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Better Hospital Food Summits 2001 Presentations. Better Hospital Food Summits 2001. Simon Williams Assistant Director The Patients’ Association. Better Hospital Food Summits 2001. Paul Cryer Business Manager Food Programme. The NHS Plan.

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Better hospital food summits 2001 presentations

Better Hospital Food Summits 2001 Presentations


Better hospital food summits 2001

Better Hospital Food Summits 2001

Simon Williams

Assistant Director

The Patients’ Association


Better hospital food summits 20011

Better Hospital Food Summits 2001

Paul Cryer

Business Manager

Food Programme


The nhs plan
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 plan1
The NHS Plan

Key Issues in the Plan

  • Investment

  • Modernisation

  • Consumerism

  • Patient Surveys

    Service Re-Design


The nhs plan chapter 16
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 food the nhs plan chapter 4
Better Hospital FoodThe NHS PlanChapter 4

  • NHS Menu

  • 24 Hour Catering Service

  • Housekeeper Programme

  • Franchising


Better hospital food implementation support pack
Better Hospital FoodImplementation Support Pack

  • Recipe Book

  • The specimen NHS Menu

  • Patients Comments and Suggestions Form

  • Some Best Practice ideas


Better hospital food fixed points
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
24 Hour Catering Service

  • The Ward Kitchen Service

  • The Snack Box

  • The Light Bite


The nhs menu acceptable menu standards
The NHS MenuAcceptable Menu Standards

  • Breakfast (Cereals & Toast Type)

  • Light Lunch

  • Two Course Dinner

  • Snacks Twice Per Day


Better hospital food design of the nhs menu
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


Better hospital food leading chef dishes pilot sites

Oldham

Bedford

Dorset County

Frimley Park

Bradford

Chesterfield

South Cleveland

Bassetlaw

Stafford General

Northampton

Charing Cross

Better Hospital FoodLeading Chef DishesPilot Sites


Better hospital food manufacturer pilots
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 food supply side issues
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 food implementation
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 food support programme 2001 02
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 food demonstration hospitals
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


Better hospital food support programme 2001 021
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


Better hospital food support programme 2001 02 www betterhospitalfood com
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)


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

Possible Performance Measures


Better hospital food future considerations
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 food next steps
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

The NHS PlanWARD HOUSEKEEPINGSERVICE


People first
People First

  • Clinical care ever more specialised

  • Length of stay continues to fall

  • Increasing use of technology

    …need to rediscover the patient


Patients food group membership

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

Patients’ Food GroupMembership


Involvement to date
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
Blimey, the things they say...

Myth

  • Patients don’t understand about healthcare

    Reality

  • They understand about receiving healthcare


Blimey the things they say1
Blimey, the things they say...

Myth

  • Patients can only give a personal view

    Reality

  • The personal view is exactly what we need


Blimey the things they say2
Blimey, the things they say...

Myth

  • They’ll just use it as an excuse to moan

    Reality

  • Constructive complaints help us examine our assumptions


Blimey the things they say3
Blimey, the things they say...

Myth

  • Patients are difficult and unruly

    Reality

  • Patients are only people


Blimey the things they say4
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


What patients say
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


What patients say1
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 wouldn’t shut

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


Time for a change
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
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
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.


Getting the basics right1
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


Getting the basics right2
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


Better hospital food summits 2001 presentations

Matron

Ward

Ward

Ward

Service Manager


Actions to date
Actions to Date

  • Steering Group

  • Patient Group

  • Regional Workshops

  • Career Structure

  • Good Practice Visits


Next steps
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


What patients say2
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


What patients say3
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


Better hospital food strategies for implementation hospital caterers association
Better Hospital FoodStrategies For ImplementationHospital Caterers Association


Better hospital food key issues
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
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 food 24 hour catering service
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


Better hospital food moving the main meal
Better Hospital FoodMoving The Main Meal

Considerations

  • Catering staffing

  • Ward routines and activities

  • Getting nurse support

  • Applicability to certain patient groups


Better hospital food menu design
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 food menu contents
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 chefs dishes
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 food strategic considerations for managers
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 food summits 20012
Better Hospital FoodSummits 2001

A Dietetic Perspective


Better hospital food what next
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
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
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
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
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
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
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
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
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
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
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
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
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
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 food early effective implementation workshop

Better Hospital FoodEarly & Effective Implementation Workshop

David Foggin

Disruption Ltd


Better hospital food summits 20013
Better Hospital Food Summits 2001

Q&A


Better hospital food early effective implementation workshop1
Better Hospital FoodEarly & Effective Implementation Workshop

David Foggin

Disruption Ltd


Better hospital food early effective implementation workshop2
Better Hospital FoodEarly & Effective Implementation Workshop

Nutritional Standards

National Dish List

Web-based menu management system

Meal timings

Patient groups with Special needs

24 Hour Snack Box

Ward Kitchen / Light Bite

Menu Design

Housekeeping Interface

Leading Chefs’ Dishes


Barriers
Barriers

1. Why not?

2. What’s stopping you?

3. Is this the true barrier?


Solutions
Solutions

1. What do you need?

2. How can you get it started?

3. Is it realistic?


Better hospital food summits 20014
Better Hospital FoodSummits 2001

www.betterhospitalfood.com/hospitals_only/food_summit



Better hospital food summits 20016
Better Hospital Food Summits 2001

THANKS FOR ATTENDING