giving different foods, it’s about what we call them. For example, I cast my mind back to the Better Hospital Food Plan; Lamb and Flageolet Beans? I spent almost two hours trying to explain to a patient what flageolet beans were and going back into the kitchen to explain to the chefs. Basically, it was just an enhanced lamb casserole. But taking that aside, we still use ‘posh’ words; creamed potatoes on the menu when at home we call it mash. Don’t you? I certainly do. Think about it; use simple words which can make such a difference to patients, especially the elderly.

hoW Will it be measuReD? The Panel recommends that required standards should be monitored via annual Patient Led Assessments of the Care Environment (PLACE) and that PLACE should be amended to include a more detailed evaluation of the taste, flavour and presentation of hospital food. However, whilst I believe that patient involvement is essential to providing a more accurate perspective of views on food, drink and general catering services and to identifying where improvements should be made, we must not allow ourselves to become distracted by overly focusing on scoring and league tables.

It is key that our menus and beverage choices meet and are suitable for the patient groups we serve, as well as being flexible in both their offering and adaptability. The advantage of the PLACE data is that it enables us to take a step back and explore in-depth patient feedback on

Improved screening of patients’ nutritional status on admission is called for, so that special dietary conditions or needs can also be identified.

specific aspects of the service and to work with the patients on those individual areas that have been identified as weaker.

But PLACE scores should not be used as yet another stick, but ‘the carrot’ to catalyse continuous, quality improvements. However, in order to achieve this across the board, a view needs to be taken about how some of the catering service is managed in future, such as night time ward snacks and drinks, as these fall under ward budgets and are outside of the caterer’s area of responsibility. In order to improve the quality of all aspects of patient food and drink provision, the caterer should be allowed to take responsibility for the whole of the ward service.

What the Hospital Food Plan clearly shows is that, because of the multidisciplinary nature of a patient’s nutritional care, we must continue to work across all departments to ensure consistency and support for a patient’s total food and drink provision. For example, we need to encourage Trusts to seek CQUIN payments to help fund improvements to areas where we need to raise standards. Consequently, there is a need for greater understanding of the wider challenges of producing and delivering food to patients on our hospital wards. In order for nutritional care to be more ‘personalised’ to an individual patient, it is important for all members of the clinical care team, as well as caterers, to recognise the role that food can make to improving the patient’s clinical outcome and to imbed food and drink as part of every patient’s recovery plan.

‘last 9 yaRDs’ All of the above can be undone in what we are calling the ‘Last 9 Yards’. In essence, good food can be ruined/spoilt in those last few steps, whether due to lack of care taken in serving the food or drink, or communication with the clinical teams and/or patients, or to giving the wrong diet. Also serving food without a smile, or showing concern for a patient’s comfort and ability to readily manage and enjoy their meal. So, the work that the group are doing for this is going to be core to moving forward. The 6 Cs are also a major influence to this area and show how the HCA are rising to meet this ‘end stage’ challenge by convening a working group of caterers, nurses, dietitians and SALT representatives from all four nations to focus on this topic on behalf of their professional colleagues.

A great example of one outcome of us all working for the same common goal is the study day with NNNG where we join forces with nurse colleagues and which took place at the end of March during Nutrition and Hydration Week. It was a successful example of a multidisciplinary event.

The HCA is still calling for a mandatory minimum expenditure on all patient meals to also be introduced in ALL TRUSTS across the UK. The deployment of ward hostesses on more wards, too, would ensure better monitoring and communication of individual patient food and drink requirements and intake. Improved screening of patients’ nutritional status on admission is called for, so that special dietary conditions or needs can also be identified. With a better protocol in place for every single patient which can be followed by all members of the team - from ward to kitchen - and throughout a patient’s stay, patients will then receive the optimum nutritional care that they expect and deserve.

This Hospital Food Plan is the beginning and not the end of the process and we as caterers and dietitians have to lead on this. What I am already so pleased to see is the close links and bonds that exist between the BDA and HCA becoming even stronger.