New rules for better food for NHS patients and staff
Published on 29 August 2014 12:00 AM
New rules to serve up better food for NHS patients and staff
- Mandatory food standards in the NHS contract for the first time
- Hospitals rated for food quality on NHS Choices
The NHS will have mandatory food standards and hospitals will be ranked on food quality as part of a wide-ranging drive to raise standards of hospital food across the country.
The Hospital Food Standards Panel, led by Dianne Jeffrey, Chairman of Age UK, has published its report to the Government today and recommends 5 legally-binding food standards for the NHS. The panel has worked with a range of organisations, including royal colleges and nutritional experts.
The mandatory requirements were selected from over 50 food quality standards. These will now be included in the NHS Standard Contract - making them legally-binding for hospitals. They include:
- Hospitals should screen patients for malnutrition and patients should have a food plan;
- Hospitals must take steps to ensure patients get the help they need to eat and drink, including initiatives such as protected meal times where appropriate;
- Hospital canteens must promote healthy diets for staff and visitors - the food offered will need to comply with government recommendations on salt, saturated fats and sugar;
- Food must be sourced in a sustainable way so that it is healthy, good for individuals and for our food industry.
In addition to the panel's compulsory standards, it has also recommended all hospitals develop a food and drink policy that aims to encourage healthy eating, high-quality food production, sustainability and excellent nutritional care.
Complementing the new standards, the Secretary of State for Health, Jeremy Hunt, has announced hospitals will, for the first time, be ranked on the NHS Choices website for the quality of their food. The latest patient inspections data has been published on NHS Choices and shows how each hospital performs on:
- Quality of food;
- Choice of food;
- Menu approved by a dietitian;
- Fresh fruit always available;
- Food available between meals;
- Choice at breakfast;
- Cost of food services per patient per day.
Food is a critical part of a patient's hospital experience. It needs to be nutritious, appetising and accessible to patients, their visitors and NHS staff. It should meet social and cultural expectations and be packaged and presented so that people can eat and enjoy it.
Food must also be clinically appropriate and everyone who needs more help to eat and drink should get it. When a patient is malnourished it makes recovery more difficult, increases length of stay and can lead to complications such as pressure sores and infections.
Hospitals that do not follow the guidance recommended by the panel would be in breach of their commissioning contract (usually held with a Clinical Commissioning Group), and commissioners will be able to take contractual action against them.
The CQC will use a range of information, including the patient inspection data, to spot potential problems with food and to determine which hospitals need closer inspection of their food practices.
Secretary of State for Health, Jeremy Hunt, said:
'We are making the NHS more transparent, giving patients the power to compare food on wards and incentivising hospitals to raise their game. Many hospitals are already offering excellent food to their patients and staff. But we want to know that all patients have nourishing and appetising food to help them get well faster and stay healthy, which is why we're introducing tough new mandatory standards for the first time ever.'
Dianne Jeffrey, Chairman of Age UK and Panel Chair, said:
'Being in hospital is often a very worrying experience and it can be made worse when the food is unfamiliar or unappetising and you have no control over what and when you eat and drink. Whilst hospitals are not five-star restaurants, it's important that food and drink is tasty, nourishing and thoughtfully presented so that people can eat as well possible.
'Getting hospital food and drink right is critical and should also be considered an important part of someone's medical care. Malnutrition and dehydration pose a real risk for patients if they go unnoticed and untreated. We know malnourished people will take longer to recover and suffer from more complications. No hospital can afford to neglect this essential part of their care.
'I believe these recommendations will help busy hospital staff make sure patients get appetising and nutritious food that they want to eat and are given the help they need to do so.'
Professor Edward Baker, Deputy Chief Inspector of Hospitals at the Care Quality Commission, said:
'It's really important for patients to have access to good quality food based on their own needs. During our inspections, we speak to patients and check records to ensure patients are receiving the right food for their individual needs. Our findings determine which hospitals need closer inspection of their food practices.'
Simon Stevens, Chief Executive of NHS England, said:
'It is time for the NHS set a clear example in providing healthier food for our patients, visitors and also our hardworking staff. That's why NHS England has agreed to include hospital standards in the next NHS Contract, which will be published later this year.'
Notes to Editors
1. Panel Members
Dianne Jeffrey CBE DL (Age UK) - Chair
Susan Jebb (Professor of Diet and Population Health)
Joanna Lewis (Soil Association)
Anne Donelan (British Dietetics Association)
Paul Freeston (Apetito)
Betty Smithson (Patient representative and PLACE assessor)
Gill Buck (Dignity and Care)
Professor Terence Stephenson (Academy of Medical Royal Colleges)
Lorna Hegenbarth (National Farmers Union)
Liz Evans (Buckinghamshire Healthcare NHS Trust)
Andy Jones (Hospital Caterers' Association)
Lyn McIntyre MBE (NHS England representing Royal College of Nursing)
Marie Batey (NHS England)
Maya de Souza (Department for Environment, Food and Rural Affairs)
Shirley Cramer, CBE (Royal Society for Public Health)
Dr Katherine Rake OBE (Healthwatch England)
Karen Wilson (Care Quality Commission)
Dame Gill Morgan DBE (Alzheimer's Society Foundation Trust Network)
David Wathey (Department of Health)
Rachel Wilkinson (Age UK)
Kevin Naylor (Department of Health)
Catherine Thompson (NHS England)
2. The inspection teams are made up of at least 50 per cent patients or members of the public, and the assessment period ran from March to June 2014. The teams judge hospital wards on the things that matter most to patients - being treated in a clean, safe, well-maintained environment, with tasty nutritious food, and high standards of privacy and dignity.
