Patients Check in to New 'Hotel Style' Service

12th May 2005

Hospital caterers, dieticians, nursing staff and housekeepers across the country rose to the challenge of the HCA National Day of Choice on 12 May. It was entirely fitting that the day chosen to launch the event was the 185th anniversary of the birth of Florence Nightingale - the earliest pioneer of enhancing patient mealtimes.

Once again Loyd Grossman OBE, Honorary Patron of the HCA and Chairman of the Better Hospital Food Panel, joined HCA National Officers and representatives from leading patient, dietetic and nursing organisations at the official launch of the event, which was held at the Royal Brompton Hospital, in Chelsea, London.

In a move to create a better mealtime experience for patients, the HCA GP committee - under the tireless steer of Chairman Ian Robinson - encouraged Members to make changes to their food service and to present patients with new levels of choice that would make a difference to their time in hospital. The idea was to give them a taste of the sort of choice they might only expect to find in a hotel or restaurant.

Many chose to combine National Day of Choice with a new drive for Protected Mealtimes, the HCA initiative that has been widely adopted by hundreds of wards since its successful launch last year.

Members were also encouraged to make sure any menus, posters and leaflets about their food service were clearly presented so patients could easily understand the new choices and levels of service that were being offered.

Nearly 2,000 hospital wards across the UK took part in the National Day of Choice in support of the HCA’s endeavours to initiate an improvement programme that will lead to a major shift towards a high-quality ‘hotel-style’ 24-hour food experience for patients.

In addition, some 40 hospitals chose to use Protected Mealtimes as their National Day of Choice theme where patients were provided with the opportunity to eat meals free from avoidable clinical and non-clinical ward interruptions. Others provided patients with the facility to eat meals away from their bedside or with family and friends.

Speaking at the launch, Loyd Grossman said: “The whole subject of food is now firmly embedded in the agenda of the NHS but its importance is not yet uniform across all NHS Trusts. But it is rising up Trust agendas in step with offering more patient choice and measurable, tangible progress in improving hospital food has been made.”

He added: “In public service catering it is a very big job. We still have a long way to go and there will be no quick fix. But with choice at the heart of what we do in future, hospitals will not be considered decent unless they have a good catering service.”

Susan Jones, Chairman of the British Dietetic Association, said: “There are several ways in which choice can be introduced into patients’ meal services in hospital, all of which have the potential to add value to their experience and lead to increased consumption of the food and enhance nutritional status.

“We are all aware of the improvements in hospital catering which have come about as a result of the Better Food Programme, in terms of the quality and availability of the food. Introducing and extending choice can take that work a step further.”

Speaking on behalf of patients, Simon Williams, Director of Policy at The Patients Association, said: “Choice means so much more to us all these days in our everyday lives and the NHS needs to reflect these changes in the way we live and the expectations we have. A greater variety of food and a choice of meals is not only essential to maintain high levels of patient satisfaction but also to add to the recovery of patients if they can eat more of the foods they like.”

Anne Benson, Co-Director of the Royal College of Nursing Clinical Leadership team, spoke about the role nursing could take to support the HCA campaign on delivering choice. “Nurses need to act when routine practices, attitudes, systems and procedures throw up barriers to delivering choice. This is not always easy and requires good leadership to support, influence and implement change. It also requires excellent team and inter-team working to span the different departments and disciplines, and to fully embrace patients and their families as members of the team.

“To achieve this, we need to fully understand the roles and contributions we all make, as well as understand the constraints and challenges we all face.”

Alison McCree, HCA Chairman, noted that the 2004 PEAT (Patient Environment Action Teams) findings show an unprecedented level of patient satisfaction with hospital food. “That can be attributed to the fact that hospital catering has already benefited from the ‘Loyd Grossman’ effect and the Better Hospital Food Programme,” she said.

