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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



Dorset County

Frimley Park



South Cleveland


Stafford General


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


  • 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/

  • Recipes and Method Statements

  • Nutritional Analysis

  • Raw Ingredient Specification

  • Costing Module

  • +500 Meal Presentation Photographs

  • 2500 hits, 4000 recipes downloaded and +200 people registered

    (interactive from 3rd June)

Possible performance measures

24 Hour Access

NHS Menu

Staff/User Complaints


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

  • 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
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...


  • Patients don’t understand about healthcare


  • They understand about receiving healthcare

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


  • Patients can only give a personal view


  • The personal view is exactly what we need

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


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


  • Constructive complaints help us examine our assumptions

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


  • Patients are difficult and unruly


  • Patients are only people

Blimey the things they say4
Blimey, the things they say...


  • We are all potential patients so we can all give the patients’ view


  • 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





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


  • 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


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


1. Why not?

2. What’s stopping you?

3. Is this the true barrier?


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

Better hospital food summits 20016
Better Hospital Food Summits 2001