National standards for healthcare food and drink provide more than just food for thought

The release of National standards for Healthcare Food and Drink on the 1st of November 2022 provides healthcare leaders with more than just food for thought. Specifically, the new standards set out a range of requirements which take the food and drink agenda directly to the boardroom table and leave it firmly on their plate.

A designated board director must take responsibility for food (nutrition and safety) and organisations must report on compliance with the healthcare food and drink standards at board level as a standing agenda item. They will be responsible for ensuring:

• the organisation achieves agreed targets to increase the level of patient, staff and visitor satisfaction with their food service
• the national standards for healthcare food and drink are implemented across the organisation
• the organisation has a food and drink strategy, evidencing a clear ambition to improve and how this will be achieved
• there is evidence of regular board reporting and compliance status, eg minutes of meeting discussing compliance checklists and documenting actions to be taken
• action plans generated are appropriately concluded
• risks are identified and appropriately managed
• good quality evidence reflects current practice across the organisation, eg Patient Lead Assessment of the Care Environment (PLACE) results
• patient and staff nutrition and hydration are prioritised
• health promotion for visitors is embedded in food and drink services
• they become the food champion for their community and engage in the national programme
• a healthy, safe and sustainable food and drink culture is established.

Moving forward, these standards will be legally binding as part of the NHS Standard Contract as well as already being part of the NHS Long Term Plan.

‘Food as medicine’

Whilst many glossy magazines this time of year are discussing menus for lavishly catered festive celebrations parties, the idea that a quarter of all patients in hospitals are malnourished is difficult to digest.

However, the new standard goes on to set out some staggering statistics on the levels of malnutrition amongst specific patient cohorts, while making the strategic case for its implementation in terms of improved patient outcomes and the cost of care eminently clear. The standard states:

‘It is harder for undernourished patients to fight infection and recover from illness, increasing the risk of longer stays with more complications and associated clinical interventions. The cost of caring for a malnourished patient is two-to-three times higher than a non-malnourished patient.’

Variation in delivery

The 2022 ERIC return presents the following statistics relating to patient feeding:

The full ERIC data dataset also presents a range of meal costs per Trust, where we see a broad variation in costs from the first (£3.69/patient meal) and third quartile (£6.44/patient meal)

It would be easy to assume that there is a direct correlation between the quality of food served and the cost of each meal, but that is not always the case. While cost variations may be in part related to issues such geography, product and meal type, it is the different structures of people and processes which are associated with service delivery which often have the most significant impact on cost.

One is example is the variable utilisation of food and beverage assistant/host services in food and drink delivery to patients. Such a role can be fundamental in helping achieve the aims of the new standard, by providing a resource to identify and support those patients who are struggling to engage with meal ordering and feeding themselves. Yet as organisations have sought to dampen increasing operational costs associated with the delivery of the catering service, it is a function which has become intermittent and somewhat piecemeal in utilisation across the NHS.

Charitable Association BAPEN raises awareness of malnutrition and works to advance both the nutritional care of patients and those at risk from malnutrition in the wider community. They assert that all health and social care professionals should be adequately trained to understand the importance of good nutritional care and have the skills appropriate to their role to implement this. Yet the realities of the busy hospital environment and the challenges of a stretched and fragmented workforce can mean that front line care staff are often limited in their engagement in patient feeding.

What does this mean for FM teams?

On the face of it, it would be easy to think that the primary activity of FM teams will be to ensure that catering service specifications are appropriately enhanced to meet the requirements of the standards. There is indeed a critical role in ensuring requirements are reviewed so that they describe and define patient catering needs clearly, consistently and in line with the obligations of the new standards. But against a backdrop of increasing backlog maintenance and rising costs across the estate, FM leaders would be forgiven for worrying about how they might manage their budgets to achieve such improvements.

A recent episode of The Food Programme (BBC Sounds) sought to challenge conventional thinking that higher-quality food must come at a cost, with several examples of hospital Trusts who have implemented cost-neutral changes to working practices which have generated significant improvements to their catering services. Indeed, those interviewed questioned whether catering should be viewed as a cost at all, noting the need for an ‘inspirational maverick in each Trust’ to champion a change in mindset so that catering is seen as a critical enabler of patient care. In this context, FM teams have an essential role to play in helping inspire change, working in collaboration with key stakeholders such as dieticians, the head of nursing and the patient-facing clinical teams.

Similarly, in making the case for strategic investment in the catering service, FM professionals should cite opportunities for aligning catering service transformation efforts with other strategic aims of the organisation. Local purchasing of fresh ingredients which reduce transport miles and associated carbon emissions while also generating additional social value through investment in British farming and other local food suppliers, supporting the creation and retention of local jobs and economic benefit. Similarly, with the use of macerators and enzyme digesters becoming illegal in 2023 via the Environment Act 2021, food waste will require separation from other waste and recycling streams, bringing with it additional associated processes and disposal costs. Investing in high-quality, appealing patient food to help reduce plate wastage has never been more important.

For FM teams, the arrival of the new standards should be viewed as a welcome recognition of the strategic role that soft FM services can play in enhancing patient experience, care, and outcomes. Indeed, there is now an unparalleled opportunity to achieve board-level sponsorship for catering service improvements to ensure that all patients receive the right nutritional care as part of their journey through the hospital.

However, to be the catalyst for a truly transformational approach, FM professionals will need to think outside of the catering box, working collaboratively across all levels of the organisation to champion and inspire a new mindset in the way we plan and deliver hospital catering in future.

Dr Rachel Hampson is an Associate Director for Archus and lead for Facilities Management consultancy services, where our specialist work includes understanding and outlining client requirements in into FM specifications and contracts, evaluating tender responses and helping healthcare organisations to make balanced decisions.

Archus are here to help in improving every aspect of defining your in-patient catering service. If your site or your existing service requires modernisation and alignment to the new standards, please get in touch.