“But it is not just about the food on the plate any more. While that is still hugely important, it is also about the whole patient food experience during a 24 hour period. It’s about being able to provide more of what patients’ fancy, when they fancy it, and more of what they associate with normality and home comforts. The hospital environment is often an intimidating and unfamiliar experience so there needs to be less of a division between what people experience inside hospital and their everyday lives outside of hospital.

“If patients fancy a cup of the favourite tea they have at home then we should, within reason, have the power to be able to provide that. Delivering this kind of choice and satisfaction to patients will surely not only improve their sense of mental and physical wellbeing but also their recovery process.”

Choice Makes All The Difference

Comfort foods and cocktails raise spirits on HCA National Day of Choice

Hospital Caterer has had the tricky task of trying to capture within a few pages the tremendous efforts that everyone made on the HCA National Day of Choice to present their patients with new levels of choice - with fun being one of the vital ingredients for success.

Dieticians set the tone at Airdale General Hospital, by dressing up as a giant carrot and strawberry to hand out free fayre over the lunchtime period. They were tempting patients and staff to choose more fruit and veg from the menu as part of the ‘5 a day programme’. Wendy Firth, Catering Services Manager (HCA Member: Yorkshire Branch), said: “We have a really wide range of healthy options on our menu and wanted to show people that you can eat healthily while in hospital. It was a great opportunity to focus on good practice and to promote this to everyone in a very light-hearted and fun way.”

Linda Howarth, Deputy Catering Manager, Torbay Hospital, South Devon reported that two of their wards took part, the Maternity Unit and the Hutchings Ward, the latter a surgical ward where a great number of special diets are required. In Maternity, meals were served at point of service, there was no need to pre-order and the dining room was specially laid out with table slips and napkins to encourage patients to enjoy an informal lunch together. Squash was offered with the meal and tea, coffee and biscuits afterwards. In Hutchings there was also an extended menu, with the assistant dietician on hand to help patients make their choice. “We asked everyone to complete a short survey of their experience and the results were very encouraging,” said Linda.

David Williamson, Support Services Manager, Stratheden Hospital (HCA Member: East of Scotland Branch) told Hospital Caterer: “Working on the adage that ‘if it’s not broken, then don’t fix it’, we followed a very similar route to last year. Practical and financial support was forthcoming, as was the involvement of the Senior Nursing Team, and 11 wards took part. Posters were photocopied and distributed throughout the wards and badges were divided between nursing staff and general assistants who help in ward kitchens. We increased the choice of beverages by offering Ovaltine Light, Blackcurrant Squash and Bovril to all wards and increased the sweeteners for beverages by adding demerara sugar to the list available to wards. This was because when I analysed ordering trends by wards, I noticed that some ordered Bovril, while others ordered Blackcurrant Squash but not all wards did. I will be monitoring the uptake of the increased choices to ensure they are what the patients want and I’ll be on the look out for new beverage choices.”

Ron McKenzie, Head of Catering and Housekeeping, County Durham & Darlington Acute Hospitals NHS Trust (HCA Member: Northern Branch) reports that all hospitals within the Trust took part in the National Day of Choice. Initiatives included cream teas and sing-a-long, strawberries and cream and the introduction of afternoon snacks and patient menu books. At Darlington Memorial Hospital, patients were treated to a VE Day 60th Anniversary theme menu, with a commemorative copy for everyone. The menu included Victory Broth, Boiled Beef and Carrots, Braised Sausages and Onion Gravy and Spotted Dick Pudding. The regeneration ovens were decorated with bunting and the ward hostesses donned air raid warden helmets. The intention is to include a themed dish on the menu once a month.

A considerable amount of press interest was generated around the country by many of the hospitals taking part in National Day of Choice. Norfolk Community Hospitals’ activities for the day - which involved Norwich Community Hospital, Dereham Hospital and St Michael’s Hospital in Aylsham - resulted in a full page of coverage in the Eastern Daily Press, after the reporter joined staff and patients for lunch. Carol Lendrum, Deputy Facilities Manager (HCA Member: East Anglia Branch), insisted he receive his hot meal last - to dispel any myths among readers who may doubt that hospital meals arrive at the bedside hot!

