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Foreword from our Chief Nurse
Why do we need a Food and Drink Strategy?
Meeting the 10 key characteristics of good nutritional care
Meeting the Nutrition and Hydration Digest (British Dietetic Association 2012) recommendations
Malnutrition Universal Screening Tool ‘MUST’
What structures do we have in place to support the provision of good nutritional care?
Nutrition Steering Committee
Hospital Food Group (sub-committee of Nutrition Steering Committee)
PLACE
Patient Experience and Carer Strategy (2016/19)
Patient nutrition and hydration
Healthier eating for patients, staff and visitors
Patient catering
Staff and visitor catering
Sustainable procurement of food and catering services
Government buying standards
Conclusion
Monitoring of this strategy
Authors
Appendices
Implementation plan for year 1
1. Patient nutrition and hydration
2. Healthier eating for patients, staff and Visitors
3. Sustainable procurement of food and catering services
Page
3
Welcome to our first Food and Drink Strategy, which
outlines our ambitions over the next three years to
provide high quality and nutritious food to our patients,
staff and visitors.
Malnutrition and dehydration are a significant risk to ill or
vulnerable people, especially to older people and both
contribute to significant harm. They are associated with
increased mortality rates and hospital admissions and the
development of various comorbidities such as impaired
cognitive function, falls, poor control of diabetes, poor
wound healing and hypothermia. Malnourished patients
in hospitals stay longer and are more likely to develop
complications or infections. Sir Robert Francis QC in his
final report of the Mid Staffordshire Foundation Trust
Public Inquiry detailed some shocking examples of poor
nutritional care and recommended that the
“arrangements and best practice for providing food and
drink to elderly patients require constant review,
monitoring and implementation”.
Every hospital has a responsibility to provide the highest
level of care possible for their patients and this, without
question, includes the quality and nutritional value of the
food that is served and eaten (Hospital Foods Standards
Panel Report 2014). Each Trust will be assessed against
the recommendations and standards within the Hospital
Food Standards Panel Report. The Chief Nurse for
England in the CNO Bulletin February 2015 stated that
‘the provision of good quality, nutritious food is an
essential part of patient care …… all NHS hospitals
must have a food and drink strategy’.
This strategy has been developed to provide staff and
regulators with a clear focus of what we want to achieve.
This strategy supports the Trust vision to deliver the very
best care for every patient, every day.
The Strategy will focus on three key areas:
1. Patient nutrition and hydration
2. Healthier eating for patients, staff and Visitors
3. Sustainable procurement of food and catering
services
This document captures those things as well as setting
out our future priorities. Delivery of these priorities also
requires a broad crosscutting approach and this strategy
should be read in conjunction with the Patient Experience
and Carer’s Strategy.
Foreword from our Chief Nurse
Tracey CarterChief Nurse, Director of Infection Prevention and Control
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Why do we need a Food and Drink Strategy?
As part of the response to the Francis report and other
key documents, the Department of Health recently
published The Hospital Food Standards Panel’s report
on standards for food and drink in NHS hospitals
(Department of Health August 2014). This report aims to
improve food and drink across the NHS so that everyone
who eats there has a healthier food experience and that
everyone involved in its production is properly valued.
The Trust will be assessed against these standards to
provide evidence for Care Quality Commission, PLACE
Assessment, Monitor and NHS England inspections.
The Hospital Food Standards Panel report
recommendations have also been written into the NHS
Contract 2016/17 (Service Condition (SC) 19.1 and
19.2). The report identified five food standards required
of hospitals, which are captured within our strategy.
The Nutrition Steering Committee has developed our
“Food and Drink Strategy” for the Trust. Membership of
this committee includes representation from nursing,
dietetics, speech and language therapy, pharmacy and
medicine.
The Hospital Foods Standards Panel recommends that all
NHS Hospitals develop and maintain a Food and Drinks
Strategy that should include:
• The nutrition and hydration needs of patients.
• Healthier eating for the whole community,
including staff.
• Sustainable procurement of food and catering services.
Hospitals are also required to meet the standards set by
the following:
• 10 key characteristics of good nutritional care.
• Nutrition and Hydration Digest
(British Dietetic Association).
• ‘MUST’ Malnutrition Universal Screening Tool (BAPEN).
• Healthier and more sustainable catering –
Nutrition Principles – Public Health England.
• Government Buying Standards for Food and Catering
Services (Department of Environment, Food and
Rural Affairs).
