Better Hospital Food Summits 2001 Presentations

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Better Hospital Food Summits 2001 Presentations
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Better Hospital Food Summits 2001

• Simon Williams
• Assistant Director
• The Patients Association

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Better Hospital Food Summits 2001

• Paul Cryer
• Business Manager
• Food Programme

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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

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The NHS Plan

• Key Issues in the Plan
• Investment
• Modernisation
• Consumerism
• Patient Surveys
• Service Re-Design

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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

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Better Hospital FoodThe NHS PlanChapter 4

• NHS Menu
• 24 Hour Catering Service
• Housekeeper Programme
• Franchising

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Better Hospital FoodImplementation Support Pack

• Recipe Book
• The specimen NHS Menu
• Patients Comments and Suggestions Form
• Some Best Practice ideas

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Better Hospital FoodFixed Points

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

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24 Hour Catering Service

• The Ward Kitchen Service
• The Snack Box
• The Light Bite

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The NHS MenuAcceptable Menu Standards

• Breakfast (Cereals Toast Type)
• Light Lunch
• Two Course Dinner
• Snacks Twice Per Day

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Better Hospital FoodDesign of the NHS Menu

• NHS Menu Group
• National Dish Selector
• National Specimen Menu
• Nutritional Standards Analysis
• NHS Patient Food Group
• Loyd Grossman and Leading Chefs
• 43 Leading Chef Dishes

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Better Hospital FoodLeading Chef DishesPilot
Sites

• Oldham
• Bedford
• Dorset County
• Frimley Park
• Bradford
• Chesterfield

• South Cleveland
• Bassetlaw
• Stafford General
• Northampton
• Charing Cross

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Better Hospital FoodManufacturer Pilots

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

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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

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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

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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

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Better Hospital FoodDemonstration Hospitals

• Royal Devon Exeter
• Leicester Royal Infirmary
• Birmingham Heartlands
• Royal Sussex County
• Newcastle Freeman
• Guys St Thomass
• Luton Dunstable
• Royal Preston Hospital

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Better Hospital FoodSupport Programme 2001/02

• Best Practice reviews with a focus on the special
  needs of patients -
• Community
• Mental health
• Learning disabilities
• Secure environments
• Paediatric
• Maternity

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Better Hospital FoodSupport Programme
2001/02www.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 registered
• www.betterhospitalfood.com
• (interactive from 3rd June)

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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

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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

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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

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The NHS Plan WARD HOUSEKEEPINGSERVICE
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People First

• Clinical care ever more specialised
• Length of stay continues to fall
• Increasing use of technology
• need to rediscover the patient

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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

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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

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Blimey, the things they say...

• Myth
• Patients dont understand about healthcare
• Reality
• They understand about receiving healthcare

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Blimey, the things they say...

• Myth
• Patients can only give a personal view
• Reality
• The personal view is exactly what we need

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Blimey, the things they say...

• Myth
• Theyll just use it as an excuse to moan
• Reality
• Constructive complaints help us examine our
  assumptions

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Blimey, the things they say...

• Myth
• Patients are difficult and unruly
• Reality
• Patients are only people

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Blimey, the things they say...

• 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

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What Patients Say...

• For two days the meals I ordered didnt arrive
• The showers and toilets have not been working for
  three days on Ward 15
• It took that long to find the ward I couldve
  died
• Tea and coffee looked the same, far too strong.
  Had to smell it to tell the difference

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What Patients Say...

• 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 wouldnt shut
• The staffs faces were so miserable that I feel
  no patient could ask for anything

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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

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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.

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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.

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Getting the Basics Right

• 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

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Getting the Basics Right

• 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

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Matron
Ward
Ward
Ward
Service Manager
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Actions to Date

• Steering Group
• Patient Group
• Regional Workshops
• Career Structure
• Good Practice Visits

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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

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What Patients Say...

• 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

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What Patients Say...

• 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

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Better Hospital Food Strategies For
Implementation Hospital Caterers Association
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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

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Better Hospital FoodMust Dos

• 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

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Better Hospital Food24 Hour Catering Service

• Development programme
• Pilot Sites Feedback
• Develop Local Operational Policies
• Staffing
• Ordering systems
• Security
• Continuously review systems
• Respond to Feedback

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Better Hospital FoodMoving The Main Meal

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

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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

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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

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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

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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

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Better Hospital FoodSummits 2001

• A Dietetic Perspective

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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

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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

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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

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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 SLTs on texture modifications
  etc...

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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

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There are serious concerns about cost

• The British dont 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)

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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?

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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
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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

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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 dos
• Analyse the gap between now and where you need to
  be
• Costed project proposal for the Board

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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.

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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

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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

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Dont forget to have fun!!!

• The hospitality element of food service is a key
  determinant of patient satisfaction
• Good food is enjoyable and fun!!!

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Better Hospital FoodEarly Effective
Implementation Workshop

• David Foggin
• Disruption Ltd

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Better Hospital Food Summits 2001

• QA

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Better Hospital FoodEarly Effective
Implementation Workshop

• David Foggin
• Disruption Ltd

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Better Hospital FoodEarly Effective
Implementation 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

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Barriers

• 1. Why not?
• 2. Whats stopping you?
• 3. Is this the true barrier?

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Solutions

• 1. What do you need?
• 2. How can you get it started?
• 3. Is it realistic?

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Better Hospital FoodSummits 2001

• www.betterhospitalfood.com/hospitals_only/food_sum
  mit

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Better Hospital Food Summits 2001
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Better Hospital Food Summits 2001

• THANKS FOR ATTENDING