Norfolk Community Hospitals launched a new ‘Extra Choices’ menu of light and easy-to-digest dishes, to offer patients an alternative to the extensive choice on the regular menu each day. “We will be following this up with a survey to get patients views on the new menu. But it’s not just about the food, it’s about the environment of the ward, having the choice to eat away from the bedside, being able to freshen up before and after meals, getting help if needed and getting the food that they want,” said Carol.

Cocktails at one of the Sheffield Teaching Hospitals NHS Foundation Trust certainly helped raise patients’ spirits. At Weston Park Oncology Unit catering staff (with matron’s approval, of course) resurrected a tradition from by-gone days: an afternoon tipple of high energy fruit smoothies, soft drinks and a small measures of alcohol to whet patients appetites before supper. “The obvious joy on patients faces was testament to the success of this initiative,” said Emma Wilson, Head of Catering (Vice-Chairman HCA Trent Branch).

The cocktails were just one of several initiatives the Trust caterers came up with for the day, with inspiration and advice coming from the Trust Patients Council and dietetic colleagues. An enhanced patient menu offered an extra choice of a traditional roast or meat pie, alternative organic vegetables, fresh fruit salad in place of tinned fruit and a choice of flavoured ice-creams. Herbal and fruit teas were offered as alternatives at beverage rounds, plus evening snacks between supper and breakfast.

Said Emma: “Meal uptake figures proved that Sheffield people enjoy traditional dishes best. Organic vegetables were particularly popular as great tasting but the biggest hit on the menu was the bread roll served with the soup which was enjoyed by many patients who had little appetite for anything else. The day has given us food for thought for the future development of catering services here in Sheffield.”

Sonja Brine, Hotel Services Manager, Salford Royal Hospital NHS Trust (HCA Member: North West England Branch) reports that there was a real team approach to the event. The Hotel Services team joined up with the Hospital Matrons’ National Nursing Week and used the day to talk to patients on issues that are key during anyone’s stay in hospital such as visiting times, hospital hygiene and, of course, food. “We extended the menu with popular requests, including a bacon sandwich at lunch time, which was taken up by 167 patients, and a fresh poached salmon salad which went out to 65 satisfied patients,” said Sonja.

“Patients on an extended stay with us, who may have lost their appetites, need to be tempted with a bit of what they fancy. So, on National Day of Choice, we asked them what they’d like to see on the menu. Responses ranged from ribs and cabbage, steak and cowheel pie, to many requests for more snack items such as filled jacket potatoes. I left one ward of mature gentlemen reminiscing about the good old days, which included a full five minutes on the joys of tripe!

“Last year we launched Protected Mealtimes which resulted in the Trust Board’s approval to adopt the scheme in 90 per cent of the hospital. We used this Day of Choice in the same way: to extend the choice to meet the many needs of our 800 patients, thereby aiding the recovery process and giving all round patient satisfaction.”

The Kingston Primary Care Trust used the day to introduce improvements in the meals service for patients at both Surbiton and Tolworth Hospitals (Cedars Block) in conjunction with the Tolworth Hospital Catering Department. Frank Goldsmith, Operational Services Contract Monitoring Officer, listed the initiatives they launched:

• An extended range of hot beverage choices
• The opportunity for patients to eat meals away from the bedside
• A Protected Mealtimes strategy between both Clinical and Operational Support stakeholders to provide patients with the opportunity to eat meals free from avoidable interruptions

“This was all well received by the patients. We had a 45 per cent uptake of specialty teas with ASSAM proving most popular. There was also a 30 per cent uptake of decaffeinated coffee,” said Frank.

