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Serving up patient benefits

Author : Sadaf Saied

30 November 2011

Food in hospitals must meet the nutritional needs of patients, be appealing, cater for individual tastes and be delivered on a tight budget. Sadaf Saied of G4S FM explains why careful menu planning is key to serving up patient benefits.

Mrs Beeton in her famous Cookery and Household Management book of 1861 said: “There is no form of cookery that requires more thought and care than that intended for the diet of the sick.” These words are still pertinent today in healthcare and a “food first” approach is vitally important to help the recovery of ill people in hospital.

As a norm, patients will not eat any food that is unfamiliar or that they do not like, especially when they have reduced appetites due to illness or medication effects. The nutritional value of food left uneaten is “nil”. Yet, when hospital foodservice teams focus on delivering appetising, good quality food in an environment conducive to meal times, it can provide both an enjoyable experience for the patient and the much-needed nutrition required to support recovery and promote health.

However, with some NHS Trust budget allocations requiring catering providers to deliver three meals, two snacks and seven beverages a day within a budget of around £4.00 per patient, providing the best possible foodservice for hospital patients is a often a complex and difficult task.

Careful menu planning is key to meeting patient’s nutritional requirements, individual dietary and specialist needs and foremost budgetary resources and constraints. A good menu planning team is essential for successful menu improvements. As a minimum, the team should consist of a catering manager, dietitian, a nurse and a patient representative. Whether it is a new menu launch or a six month menu review, collating information such as food satisfaction survey results, patients’ preferences, food consumption and wastage information prior to starting the process can prove extremely useful in the initial stages of menu planning.

Every hospital setting is different and a bespoke menu solution needs to be carefully planned and take into consideration the specific requirements of the facility. Key factors must always include the patient population and their needs, budget, the type of hospital unit, the length of patient stay, foodservice arrangements and staffing.

To assess the dietary needs of different patient populations, the planning team needs to undertake an analysis of age, gender, cultural, ethnic, social and religious diversity, length of stay, physical mental health disabilities, food preferences, the percentage of malnourished patients and any medical specialities within the hospital.

Meeting nutritional requirements of all patient groups in the hospital should be the principal factor in menu planning. Most often the calories and the protein in the menu are taken as lead markers when planning menus but it may also go into more detail for a specialist hospital. For example, a hospital that deals with patients who have swallowing difficulties may require special texture modified food. This could be very different to another need within a hospital treating kidney diseases where meal requirements need to be low in minerals like potassium and sodium. The nutritional needs of patients in hospital are varied from the ‘nutritionally well’ to the ‘nutritionally vulnerable’ so menus designed should meet both ends of the spectrum - from healthier eating to providing higher energy.

The typical length of patient stay must be considered. Normally, the longer the patient stays the more important that food becomes and these facilities must have appealing food choices with seasonal variation.

Food service arrangements on site are integral to any proposed menu changes. With the drive for greater efficiencies in hospitals, there is currently a wide variety of production methods including traditional, cook chill, cook freeze or hybrid and the more recent steam microwavable meal options. Menus need to consider what is practically possible within the current production method while also considering the availability of ingredients and the skills of staff.

Every year in the light of new evidence there is Governmental guidance, standards and regulations and best practice documentation published that menu planners need to conform to. Menus that tick all these boxes can help foodservice teams immensely when it comes to audits and compliance as these needs to be considered as well.

Patient needs also should be reflected in the meal timings, which in turn must be considered by menu planners. A care of the elderly unit may have a cooked breakfast and therefore lighter lunch and supper, whereas a maternity unit may be organised so that patients can have meals more frequently and at times dictated by the patient. In a rehabilitation unit, main meals may be built around their therapy sessions to aid the recovery process.

Food procurement and sustainability issues in the current climate also drive menu decisions. With the NHS spending £300 million on food ingredients and £500 million on catering, DEFRA has highlighted the scope for hospitals to deliver greater efficiencies and become more sustainable. Sustainability criteria for food procurement is extensive and must consider energy use, waste management, seasonal produce, fairly traded produce, higher animal welfare standards and ensuring small businesses have the opportunity to access contracts.

Sustainable produce in simple terms may mean to use all cuts of chicken rather than go for only chicken breasts - using all parts of meat efficiently and thus reducing wastage. It can also mean using local producers to buy in dairy and bread to reduce food miles and carbon footprint and it can also mean using seasonal vegetables and promoting these as ‘chef’s specials’ on menus.

While this is an evolving concept, balance needs to be delivered and the practicalities carefully considered when catering for large hospitals where consistency in delivering nutrition and uniformity in meal service are factors over and above sustainability criteria.

Once a new menu has been developed, nutritionally analysed and tested, patients and staff need clear information about the food service to empower them to make the best use of it. Dietitians in collaboration with catering colleagues can contribute in developing user-friendly and patient-centred information in a variety of formats. This could include written and pictorial menus and patient menu booklets giving information on the full range of foods and beverages available with diet codes to assist with menu choices. The menu information can be given in languages most familiar to patients and also in electronic and interactive information. It also means that staff must be good communicators, knowledgeable about the food service so that they can provide guidance to patients about appropriate food choice.

Dietitians need to collaborate closely with catering managers to ensure appropriate training is given to frontline staff to make menu choice easy and accessible for patients - ensuring food is enjoyed and eaten at the end of the food chain in hospital. Dietitians, whether part of the Catering Team, NHS management team or a service specification team are responsible for setting and monitoring the nutrition standards for hospital menus. Catering liaison dietitians specifically are well placed to develop and maintain good links between the food service and clinical teams.

At G4S FM, we have been working to embed menu planning best practice into our existing catering contracts. At Liverpool Women’s Hospital after being awarded a catering, cleaning, ward hostess and portering contract, we are going to be working in partnership with the Liverpool Women’s NHS Foundation Trust to deliver significant changes to the food service.

Careful menu planning and consideration for the needs of the patient will be a key part of this process which will also see greater personalisation at meal times. In early 2012, a major menu planning exercise involving our catering experts, patients and clinical staff will aim to develop a six monthly seasonal menu.

As well as changes to the menu, we will also ensure that our chefs are also on hand at meal times to monitor what is being eaten and obtain first hand knowledge about the food they cook.

Meeting the nutritional needs of patients must be the guiding factor in menu design and food service within hospitals. Menus must also be practical to deliver within existing production methods and budgets, as well as being focused on sustainable procurement. Get this balance right and providers can serve up major benefits for patients and the NHS.

Sadaf Saied is G4S FM’s Head of Dietetics

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