A raft of quality improvement initiatives and new legislation have ensured that hospital food has been in the public eye for much of the last decade, says Maxine Cartz, Medirest dietitian and vice chair of the BDA Food Services Specialist Group.
The first Nutrition and Hydration Digest was published in 2012 and Digest #2 followed in 2017. It has been integral in creating consensus – through consistent information, menu coding and good practice standards – on hospital food for patients, staff and visitors.
In 2014, we had the Hospital Food Standards, incorporating:
- 10 key Characteristics of Good Nutrition and Hydration Care;
- Nutrition and Hydration Digest;
- Nutrition screening;
- Healthier and more sustainable catering for staff and visitor catering; and
- Compliance with Government Buying Standards.
Hospitals were required to develop a food strategy as part of their compliance with these standards.
In 2015, an initiative to improve the ease of opening packaging was launched as many products – juices, sandwiches, preserves, spreads and cheese portions – can be tricky to open particularly for elderly patients or those with fine motor problems.
The solution was the implementation of user testing protocols from the ISO standard, Packaging Ease of Opening (ISO17480). The standard, issued in 2015, contains a methodology for assessing the ease of opening of packaging with a pass/fail criterion based on the number of unopened packs or a poor satisfaction score.
Allergen awareness has become much more apparent during the last 10 years. The Food Information Regulations launched in 2014, with an update in 2019, and more recently, we have embraced the introduction of Natasha’s Law.
Going the last nine yards
The ‘Last 9 Yards’ is a Hospital Caterers Association initiative where multidisciplinary teams at ward level work together to ensure the meal service to patients works well. Even when the basic hurdles – menu planning, cooking, regeneration and transportation of food around a large hospital – have been overcome, the last leg of the food journey, delivery to the patient, is where it can easily fail. Success for patient catering is food being served attractively, at the correct temperature, being eaten and enjoyed.
The IDDSI Framework was adopted in the UK in 2019 to bring global standardisation to descriptions of modified texture meals and to improve patient safety for people with dysphagia by introducing a common international language. There is no doubt that the IDDSI levels and evaluation tools have improved the consistency of meals and drinks designed for people with dysphagia.
Following the listeria outbreak in 2019, the government announced a review of hospital food despite another ongoing workstream in the development of the new hospital food standards.
The Report of the Independent Review of NHS Hospital Food was published in October 2020 and considered all aspects of hospital food including the impact of Covid-19. The landmark report highlighted key findings such as recognising the clinical importance of nutrition and hydration and taking into consideration many other aspects including technology, 24/7 provision, sustainability and waste.
In addition, we will soon welcome the new Hospital Food and Drink Standards. These are currently under review and are due to be published before the end of 2021.
When I started as a food service dietitian in 1994, the focus was on simple, traditional food and we used one main guidance document, The Health of the Nation Nutrition Guidelines for Hospital Catering (1995). Now we have a plethora of targets and standards to uphold. What’s been clear particularly over the past decade is the vital role food service dieticians play in ensuring food enhances the patient experience.
Using Compass Group UK & Ireland’s healthcare catering as an example, we offer patients a full menu of over 40 meals each day on our a la carte menu as well as providing over 100 meal options for patients with cultural, modified texture and allergen requirements. This demonstrates how the landscape and standards have been enhanced and that the patient is at the heart of the offer.
The five-point best practice guidance for hospital catering
- Bring food service closer to the patient;
- Focus on what patients have told us they want: food that tastes good, the right amount of choice and food served at the correct temperature;
- Food and nutrition must be an integral part of patients’ overall care, understanding the importance of the multidisciplinary team working together for a patient-centric approach;
- Consider patients groups and therapeutic requirements in menu planning but do not forget patients are individuals too; and
- Continue to evaluate, innovate and improve.