Better Hospital Food Summits 2001 Presentations. Better Hospital Food Summits 2001 Simon Williams Assistant Director The Patients’ Association

Better Hospital Food

Summits 2001 Presentations


Summits 2001Simon Williams

Assistant DirectorThe Patients’ Association


Summits 2001Paul Cryer

Business ManagerFood Programme

The NHS Plan

The Plan exists because patients said they wanted a more modern

and responsive NHS.

They wanted the basic things to be right

The NHS Plan

Key Issues in the Plan

InvestmentModernisation ConsumerismPatient Surveys

Service Re-Design

The NHS PlanChapter 16

• To secure year-on-year improvements in patient satisfaction including standards of cleanliness and food as measured by independently audited surveys

• Also included in NHS Planning Guidelines for 2001/02

Better Hospital FoodThe NHS Plan

Chapter 4

NHS Menu 24 Hour Catering Service Housekeeper Programme Franchising

Better Hospital FoodImplementation Support Pack

Recipe Book The specimen NHS Menu Patients Comments and

Suggestions Form Some Best Practice ideas

Better Hospital FoodFixed Points

24 Hour Catering Service Main Meal Menu Design Acceptable Menu Standards Use of Snack Box Leading Chefs Dishes Nutritional Outcomes

24 Hour Catering Service

The Ward Kitchen Service The Snack Box The Light Bite

The NHS MenuAcceptable Menu Standards

Breakfast (Cereals & Toast Type) Light Lunch Two Course Dinner

Snacks Twice Per Day

Better Hospital FoodDesign of the NHS Menu

NHS Menu Group National Dish Selector National Specimen Menu Nutritional Standards & Analysis

NHS Patient Food GroupLoyd Grossman and Leading Chefs

43 Leading Chef Dishes

Better Hospital FoodLeading Chef Dishes

Pilot Sites

Oldham Bedford Dorset County Frimley Park Bradford Chesterfield

South Cleveland

Bassetlaw Stafford

General Northampton Charing Cross

Better Hospital FoodManufacturer Pilots

Alpha Catering Brake Bros. Delta Catering Anglia Crown Tillery Valley Foods Apetito The Royal London CPU South Tyneside Hospital CPU

Better Hospital FoodSupply Side Issues

NHS Estates working with The Purchase and Supply Authority on -

Snack Box Supply Raw Ingredient Specifications Snack Box content stock lines OJEC Advertisement + Interim

Delivered Meals Arrangements

Better Hospital FoodImplementation

The Ward Kitchen Service - by December 2001

The Snack Box - by December 2001 Light Bite - as soon as possible - but

would benefit from support of Housekeeper programme

The NHS Menu - by Dec 2001

Better Hospital FoodSupport Programme 2001/02

www.betterhospitalfood.com Further work with Leading Chefs to at

least double the number of dishes Review of menu ingredients

specifications Performance management guidelines Best Practice Reviews from

Demonstration Sites

Better Hospital FoodDemonstration Hospitals

Royal Devon & Exeter Leicester Royal Infirmary Birmingham Heartlands Royal Sussex County Newcastle Freeman Guys & St Thomas’s Luton & Dunstable Royal Preston Hospital


Best Practice reviews with a focus on the special needs of patients -

Community Mental health Learning disabilities Secure environments Paediatric Maternity


www.betterhospitalfood.com

Recipes and Method Statements Nutritional Analysis Raw Ingredient Specification Costing Module +500 Meal Presentation Photographs 2500 hits, 4000 recipes downloaded and +200

people registeredwww.betterhospitalfood.com (interactive from 3rd June)

Possible Performance Measures

24 Hour Access NHS Menu Staff/User

Complaints Waste Wards with

Housekeeper

Net Cost of Meal/Day

Nutritional Outcomes

Customer Care Programmes

Generic Working Staff Training

Better Hospital FoodFuture Considerations

Menu Content & Mix Food Production & Meals Procurement

Options Logistics Staff Training and Development Regeneration Meals Service Systems and Skill Sets Patient Feedback Systems

Better Hospital FoodNext Steps

Chief Executive letter Further guidance at

www.betterhospitalfood.com Trust Action Plans - to be completed by end

June Publish outcomes from Demonstration Sites NHS Estates working locally with Trusts to

promote and support Best Practice solutions

The NHS Plan

WARD HOUSEKEEPING

SERVICE

People First

Clinical care ever more specialised Length of stay continues to fall Increasing use of technology

…need to rediscover the patient

Patients’ Food GroupMembership

Neil Marsden Bill Lyons Stan Messenbird David Poole Douglas Dale Rose Vandepeer Sylvia Whitrod

Mohammed Riyami

Hilary Rowbottom Duncan Shepherd Maggie Bevan Roger Goss Jenny Henderson Ian Semmons

Involvement to Date

Meet monthly (since July 2000) NHS Menu content, design and structure Tasting sessions at hospitals and

Westminster College Housekeeper seminars Housekeeper practice visits Housekeeper Good Practice Guide

Blimey, the things they say...