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Meeting the 10 key characteristics of good nutritional care
The 10 Key Characteristics of Good Nutritional Care were
developed in 2003 in response to the 100
recommendations made in The Council of Europe
Resolution (12/11/2003) Food and Nutritional Care in
Hospitals. A group of organisations distilled the
recommendation into 10 broad recommendations. The
stakeholder organisations (Government and Non-
Meeting the Nutrition and Hydration Digest (British Dietetic Association 2012) recommendations
The BDA Digest is a detailed toolkit that includes
provision of food and drink to hospital patients. Using the
Digest will help hospitals to deliver meals of appropriate
nutritional content, tailored to individual needs.
Malnutrition Universal Screening Tool ‘MUST’
The Trust has been using ‘MUST’ since 2012 as a way of
screening patients for malnutrition on admission to the
hospital and to identify those patients whose nutritional
status declines during their hospital stay. This is a
validated screening tool and is recommended for use in
the Hospital Food Standards Panel Report as well as the
NICE Nutrition Support Guideline (2006) and the NICE
What structures do we have in place to support the provision of good nutritional care?
Nutrition and hydration care is reported to the Board
through the Trust governance structure.
Government Organisations) included The Hospital
Caterers Association, The Royal College of Nursing, The
Department of Health, BAPEN, British Dietetic Association
and the National Patients Safety Agency.
With this Food and Drink Strategy, we will meet all the
key recommendations.
The Medirest contract specification includes compliance
with the Nutrition and Hydration Digest.
Quality Standards (2013). Our compliance is assessed
monthly as part of the Evaluations of Test Your care
results.
Nursing staff are provided with face-to-face training on
the ‘MUST’ and all newly qualified nursing starters receive
‘MUST’ training as part of their induction programme.
Nutrition Steering Committee
The Nutrition Steering Committee (NSC) is a
multiprofessional group that ensures that patients of
WHHT receive the best and most appropriate nutritional
care in line with NICE and other national guidelines.
It ensures that adequate training for staff is in place and
appropriate governance measures are in place. The NSC’s
main focus is to ensure that good nutritional practices are
embedded and sustained across the entire organisation,
and provides the appropriate assurance that the Trust is
compliant with the Care Quality Commission (CQC)
Fundamentals for nutrition and hydration and to ensure
compliance with NICE Guidance for nutrition support.
In addition to the Nutrition Steering Committee, there is
a Nutrition and Dietetics Department, a Nutrition Team
(including a Consultant Gastroenterologist, nutrition
nurse specialists, dietitian and pharmacist), all working in
collaboration with the Catering Department to meet the
nutrition and hydration needs of the patients in a safe,
effective and timely manner.
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Hospital Food Group (sub-committee of Nutrition Steering Committee)
The purpose of the Hospital Food Group is to ensure
delivery of good, patient centred, safe and effective
nutrition and hydration, as well as ensuring equality,
improved outcomes and a better patient experience.
We work together to provide a hospital menu that meets
national standards and provides a variety of meals for all
PLACE
PLACE (Patient Led Assessment of the Care Environment)
was introduced in 2013. It is embedded in the
assessment culture at WHHT. The planned annual
assessment is routinely completed, testing the quality of
food, and assessing the quality of the organisation’s
strategic provision of the patient’s food and hydration.
A further two internal assessments are completed per
year. The annual results are shared publicly and help drive
improvements in the nutritional care provided to our
patients. The results show how we are performing
nationally and locally.
different types of dietary requirements. We also work to
find solutions to issues that may arise around catering,
food delivery / service and patient satisfaction. There is
representation from catering and adult and paediatric
dietetics as well as wards / departments.
Patient Experience and Carer Strategy (2016/19)
This strategy with its focus on patient experience and
carers, sets out how our staff will deliver the excellent
experience for patients that is essential to achieving our
vision to deliver the very best care for every patient every
day. Our values underpin everything we do and we
expect our staff to work to these values in the delivery of
safe, consistent and high quality patient care.
This strategy also recognises that our staff are our biggest
asset and that in order to deliver a good patient
experience, we also have to ensure a positive staff
experience. There are cross cutting themes between the
Patient Experience and Carer Strategy, the Workforce
strategy and the Food and Drink Strategy that apply to
staff as well as patients, volunteers and carers.
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Patient nutrition and hydration
MUST screening is in place to ensure early identification
of patients at risk of malnutrition and timely referral to
the Dietetic service. MUST training is delivered on all the
wards by ward Dietitians and MUST training is included in
the Band 5 induction programme. The Test Your Care
results capture compliance with MUST screening at
individual ward level.
Nursing documentation has been updated to include
MUST in the risk assessment booklet (figure 1) and the
food charts have been updated to allow for a more
accurate assessment of food intake.
Oral Nutritional Supplements are written up on the Drug
chart to ensure that they are received in a timely manner.
