Whenever healthcare caterers gather to compare notes, there is a recurring theme – products of the best quality, well cooked and beautifully presented can nevertheless be a let down if they are cold when they are put down in front of the patient. Or if they are placed just out of reach of someone who struggles to feed themselves. Or if there’s no special cutlery or help provided for those that need it. Or if the meal is served while medical staff are still busy on the ward.
The list goes on, but the effect is always the same. All the planning, good work and effort that has gone into the food up until that point can spoilt on the last leg of the journey from the kitchen to the patient.
This final step, which has been given the name ‘the last nine yards’, has become the focus of attention as caterers try to deliver the best possible service.
Phil Shelley, chair of the Hospital Caterers Association (HCA), explains what he believes the campaign is all about.
“The first thing is to get people to relate it to their normal lives – perhaps going out for a meal. It’s the last point of service, and begins before you receive your meal and before the plate is put in front of you.
“Are you ready? How is it presented? Is it what you ordered? Whatever good work has gone on in the background, it can be spoilt if this last point of the service doesn’t meet expectations.
“The driver behind it is you’ve got to have the buy-in from somebody at the top. It needs to be led by the chief executive and the director of nursing.
“We talk a lot about the ‘the power of three’, which is the catering, clinical and dietetic teams coming together. Everyone has to be working towards the same purpose.”
Shelley adds that there would always be some good and some bad experiences, and that Health Secretary Jeremy Hunt’s plans for a fully seven-day NHS service was very, very challenging for everyone.
“Whatever happens, we need to be a bit clever about this. We know, for example, that the dietetic support won’t be the same at weekends, so we need to have menus in place that mean we can at least have a holding position until the full dietetic support comes back in on the Monday.”
Anne Donelan (right) represents the British Dietetic Association (BDA) in the Last 9 Yards group and has her own take on the campaign.
“When things go wrong with the final delivery of the food, that’s when you get people posting photos of it on social media.
“The best food in the world can leave the kitchen, but it’s the most dangerous part of the food journey and it’s where things can go horribly wrong.
“That’s where the mistakes are made. One person can make or break the experience. It didn’t start off slops, but that’s what it ended up.
“It’s because so many people are involved. There is lots that is regimented in many parts of the food chain, but the final stages involve people from so many disciplines, from nurses to ward service.”
She believes that too many working on the last nine yards don’t fully understand what it sets out to achieve.
“It’s all very well to tick boxes to say we do training, but that doesn’t mean someone’s taken it on, that the training is ongoing or that the agency staff you’ve had to bring in at short notice know about it.
“So the focus at the minute is simply to articulate what the group’s about. Commissioners need to understand and trusts need to understand what these initiatives mean, and that they need to comply with them.
“People understand what it means when you explain it. It’s simple things like the plate being out of reach or no one checking what food’s been eaten – not how do we make it better, but what do we need to do.
“We need to explain and let people take responsibility. We want people to question why the food doesn’t arrive as it started out.”
She says that the culture on the ward makes a difference, which is one reason why the last nine yards in one can be better than the service on another – even within the same hospital.
“We need to find the right words. Somehow, we haven’t hit the right buttons yet.
“It’s too easy to blame the kitchen. Most people understand, so show them where the tools are and have one banner that it all sits under.
“There should be no blame, just focus them on influencing something for the better.”
The idea of the last nine yards, though, goes back to Andy Jones, former HCA chair, and now head of the PS100 group of public sector caterers and influencers.
He says: “Good, nutritious food assists the patients recovery and enables staff to work better. We know we’ve some way to go and there’s always room for improvement.
“However, all of the good work done by caterers can be undone in what we are calling the last nine yards. In essence, good food can be ruined in those last few steps.”
When he succeeded Jones (right), Shelley told the HCA Conference in 2015: “Our aims as an association for the coming year are clear: putting the patient first in our daily routines, whether that is in staffing structures, financial controls, menu planning, bedside booklets, or procurement of food and equipment.
“We must find a way within our own environment to be part of the clinical decision-making. We also need to reflect that the only way we can improve the patient experience is through their meals, and the caterer is nearer the front line than any other facilities service that we provide.
“Our focus is on the last nine yards, spearheading campaigns and initiatives that will enable hospital caterers to not only continue to achieve those high standards but, most importantly, safeguard the nutritional care of all of our patients as well.
Shelley concludes: “There is no doubt that hospital food and catering services will continue to be in the spotlight as patients’ expectations continue to rise and the NHS is used as a political weapon.
“I feel the government must act to support our campaign to ensure those most vulnerable are given the best possible care."