Campaigning for Better Hospital Food

The Campaign For Better Hospital Food looks at the need for high standards in hospital food so that more meals are freshly cooked with care, tasty to eat and made using nutritious ingredients. Katherine Button provides an update on the campaign and the national push for higher standards.

The Campaign for Better Hospital Food is a Ronseal campaign; it does exactly what it says on the tin. We push for higher hospital food standards for patients, visitors and staff. We work with hospitals to share best practice wherever we find it and we campaign to affect transformational change within Trusts that are taking backwards steps on food.

The Campaign for better Hospital Food is part of Sustain; the alliance for better food and farming. The Sustain alliance has campaigned since 2002 for improvements to public sector food standards. Hospital food accounts for around one third of national public sector food spend and the aim has always been to achieve healthy, high quality and sustainably produced food served in hospitals.

It’s been a great few years for the campaign and we’ve seen real success and progress. After the head of NHS England Simon Steven’s statement last year that hospitals should be ‘health promoting environments’ we redoubled our efforts to campaign to improve the food offer for hospital staff, many of which currently rely on vending machines or ordering takeaways to the wards. We developed ten recommendations to improve hospital food, liaising with the Soil Association and several trail-blazing hospital Trusts, and presented them to Simon.

One of the key recommendations was that hospitals should ensure that there is provision of healthy food for staff on shifts, 24 hours a day to support staff health and well-being. We recommended that commercial food providers should be tackled head on to better promote healthier options and that Trusts should be empowered to negotiate with retail outlets and catering providers. We asked for better data to be available on the timeline for contract renewal to provide a means of targeting interventions and phasing in change. NHS England sets national targets for hospitals that are called Commissioning for Quality and innovation (CQUIN), and in addition we recommended that these CQUINs should be used to incentivise better food quality and leadership around hospital food.

Campaign Success
We are very happy to report that on the 5 March this year NHS England announced that a new CQUIN on ‘NHS staff health and well‑being’ would be one of five national CQUIN targets that apply to all hospital Trusts.

The new national CQUINs became operational in April 2016 and all hospitals will now have to report to NHS England on their progress towards meeting these targets, which we anticipate will run for two years. This is the first time that food has been included in this core set of NHS England aims and measured centrally, which is fantastic news for hospital patients, visitors and staff. Putting the focus on food in this way is a reassuring marker on the journey towards better NHS food. It is also a great moment for the Campaign too as we saw many of our recommendations come to fruition.

Food targets as a national CQUIN
The CQUIN means that a percentage of a hospitals budget will be dependent on achieving certain food standards for staff, visitors and patients. The standards fall into two indicators. Firstly, the provision of healthy food on hospital premises, including: the banning of price promotions on sugary drinks and foods high in fat, sugar and salt (HFSS); the banning of advertisement on NHS premises of sugary drinks and foods high in fat, sugar and salt (HFSS); the banning of sugary drinks and foods high in fat, sugar and salt (HFSS) from checkouts; and ensuring that healthy options are available at any point including for those staff working night shifts.

The second indicator is better data. Providers will be expected to submit national data collection returns by July based on existing contracts with food and drink suppliers. This will cover any contracts covering restaurants, cafés, shops, food trolleys and vending machines or any other outlet that serves food and drink.

The data collected will include the following; the name of the franchise holder, food supplier, type of outlet, start and end dates of existing contracts, remaining length of time on existing contract, value of contract and any other relevant contract clauses. It should also include any available data on sales volumes of sugar sweetened beverages (SSBs).

The NHS staff health and well-being CQUIN is relevant for four types of provider: acute trusts; community trusts; ambulance trusts; and mental health trusts.

CQUIN funds will be paid on deliver of these outcomes. In many cases providers will be able to achieve these objectives by renegotiating or adjusting existing contracts. This is of course fantastic progress and we are eager to see the results. However, although these are financial incentives that will be watched closely by NHS England, there is no legal requirement for these targets to be met. This means that hospitals that fail to meet the standards will not receive a fraction of a percentage point of their overall budget – a big incentive – but for high standards to be guaranteed we must make that extra step and make them a requirement.

We’ve come so far
The first big campaign win came in August 2014 when the Campaign for Better Hospital Food was instrumental in pushing the government into setting minimum hospital food standards in England for the first time.

These rules, written into the NHS Standard Contract, require hospitals to have a Food and Drink Strategy and to follow guidance on food and nutrition spread across five documents. This move came as a result of the Hospital Food Standards Panel report, led by Dianne Jeffrey, Chair of Age UK and involving industry and the third sector, including Sustain and the Soil Association’s Food for Life.

Unlike the CQUINS these Standard Contract requirements are not monitored centrally by NHS England but we do know that not all hospital trusts in England are yet in compliance with these rules. Performance is predominately self-reported using PLACE assessments and due to the nature of the standards, as recommendations rather than requirements, there is sometimes confusion about what compliance looks like and what best practice might be.

So, despite the great progress in getting food standards in the NHS Standard Contract, the standards that apply to hospital food remain weak, hard for hospitals to follow and difficult for regulatory bodies, such as the Care Quality Commission (CQC) and local Clinical Commissioning Groups (CCGs), to monitor. This is why we continue to campaign for an independent body to regulate and monitor the quality of hospital food.

In some areas the rules themselves require further work. One of the worst examples is a get-out clause in the Government Buying Standards for caterers and commissioners whereby a trust can ‘depart’ from UK legislative standards for animal welfare and food production, if this ‘leads to a significant increase in costs which cannot reasonably be compensated for by savings elsewhere’. The food standards therefore are flawed, and we continue to campaign for improvements, but taken in tandem with the new national CQUIN targets on food there is hope that this is the start of a good foundation on which to build a better food future for our health service.

Why Hospital Food is so Important
Good diet and nutrition are key to building health and resilience in patients, but also visitors and staff – this means the NHS is well placed to lead by example. However, at the moment our most recent evidence suggests that 67 per cent of hospital staff would be unhappy to eat the food they serve to patients and six out of 10 patients rely on family to bring them food because they don’t want to eat what they’re served in hospitals.

Unhealthy diets resulting in obesity and diabetes are also a growing problem with 64 per cent of adults either overweight or obese and 50 per cent of the NHS’ 1.4 million employees overweight or obese. Treating obesity and the associated health problems costs the NHS around £6 billion every year – or five per cent of the entire NHS budget. Estimates from Public Health England put the cost to the NHS of staff absence due to poor health at further £2.4 billion a year – accounting for around £1 in every £40 of the total budget. This figure is before the cost of agency staff to fill in gaps, as well as the cost of treatment, is taken into account. Hospital food has a direct impact on our health and there is a clear incentive to drive up standards.

Our Focus for the Future
Alongside with campaigning for tougher measures and monitoring, we are developing a methodology for measuring and reporting the quality of hospital food. We are also working with partners to hold a pilot workshop to share knowledge and best practice among hospital trusts on how to work with caterers, suppliers, on-site retailers and vending machine providers to improve food standards.

Patients prefer meals that are freshly cooked in an on-site hospital kitchen so we continue to campaign for food preparation to be brought back into hospitals, or regional hubs, building nutritional health, saving money and sourcing food locally to support nearby farmers and growers.

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