Decaffeinated tea and coffee were also a welcome addition to the regular choice of beverages at Leighton Hospital, which is part of Mid Cheshire Hospitals NHS Trust. Carol Delves, Facilities Manager (Treasurer HCA Merseyside and North Wales), said: “We also introduced Flora portions in place of a non-branded margarine to give patients the choice of a healthy eating option. Better hygiene practices were also promoted with the provision of hand wipes on patient meal trays, and Cravendale milk dispensers were installed in each ward kitchen, which produce less environmental waste.”

Pam Stansfield, Head of Catering at the Pennine Acute Hospitals Trust (HCA Member: North West England Branch), described how patients at three of their hospitals got a little bit extra with their afternoon tea on 12 May. At the Royal Oldham Hospital, catering staff baked parkin and carrot cake, while at Fairfield General Hospital and Rochdale Infirmary patients were given extra fruit that included varieties such as pineapple and melon. “It’s a big job feeding all the patients within the Trust with three meals a day and we are always looking at ways to improve the choice of food and drink,” said Pam.

Staffordshire General Hospital’s Senior Catering Manager, Andrew Baker (HCA Member: West Midlands Branch) introduced a hotel-like service for patients on the maternity ward. He and his assistant Robert Willatt provided a breakfast cart for mums and mums-to-be to choose and take their breakfasts at anytime between 08.00 and 10.00, so they could fit their first meal of the day around baby feeds. The range included healthy food options, such as yoghurt and fruit.

Andrew said: “This is providing the level of service, flexibility and choice you’d expect in a hotel. This will make their stay more comfortable and homely.” The Stafford League of Hospital Friends provided funding for the cart.

Paul Nettleton, from Ipswich Hospital NHS Trust (HCA Member: East Anglia Branch), told the journal that they tickled the taste buds of their patients with a greater choice of foods and several special events. Older patients on Bealings, Westerfield and Orford Wards were served full English breakfast, while menus throughout the hospital offered two extra main meal dishes and more puddings. Fruitpacks, smoothies and fruit bars were given out as snacks and everyone working at or visiting the hospital was invited to sample new snacks and drinks to experience for themselves how hospital food has changed for the better. “We had a very successful day, lots of fun and a great atmosphere,” said Paul.

Stuart Kermack, North Bristol NHS Trust (HCA Member: West of England Branch) The Trust offers a choice of meals for all its patients, with plenty of options for those requiring special diets. The meals regularly include dishes designed for the NHS by some of the country’s leading chefs. The additional dishes that were offered for National Day of Choice were featured in advance on the menu so patients had time to make their choice. Decaffeinated coffee was also added to the regular range of beverages.

Thanks to everyone who submitted information and pictures about their respective hospital activities for our HCA National Day of Choice round-up.

HCA National Day of Choice Feedback

Dave Rogers

Kings Park Hospital, Bournemouth, HCA Member: Wessex Branch
“The day proved very popular in our Older Peoples Mental Health Unit. We already have Protected Mealtimes and an excellent environment where the patients can eat, so we offered an increased choice of options for breakfast, lunch and dinner. ‘How wonderful to have a choice’ and ‘It’s nice to be spoiled’ were just some of the comments we received.”

Scott Jones

General Facilities Manager, Southampton City Primary Trust HCA Member: Wessex Branch
“Patients were presented with a number of choices to mark the day, including at least one additional main menu option either at lunch or supper. They introduced the option of Protected Mealtimes so patients could enjoy their food without interruption and adapted the menu so people could select five portions of fruit and vegetables each day. Patients also had the opportunity to select meals as they were served, rather than deciding in advance, or they could make their choice less than four hours before mealtime.”

Carol Tarren

Deputy Hotel Services Manager, Friarage Hospital, Northallerton HCA Member: Northern Branch
“Along with the usual hot beverage choices we serve, decaffeinated coffee and two choices of flavoured tea are now offered to all patients. They can also order fresh fruit from the menu to be served with the lunch and evening meal and in addition a bowl of fresh fruit is now offered at every beverage service. The 5-a-day logo will be printed on all menu information within the next few months.”