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Good quality, high standard catering in hospitals and healthcare establishments is crucial. As the NHS in England Food Standards Report of 2014 states: ‘Food is a critical part of a patient’s hospital experience. It needs to be nutritious, appetising and accessible to patients, their visitors and NHS staff. It should meet social and cultural expectations and be packaged and presented so that people can eat and enjoy it. Food must also be clinically appropriate and everyone who needs more help to eat and drink should get it. When a patient is malnourished it makes recovery more difficult, increases length of stay and can lead to complications such as pressure sores and infections.’
The NHS in England will have legally binding food standards, and hospitals will be ranked on food quality as part of a wide-ranging drive to raise standards of hospital food across the country. The other ‘three Nations’ have all got robust standards, with Scotland taking the lead and making them mandatory by means of legislation.
Food is the best form of medicine and when you are ill, whether it is in hospital, in social care or even in your own home, you look for food that will not only assist in your recovery, but will make you feel better. Then, as the recovery progresses, you look for more nutritious foods which assist in your recuperation. So based on this ‘truism’, patient catering is all about ‘eating for good health’.
To the Hospital Caterers Association (HCA), the standard of catering in hospitals is of the highest priority. As such, it is key that we set a clear example by providing good nutritious food for patients, with healthier menus for visitors and staff. This menu and beverage choice will meet visitor and staff needs and will be suitable for the patient groups we serve, as well as being flexible in their offering and adaptability. Good nutritious food helps patients to recover quickly and go home to their loved ones. This means caterers have just as important role to play as the clinicians.
So we’re not just caterers, we are actually clinicians, because the food and care we provide plays an integral part in the patient’s recovery plan. Therefore it is important for all members of the clinical care team, as well as caterers, to recognise the role that good quality food based on the patient’s needs can play in improving the patient’s clinical outcome.
The four nations
Considering the ‘detail’, as part of a wide-ranging drive to raise standards of hospital food across the UK, the NHS now has a Food Standards Plan for England. Plus we have the ‘Food in Hospitals, National Catering and Specification for Food and Fluid Provision in Hospitals in Scotland’; ‘The All Wales Catering and Nutrition Standards for Food and Fluid Provision for Hospital Inpatients’, along with ‘The All Wales Menu Framework’, set up to introduce a standardised menu for the whole of Wales, and ‘Promoting Good Nutrition – the ‘10 A Day’ strategy for good nutritional care for adults in all care settings in Northern Ireland’.
The recent PLACE in England results have once again highlighted the disparity in spend in patient food across the NHS. The Association has shown by caterers leading that costs need not rise. As a consequence, the HCA is still calling on the government for a mandatory minimum expenditure on all patient meals to be introduced in all Trusts across the UK. However, until this happens, HCA Members are tasked with getting their CEOs or Directors of Nursing on side to produce and implement their organisation’s ‘Food and drink strategy’. This aims to encourage eating for good health as well as healthy eating, high-quality food production, sustainability and excellent nutritional care.
Adopting this as a strategic board issue will serve to embed food and drink as a vital part of the patient’s recovery plan. 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 they expect and deserve.
The welfare of staff and visitors also impacts the patient’s recovery, so ensuring that we offer a balance of healthy choices is something that caterers must lead upon. We are also encouraging our Members to put the calorie content on the menus for staff and visitors, making it easier for them to choose a healthier diet.
The new Hospital Food Plan for NHS England goes a long way in helping to achieve the much needed improvements. We know there are people who want nutritional standards to become mandatory, however mandatory standards for nutrition are already in place with the British Dietetic Association’s ‘Food Counts Digest’. These are the standards which every caterer in the UK has to achieve in all the menus they provide. As England welcomes the introduction of the new standards, Scotland, Northern Ireland and Wales have been working to standards for several years.