Myth Patients don’t understand about

healthcare

Reality They understand about receiving

healthcare


Myth Patients can only give a personal

view

Reality The personal view is exactly what

we need


Myth They’ll just use it as an excuse to

moan

Reality Constructive complaints help us

examine our assumptions


Myth Patients are difficult and unruly

Reality Patients are only people


Myth We are all potential patients so we

can all give the patients’ view

Reality People inside the system see

things differently from those outside it

What Patients Say...

For two days the meals I ordered didn’t arrive

The showers and toilets have not been working for three days on Ward 15

It took that long to find the ward I could’ve died

Tea and coffee looked the same, far too strong. Had to smell it to tell the difference


Poor quality drinks and the water jugs were dirty

Liquid soap did not work and was not replaced after request

I was cold - the windows wouldn’t shut

The staff’s faces were so miserable that I feel no patient could ask for anything

Time for a Change

Messages from the consultation:

A service fit for the 21st Century Value the NHS Bring back Matron Patient centred services An environment of Care

NHS Plan Chapter 4 (4.17)

“…half of all hospitals will have new ‘ward housekeepers’ in place by 2004 to ensure that the quality, presentation and quantity of meals meets patients’ needs; that patients, particularly elderly people, are able to eat the meals on offer; and that the service patients receive is genuinely round the clock….”

Getting the Basics Right

patients feel warm, safe and cared for;

patients’ individual needs are met; hospital wards are clean; food is enjoyable (and enjoyed); equipment works.


Ward sisters/charge nurses will manage the ward environment

Ward housekeepers must be ward-based and part of the ward team

Ward housekeepers must be multi-skilled and flexible


Patients must be involved

There must be commitment from the top

A system of continuous quality improvement must be in place.

Appropriate training and development must be provided

Matron

Service Manager

Ward Ward Ward

Actions to Date

Steering Group Patient Group Regional Workshops Career Structure Good Practice Visits

Next Steps

Good Practice Guide to be published

Regional Workshops

Development of service in Mental Health

Work on career and development opportunities

Monitor progress against NHS Plan targets


I found the staff excellent - friendly, very kind and loving people to have around you

I was happy with my stay but only due to the helpfulness of staff

A hospital to be proud of. Apart from needing an operation I would gladly come again

Like a first class hotel with no bill at the end


The food was not “home cooking”, but it was attractively presented and no-one need go hungry

The staff were very, very good and could not have done more for everyone

I was greeted on arrival like an old friend

At 86 years old I was very proud to see such good work done


Strategies For Implementation

Hospital Caterers Association

Better Hospital FoodKey Issues

Designed by NHS catering managers, dieticians and nurses - The NHS Menu Group

Sets a national acceptable standard for catering services - on which to build for the future

Raises the profile for catering services - both in the Trust and with patients

Provides a Benchmark for year on year service improvements

Needs to accommodate the full range of patients - one size will not fit all - Specials Groups

Better Hospital Food“Must Do’s”

Implement the 24hr service Move the main meal to the evening Implement the Menu design Use the Snack Box Adopt and exceed acceptable content of

menus Implement leading chefs dishes Achieve nutritional outcomes

Better Hospital Food24 Hour Catering Service

Development programmePilot Sites FeedbackDevelop Local Operational Policies

Staffing Ordering systems Security Continuously review systems Respond to Feedback

Better Hospital FoodMoving The Main Meal

Considerations

Catering staffing Ward routines and activities Getting nurse support Applicability to certain patient groups

Better Hospital FoodMenu Design

A Menu for each patient Laminated easy to clean cover Provides a corporate identity for catering

services Sets out what patients can expect Meals ordering systems remain separate Trusts own menu slotted into the design Design layout can be downloaded from the

web site

Better Hospital FoodMenu Contents

Acceptable framework defined - many Trusts already exceed this and will not need to make great changes

If Trusts already exceed acceptable standard - then stick with it - do not change

The National Dish Selector - feedback required for further development

Need to monitor nutritional outcomes Integrate Leading Chef Dishes into daily Menu

choice

Leading ChefsDishes

43 Dishes developed by Leading Chefs in Loyd Grossman team

Worked with NHS chefs in development Recipes trialed and proved successful at 11

hospital sites Involvement of 6 commercial manufacturers Plan for Leading Chefs to rework further

traditional dishes on the dish selector over next six months

Better Hospital FoodStrategic Considerations for

Managers Develop your Implementation Plan Identify some key early wins Promote food services within your Trust at

Board Level through early implementation of the Better Hospital Food programme

Encourage and support the adoption of multidisciplinary teams with shared values and objectives

Seek out and implement Best Practice examples

Better Hospital FoodSummits 2001

A Dietetic Perspective

Better Hospital Food - what next?

