Cost cutting and the parlous state of NHS funding stand out as the most immediate reasons for sleepless nights among hospital caterers.
In a report based on responses from 400 branch members representing 266 NHS hospital trusts across the UK, the Hospital Caterers Association (HCA) has provided a snapshot of publicly funded patient, staff and visitor feeding.
Titled, ‘NHS Patient Catering, UK – Four Nations Report’, it reveals the principal concerns of caterers, the major challenges they face, and asks them what they believe the answers might be.
Among concerns, food waste (22%) and staffing (21%) followed finance and cost-cutting (57%).
Asked, for instance, how they would rate food waste as an issue, 83% said they believed it was a high priority, with 57% believing that bulk waste (waste left on trolleys) made up the largest element of food waste, then plate waste (38%) and preparation waste (5%).
Advance ordering, movement of patients and lack of modern technology were all cited as contributing factors, with advance ordering being rated the biggest factor (69%).
A huge 81% also said they were apprehensive about implementing the 20% tax on all sugary drinks and foods sold in NHS cafes. NHS England chief executive Simon Stevens wants this introduced by 2020 as part of plans to try to tackle the growing problem of obesity.
Caterers worry about how this is to be implemented, how much the public will support the measure, what support and training they will receive and the impact of the move on existing catering contracts.
When it comes to identifying possible answers to these and other challenges, nearly all (94%) felt caterers should be given back complete control of the catering service from kitchen to ward service.
Other ideas to help hospital caterers deliver the right food in the right way to the right people came from the 61% who felt they would benefit from a more collaborative approach between clinical disciplines such as dietitians and nurses.
Chair of the HCA Phil Shelley said: “This report is in response to our members desire to share best practice and work collaboratively to help overcome the many challenges they face in providing a safe, nutritious, cost-effective and relevant catering service in their trusts.”
He said that, within NHS England, tight budgets were a major issue, but believed they also presented an opportunity.
“Financial pressures can cause unbalanced decision making; this often leads to short-term planning, which has a negative long-term affect,” he continued. “Quality in our purchasing, preparation, service and presentation need to be continually challenged if we are to raise our standards.
“There must be complete ownership of the patient meal service in all healthcare settings – preferably by the catering management team; this ensures food safety and a support mechanism to drive patient satisfaction.”
He adds that empowering catering managers to make the purchasing decisions – using price and quality to achieve savings without diminishing nutrition – would be a positive step forward.
“Retail catering within the NHS must be managed in a business environment; we need consistently high standards and a range of nutritionally balanced choices available around the clock if we are to drive footfall and profit,” Shelley said.
“Brand and promote your retail areas – menus and meal deals need to be balanced appropriately to ensure that offers are relative to working in the health service.”
Stewart McKenzie, HCA vice-chair and site facilities manager at NHS Greater Glasgow and Clyde Gartnavel Royal Hospital, said funding was a critical issue among members in Scotland too: “Money has to be the top issue for all of our caterers, our challenging economic environment is driving every decision. The need to continually make savings while delivering more is at the top of every caterers’ list.
“NHS Scotland doesn’t have the money to adequately provide and reinvest in its own facilities, and this has led to two key outcomes that are now shaping the role of catering across NHS Scotland.
“Firstly, there has been a move away from government-owned infrastructure to PFI/PPP builds and secondly, and more specific to catering, we are moving from traditional cooking on-site to cook freeze throughout most of Scotland.”
He said that food waste was another priority issue, but that operators were coming up with solutions: “The challenge here is to provide adequate control systems and more technology to help combat waste. A good example of this would be at the new Queen Elizabeth hospital, which is using hand-held bed ordering devices to enable requests closer to the point of service.”
He said NHS Scotland worked under the Healthyliving Award standards, which require ‘the offering’ to have 70% ‘healthier’ choices.
“In addition to this, and unlike our colleagues in England, we are already restricted around the sale of sugary drinks, including vending,” he added.
Meanwhile, Neil Hiddlestone, chair of HCA’s Wales Branch, said priorities for members in the principality included food prices, meal ordering and patient nutrition.
Hospital catering in Wales is built around the All-Wales Menu Framework, which was introduced in 2013 and provides a national database of nutritionally analysed menus for every hospital to use.
He said that, together with the All Wales Nutrition and Catering Standards for Food and Fluid for Hospital Inpatients, which were introduced in 2011, they provided guidance for catering staff.
“These have helped to formalise the catering process and put in place national processes for patients to receive the best possible nutrition. They also help caterers to achieve more consistent cost control, allowing the streamlining of ingredients where possible.”
In Northern Ireland, chair of the HCA’s Northern Ireland Branch Else Witherspoon outlined four challenges facing caterers in the region:
- delivering a suitable out-of-hours service
- the introduction of new nutritional standards
- the introduction of a new, computerized recruitment system
- succession planning through training and staff development.
“We really are a 24-hour service in hospitals for patient catering, but it’s very difficult to run this service without investment and avoid high food wastage,” she said.
“We do not have catering staff working in the evening, so we have to ensure the nursing teams are trained and enabled to support their patients with the right hydration and nutrition in these times.
“We hope our collaboration between the suppliers, dietitians and nurses will offer up some practical solutions.”
She says that nutritional standards will help bring the catering service into line with government efforts to combat obesity through greater use of low-salt, low-sugar and low-fat foods.
“Some of the recommendations such as taking chips off the menu can be problematic, particularly in visitor and staff catering. For example if we don’t put chips on the menu, people don’t stop eating them, they will just procure them elsewhere and we have income targets to meet,” she pointed out.
On workforce development, she added: “We are committing to a strong investment in our staff and people, which is an incredibly powerful message to send out.”