A Standard Operating Procedure is in place for protected
Mealtime. Enteral and parenteral policies are in place.
Skin champions have been recruited for each ward area
to facilitate training and development in the follow areas:
• pressure ulcers
• nutrition
• continence.
A new Hydration Risk Assessment Tool has been
introduced which enables staff to implement the most
appropriate method of fluid monitoring and
management for their patients based on clinical need.
To support this we have updated the Fluid Balance chart
(figure 2) and introduced a Hydration chart (figure 3).
Priorities for the strategy:
1. Pilot ‘Nutritional Care Tool’ - This is a web based audit
tool similar to a safety thermometer which can
provide data on nutrition screening, the effectiveness
of nutritional care and patient experience. Currently
our Test Your Care data only looks at process
measures. This tool will enable us to look at outcome
measures as well as patient experience.
2. To recruit and train volunteers to become dining
companions. Patient Experience and Carer Strategy
(2016/19) – making the best use of our volunteers
(priority 4).
3. The skin champions have been recruited and our
priority now is to embed this role at ward level.
4. To improve compliance with MUST screening. Patient
Experience and Carer Strategy (2016/19) – getting the
basics right (priority 2).
5. To audit beverage provision across all ward areas.
Figure 1:
Malnutrition
Universal
Screening Tool
(MUST)
Figure 2: 24 hour fluid balance chart (adult)
Figure 3:
Hydration chart
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Healthier eating for patients, staff and visitors
Patient catering
Nutrition specification is included within the cateringcontract to ensure every patient’s nutritional needs aremet. Catering contract specifications are currently underreview. The Catering contract is monitored bi-monthly bythe dietetics team.
There is an extensive a la carte cook chill menu available.There is a provision for special diets e.g allergy, modifiedconsistency etc, and a range of meals are available thatcater for religious and cultural needs. Snacks are availablein between meals; snack boxes are available for patientswho have missed a meal or require a meal outside normalmeal times. For patients who may be going home where
Staff and visitor catering
The 2016/17 CQUIN is split in to two parts:
Part A: Providers will be expected to achieve a step-change in thehealth of the food offered on their premises in 2016/17including:• The banning of price promotions on sugary drinks and foods high in fat, sugar and salt (HFSS). The majority of HFSS fall within the five product categories: pre-sugared breakfast cereals, soft drinks, confectionery, savoury snacks and fast food outlets.• 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.• Ensuring that healthy options are available at any point including for those staff working night shifts.
Part B: Providers will also be expected to submit national datacollection returns by July based on existing contracts withfood and drink suppliers. This will cover any contractscovering restaurants, cafés, shops, food trolleys andvending machines or any other outlet that serves foodand drink.
The data collected will include the following; the name ofthe franchise holder, food supplier, type of outlet, startand end dates of existing contracts, remaining length oftime on existing contract, value of contract and any other
there is no food available a discharge pack can beprovided. A children’s menu is available on the paediatricward.
A finger food menu is available on Bluebell ward(Dementia Care Ward) and there is a provision of smallermeals within the a la carte menu choice.
Where required, patient’s meals can be fortified at wardlevel by using additional butter, cream or cheese. Forpatients with higher energy requirements Dietitians canorder additional meals or snacks.
relevant contract clauses. It should also include anyavailable data on sales volumes of sugar sweetenedbeverages (SSBs).
The Trust is currently working with our providers toachieve these objectives by working with the Estates andFacilities Department, Head of Facilities, Business andContracts Manager and dietitians. An action plan onachieving this has been developed.
The 2017/19 CQUIN recommendations:Firstly, maintaining the four changes that were requiredin the 2016/17 CQUIN in both 2017/18 and 2018/19.Secondly, introducing three new changes to food anddrink provision.
In year one (2017/18):a) 70% of drinks lines stocked must be sugar free (less than 5 grams of sugar per 100ml). In addition to the usual definition of SSBs it also includes energy drinks, fruit juices (with added sugar content of over 5g) and milk based drinks (with sugar content of over 10grams per 100ml). b) 60% of confectionery and sweets do not exceed 250 kcal. c) At least 60% of pre-packed sandwiches and other savoury pre-packed meals (wraps, salads, pasta salads) available contain 400kcal (1680 kJ) or less per serving and do not exceed 5.0g saturated fat per 100g.
Health and Wellbeing CQUIN – Healthy food for NHS staff, patients and visitors.
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Sustainable procurement of food and catering services
Government buying standards
The Government Buying Standards were devised by the
Department for Environment, Food and Rural Affairs
(Defra). The standards encourage and enable hospital
caterers to buy sustainable products. There are three key
criteria within these standards:
• Foods produced to higher sustainability standards –
where is food produced to higher environmental
standards such as fish from sustainable sources,
seasonal fresh food, animal welfare and ethical
trading considerations.