Adhering to the the standards
So we don’t need to re-invent the wheel; we just need to ensure that people adhere to those standards. So how do we do this? We do it by working with and listening to the patients we serve, ensuring we provide menus and the dishes they want to eat. That can vary according to the patient group as one size does not fit all. We not only have to cover the different age groups, we are now faced with an increasingly ageing population and obesity is on the rise. So we are also mindful of rising malnutrition, which we believe costs the NHS more than obesity and which will grow with the ageing population and as the challenges in the social care/health care mix become more prevalent.
So there needs to be far greater recognition of the nutritional value of food in the treatment of patients. This is why we support and work with one of our fellow organisations, the National Association of Care Catering (NACC) to raise awareness and improve understanding of good nutrition and hydration and to protect the NHS from the burden malnutrition of the elderly patients will undoubtedly place on the budget.
Eating for good health
Patients’ food is all about eating for good health and we need to focus on that. This is something this Association has driven through in the various guides we have published, and indeed utilise, and in the campaigns we are running. We are very proud that our Ward Guide is in England’s Hospital Food Plan. But all of these great intentions can be undone in what we are calling the ‘Last 9 Yards’.
In essence, good food can be ruined in those last few steps, whether due to lack of care taken in serving the food or drink, mis-communication with the clinical teams or patients, to giving the wrong diet, or even serving food without a smile or showing concern for the patient’s comfort and ability to readily manage and enjoy their meal.
So the work that the HCA is doing in this area is our focus, going forward. It’s all about caring and making a difference together, so also of major importance and influence is our support of, and working to, NHS England’s ‘The 6Cs are for everyone’ values. This has involved tailoring the values of the 6Cs for our Members who are principally caterers, but are also people working across the wide area of food service provision, and their suppliers.
And once again we have recommended that our Members and their teams not only follow this ethos, but share it with their chief executives or Directors of Nursing, so that the 6Cs become embedded as an intrinsic part of the culture, and indeed behaviour across their organisations.
This shows how the HCA is 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 the ‘Last 9 Yards’ on behalf of their professional colleagues. 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.
So whether it’s protected meal times which ensure that patients can eat their meals undisturbed, giving them the dignity they deserve; or providing assistance in opening the packaging, it is essential that our menus and beverage choices meet and are suitable for the patient groups we serve.
To reiterate, to improve the quality of all aspects of continuous patient food and drink provision, the caterer should be allowed to take responsibility for the whole of the ward service to ensure consistency and support. The HCA is constantly looking at our service offering, exploring how improvements can be made, with equal focus on the ward end. It’s not just about meeting their food needs, which is paramount, it’s also about customer care. This is shown through how you speak to patients, not just the smile that you give, and just as important, it’s how you treat them and give them time.
For example, hydration is extremely important for patients to assist in the absorption of any prescribed drugs, so we must also look at our mealtimes. Twelve noon is not a suitable mealtime if that is when hospitals have the drugs round. And that is one of the great things this Association is doing; we are challenging the status quo and changing the way we serve the meals to patients. The patients are our customers and the customer is always right. Working with fellow associations and like minded partners, we listen to what they want, and this is the ethos I want to foster. We don’t want to see patients coming back into hospital, so working with the NACC, we are tackling the problem of why they are coming back into hospital, especially elderly people. And we are part of the PS1004 group, looking at the whole aspect of patient catering.
We are also looking at what we offer to patients. We need to ensure that we use natural sugars and natural salts more, working with the clinicians to ensure we achieve a true balance, meeting both the medical needs and patients’ needs. The benefits of the ‘Food Standards Plans’ across the 4 Nations are universal, so we’re asking all caterers to lead and drive the Plans to ensure this standard of service is accepted as an integral part of the patient’s recovery plan and staff and visitors’ wellbeing.
I am proud to lead the Association as National Chair, ensuring that the patients are at the core of all we do and that they are involved in their food service offer. But above all, our mission is to see that food is embedded in all healthcare establishments, with CEO and Directors of Nursing buy-in, as part of the recovery plan. Consequently the Plans are the beginning and not the end of the process, and we as caterers have to lead this.