Launched on Tuesday 8th May A vital toolbox for the dietetic

profession Raising the standard of food

provision Will increase the amount of

food eaten Reducing the incidence of

malnutrition

How will this assist dietitians?

Will save time and resources Catering for more individuals Fewer food ordering errors Standard recipes with photographs Nutritional composition known Standardisation of diet coding

Menu planning made easier Releases resource for other things

e.g. National Service Frameworks

Central resource on website

The national recipe database Possibilities for integrated nutrition care

information systems Focus for development of national

consensus on food services Focus for information sharing across the

service A public resource for sound recipes and

ideas Nutritionally analysed and “kite

marked” A reliable and reputable information

This is only the beginning!

Launch of the project is a watershed Implementation presents us all with

challenges Development opportunities ahead include:

Standardisation of tools for nutritional assessment of menus

Further work on standards for diet coding

Further work on specifications for national recipes

Further work with S&LT’s on texture modifications etc...

Better Hospital Food is not the whole story...

It is vital that Dietitians link in with the multi-disciplinary team

Food service is a team effort

Other initiatives e.g. Essence of Care vital for success

Success = food eaten

There are serious concerns about cost

The British don’t like to spend a lot of money on food!

Across the country there are wide variations in the amount allowed per day

The dietitians role in the team will be to present the nutritional arguments for investment

A key point is that malnutrition in hospital is not without cost In 1992 Kings Fund Estimate of cost was

£266M Food is cheap at £2.40per day (Tube feed

£10, TPN £80)

There is an urgent need for sound evaluation

Better Hospital Food requires better funding

This expenditure must be justified Main business case for investment must

ask questions: Is more food eaten? More food eaten = better nutrition? Better nutrition = less morbidity and

mortality? Less morbidity reduces hospital costs? Is the reduction in costs sufficient to

justify investment?

Recent work suggests that investment is justified

Hugh Tucker and Stanley Miguel (1996) Audit of 2500 patients in 20 US hospitals Substantial reduction in length of stay when

nutritional needs met One day for every two days earlier the intervention Saving for a typical large US hospital $1 million per

annum

Tucker HN, Miguel SG; Cost Containment Through Nutrition Intervention, April 1996, Nutrition Reviews, Vol. 54 No. 4, pp 111-121

Food service needs champions at a high level

Quality of food service often not defended in face of cost improvements

Quality of food service loses out to price in market testing

Doctors and nurses have low awareness and training on nutrition

May be an over emphasis on “Healthy Eating” Consequently food provision has a humble

profile in the perennial struggle for resources

Dietitians should make sure they are involved in planning

Trusts need a representative project team Caterers, dietitians, nurses, patient

representatives, doctors The team needs a clear line of

reporting to Trust Board Be very clear about the “must do’s” Analyse the gap between now and

where you need to be Costed project proposal for the Board

Making implementation stick

On page 111 the NHS Plan says that by 2004 there will be:

“a hospital nutrition policy to improve the outcome of care for patients. This will also reduce dependency on intravenous feed regimes.”

Making implementation stick (2)

Nutritional care should be fully covered by the Trusts Clinical Governance

This must include the fundamental and key contribution made by food services

Performance assessment and audit structures need to be in place Nutritional Care Committees

akin to Drugs and Therapeutics Committees

Training and development

A key aspect of implementation will be training and development of staff

Important to involve Staff Development Units

Tap into all available resources Learning accounts / return to

learning schemes Funded NVQ schemes Resources from local Workforce

Confederations Input to contracted teaching and

training resources

Don’t forget to have fun!!!

The hospitality element of food service is a key determinant of patient satisfaction

Good food is enjoyable and fun!!!

Better Hospital FoodEarly & Effective Implementation

Workshop

David FogginDisruption Ltd

Better Hospital Food Summits 2001

Q&A


Workshop

David FogginDisruption Ltd


Workshop

24 Hour Snack Box

Ward Kitchen / Light Bite

Menu Design

Housekeeping Interface

Leading Chefs’ Dishes

Nutritional Standards

National Dish List

Web-based menu management system

Meal timings

Patient groups with Special needs

Barriers

1. Why not?

2. What’s stopping you?

3. Is this the true barrier?

Solutions

1. What do you need?

2. How can you get it started?

3. Is it realistic?

www.betterhospitalfood.com/hospitals_only/food_summit

Better Hospital FoodSummits 2001


Summits 2001


Summits 2001

THANKS FOR ATTENDING

Documents

Better Hospital Food Summits 2001 Presentations. Better Hospital Food Summits 2001 Simon Williams Assistant Director The Patients’ Association