There were a total 6,523 "Patient Assessors" in the inspections in 2014.
3. The five mandatory standards will be:
3.1. The 10 key characteristics of good nutritional care (Nutrition Alliance):
• All patients are screened on admission to identify the patients who are malnourished or at risk of becoming malnourished. All patients are re-screened weekly.
• All patients have a care plan which identifies their nutritional care needs and how they are to be met.
• The hospital includes specific guidance on food services and nutritional care in its Clinical Governance arrangements.
• Patients are involved in the planning and monitoring arrangements for food service provision.
• The ward implements Protected Mealtimes to provide an environment conducive to patients enjoying and being able to eat their food.
• All staff have the appropriate skills and competencies needed to ensure that patients; nutritional needs are met. All staff receive regular training on nutritional care and management.
• Hospital facilities are designed to be flexible and patient centred with the aim of providing and delivering an excellent experience of food service and nutritional care 24 hours a day, every day.
• The hospital has a policy for food service and nutritional care which is patient centred and performance managed in line with home country governance frameworks.
• Food service and nutritional care is delivered to the patient safely.
• The hospital supports a multi-disciplinary approach to nutritional care and values the contribution of all staff groups working in partnership with patients and users.
- screened on admission to identify
3.2. Nutrition and Hydration Digest - these standards look at how a dietitian can play a role in patients' hospital food making sure that a patient is receiving the optimal food consumption to help recovery.
3.3. Malnutrition Universal Screening Tool - these standards will mean patients are screened for malnutrition when they are admitted to hospital. A diet tailored around their needs can then be worked on by the dietitian.
3.4. Government Buying Standards for Food and Catering Services - this standard is based on 21 criteria making sure food is served to a higher nutritional standard and produce is brought within the local economy if possible.
i. 50% of tea/coffee fair trade
ii. Fish twice a week
iii. Menus reflect seasonal produce
iv. Tap water available
v. No salt when cooking rice, potatoes and vegetables
vi. 50% of deserts should be fruit based
3.5. Healthier and more sustainable catering guidance - The NHS needs to lead the way on healthier eating and therefore healthier options need to be available on site.
4. Definitions for the Food Indicators on NHS Choices
4.1. Quality of food - The quality of the food and the way it is presented and served on the ward are important for patient health and also affect the quality of their overall experience.
This indicator shows the results of the 2014 Patient-Led Assessments of the Care Environment. Assessment teams visited every hospital and tasted the food on a sample of wards. They tasted every item of food on offer, and rated it for taste, temperature and texture. They also looked at how well the food was served, including whether the ward was prepared for mealtimes, whether patients had the chance to wash their hands and whether unnecessary activity was stopped during the meals. Their views were brought together into a single score.
4.2. Choice of food - This indicator looks at the way the hospital as a whole organises its food services. It covers the amount of choice available at each meal, along with information about how often the menu is changed and how well the hospital provides for patients who need particular diets, such as gluten-free, vegetarian or kosher. It also looks at the timing of meals and how long in advance patients are required to order their food.
4.3. Choice at breakfast - A varied menu, with a wide range of choices at each meal, helps patients to select a diet that suits their needs. There is a long gap between the evening meal and breakfast, so a good choice here is important. ‘Choice at breakfast' also acts as a representative of all meals.
To get the top score on this question, hospitals have to confirm that they offer at least five different breakfast items, including at least three different cereals and two hot or cooked options (e.g porridge, boiled egg, beans on toast).
4.4. Fresh fruit always available - The government advises that everyone should aim to eat five portions of fruit and vegetables per day. Having fresh fruit available at all times helps patients to meet this goal, and allows those who wish to eat a healthier diet to do so easily.
4.5. Food available between meals - Patients need to get enough food to meet all their dietary needs, especially if they are malnourished or have lost weight in the course of their illness. But when people are unwell, they often lose their appetite and need to eat ‘little and often' to keep up their food intake.
4.6. Menu approved by a dietitian - Hospitals must provide for a wide range of dietary needs, including special clinical, religious and cultural needs. They must also meet a wide range of tastes. To say ‘yes' to this question, hospitals had to confirm that the menu has been approved by a registered dietitian as being capable of providing an appropriate balanced diet for all patients
4.7. Cost of food services per patient per day - There is no simple relationship between the amount spent on food and its quality. Some hospitals provide excellent food at low cost. This indicator does not show whether a hospital is spending the right amount, but it does show whether its costs are higher or lower than the average.
This is the total cost of providing food and drink, and includes the cost of provisions, equipment and staff. It is NOT just the cost of the food.
5. The NHS Standard Contract
5.1. The NHS Standard Contract is published annually by NHS England and is used by NHS commissioning organisations for all of their healthcare contracts with providers other than for primary care. The draft NHS Standard Contract for 2015/16 will be issued later in the autumn for a period of consultation and will include proposed wording in relation to hospital food standards. Final agreed wording will be included in the final version of the Contract for 2015/16, which is expected to be published in December 2014.
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