Conclusion
The Food and Drink Strategy 2016/19 has identified areas
where improvements can and should be made to meet all
the Hospital Food Standards Panel report and the NHS
Contract 2016/17.
Monitoring of this strategy
Implementation plan will be monitored by Therapy Lead
(Dietetics) and reported to Nutrition Steering Committee.
Authors
Tracy Carter, Chief Nurse and Director of Infection and Prevention Control
Smita Ganatra, Therapy Lead for Dietetics and OPD Physiotherapy
Jill Wallis, CNS Nutrition
Carl Hodgkiss, Head of Facilities
• Foods procured and served to higher nutritional
standards – to reduce salt, saturated fat and sugar and
increase consumption of fibre, fruit and vegetables.
• Procurement of catering operations to higher
sustainability standards – including equipment, waste
and energy management.
Medirest are currently meeting all manadory and best
practice standards.
In year two (2018/19)The same three areas will be kept but a further shift inpercentages will be required:a) 80% of drinks lines stocked must be sugar free (less than 5 grams of sugar per 100ml). In addition to the usual definition of SSBs it also includes energy drinks, fruit juices (with added sugar content of over 5g) and milk based drinks (with sugar content of over 10grams per 100ml). b) 80% of confectionery and sweets do not exceed 250 kcal. c) At least 75% of pre-packed sandwiches and other savoury pre-packed meals (wraps, salads, pasta salads)
available contain 400kcal (1680 kJ) or less per serving and do not exceed 5.0g saturated fat per 100g.
Trust plans to achieve a step-change in the health of thefood offered on their premises.
Priorities for the strategy:1. To reinstate the Hospital Food Group.2. To meet the Health and Wellbeing CQUIN - 1b Healthy food for NHS staff, visitors and patients annually3. PLACE results are shared with Therapy Lead for Dietetics.4. Medirest patient surveys to be shared with the Therapy Lead (Dietetics).
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1. Patient nutrition and hydration
Priority Planned actions for 2016/17 By whom
Pilot ‘NutritionalCare Tool’
Identify ward areas suitable for the pilot
Pilot the tool
Share the results at the Nutrition Steering Committee (NSC)
CNS Nutrition
To recruit andtrain volunteersto become diningcompanions
To link in with volunteer recruitment campaign
Training programme for the volunteers developed
Training delivered
Dining companions available at ward level
CNS Nutrition
To embed skinchampion’s role
Deliver 2 study days a year to update and educate SKIN Champions
Support the SKIN Champions by protecting their7 ½ hours a monthcontracted time
CNS Nutrition
CNS Tissue Viability
CNS Continence
To improvecompliance withMUST screening
Provide ongoing training
Training logs to be shared with matrons in individual areas
Ongoing monitoring through “Test your Care” results
CNS Nutrition
Therapy Lead (Dietetics)
To audit beverageprovision
To complete the beverage audit
Share the results at NSC
Action plan
Therapy Lead (Dietetics)
AppendicesImplementation Plan for Year 1.
Implementation plan
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2. Healthier eating for patients, staff and visitors
Priority Planned actions for 2016/17 By whom
To re-instateHospital FoodGroup
To have Hospital Food Group meetings 6 times per year
Update terms of reference for the group
Therapy Lead (Dietetics)
To meet Healthand WellbeingCQUIN - 1b
Collection and validation of data required by the CQUIN
Meeting with on site food vendors to discuss and put together a planof action
Ensure that on site food vendors provide healthier food and beverages24 hours a day.Facilities and dietitians to work with caterers to reformulate recipes toprovide meals which are lower in fat, salt and energy and which do notcontain artificial trans-fat
Advertising – on site vendors will cease advertising and promotion ofthe consumption of sugary drinks and foods high in fat, sugar and salt.
Vendors will supply guideline daily amounts on menus per portion as aminimum
The Trust will ensure that water is visible and freely available
On-going management and monitoring of the CQUIN
Business Manager
Facilities Manager
To share PLACEresults
To be supplied by Facilities manager and shared with NSC Business Manager
Facilities Manager
To share Medirestpatient surveyresults
To be supplied by Medirest and shared with NSC Medirest
3. Sustainable procurement of food and catering services
Priority Planned actions for 2016/17 By whom
Ensuresustainableprocurement offood and cateringservice is includedin any futurecontractspecification.
Review new contract specification Therapy Lead (Dietetics)
Business Manager
Medirest to report compliance as part of contract monitoring Business Manager
Facilities Manager