better hospital food summits 2001 presentations. better hospital food summits 2001 simon williams...
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Better Hospital Food
Summits 2001 Presentations
Better Hospital Food
Summits 2001Simon Williams
Assistant DirectorThe Patients’ Association
Better Hospital Food
Summits 2001Paul Cryer
Business ManagerFood Programme
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 Plan
Key Issues in the Plan
InvestmentModernisation ConsumerismPatient Surveys
Service Re-Design
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 FoodThe NHS Plan
Chapter 4
NHS Menu 24 Hour Catering Service Housekeeper Programme Franchising
Better Hospital FoodImplementation Support Pack
Recipe Book The specimen NHS Menu Patients Comments and
Suggestions Form Some Best Practice ideas
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
The Ward Kitchen Service The Snack Box The Light Bite
The NHS MenuAcceptable Menu Standards
Breakfast (Cereals & Toast Type) Light Lunch Two Course Dinner
Snacks Twice Per Day
Better Hospital FoodDesign of the NHS Menu
NHS Menu Group National Dish Selector National Specimen Menu Nutritional Standards & Analysis
NHS Patient Food GroupLoyd Grossman and Leading Chefs
43 Leading Chef Dishes
Better Hospital FoodLeading Chef Dishes
Pilot Sites
Oldham Bedford Dorset County Frimley Park Bradford Chesterfield
South Cleveland
Bassetlaw Stafford
General Northampton Charing Cross
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 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 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 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 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 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 FoodSupport Programme 2001/02
www.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 registeredwww.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
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 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
People First
Clinical care ever more specialised Length of stay continues to fall Increasing use of technology
…need to rediscover the patient
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
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...
Myth Patients don’t understand about
healthcare
Reality They understand about receiving
healthcare
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 say...
Myth They’ll just use it as an excuse to
moan
Reality Constructive complaints help us
examine our assumptions
Blimey, the things they say...
Myth Patients are difficult and unruly
Reality Patients are only people
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...
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 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
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)
“…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
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 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 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
Matron
Service Manager
Ward Ward Ward
Actions to Date
Steering Group Patient Group Regional Workshops Career Structure Good Practice Visits
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 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 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 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”
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 Food24 Hour Catering Service
Development programmePilot Sites FeedbackDevelop Local Operational Policies
Staffing Ordering systems Security Continuously review systems Respond to Feedback
Better Hospital FoodMoving The Main Meal
Considerations
Catering staffing Ward routines and activities Getting nurse support Applicability to certain patient groups
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 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 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 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 FoodSummits 2001
A Dietetic Perspective
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?
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
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!
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<’s on texture modifications etc...
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
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
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
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
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
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
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)
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
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!!!
The hospitality element of food service is a key determinant of patient satisfaction
Good food is enjoyable and fun!!!
Better Hospital FoodEarly & Effective Implementation
Workshop
David FogginDisruption Ltd
Better Hospital Food Summits 2001
Q&A
Better Hospital FoodEarly & Effective Implementation
Workshop
David FogginDisruption Ltd
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
Barriers
1. Why not?
2. What’s stopping you?
3. Is this the true barrier?
Solutions
1. What do you need?
2. How can you get it started?
3. Is it realistic?
www.betterhospitalfood.com/hospitals_only/food_summit
Better Hospital FoodSummits 2001
Better Hospital Food
Summits 2001
Better Hospital Food
Summits 2001
THANKS FOR ATTENDING