food and drink strategy 2016/19

Food and DrinkStrategy2016/19

West Hertfordshire HospitalsNHS Trust

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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

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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:


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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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


AppendicesImplementation Plan for Year 1.

Implementation plan

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2. Healthier eating for patients, staff and visitors


To re-instateHospital FoodGroup

To have Hospital Food Group meetings 6 times per year

Update terms of reference for the group


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


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

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Food and DrinkStrategy2016/19

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