HCA National Service Excellence Day

Serving Excellece, Enhancing Patient Mealtimes

5th July 2007

Caterers, dietitians, nurses and ward staff in more than 100 hospitals nationwide rose to the challenge of the HCA National Service Excellence Day on 5 July to mark the start of a nationwide campaign to support improvements in patient food and beverage services at ward level. The day - which was also the 59th anniversary of the NHS - was launched by HCA President, Lady Waldegrave, at the Royal Brompton Hospital, London.

Service Excellence Day - the HCA’s third National Day addressing issues concerning healthcare catering - was spearheaded by Ian Robinson, Chairman of the Oxford Branch and General Manager Hotel Services, Salisbury NHS Foundation Trust. He explains the importance of the event and the pivotal role HCA caterers have to play in driving forward improvements.

The HCA National Service Excellence Day builds on the HCA Protected Mealtimes Day and the HCA National Day of Choice, held in 2004 and 2005 respectively. Each of these days had one thing in common - all required a commitment from participants to undertake actions that deliver real and sustainable improvements around the food agenda that benefit patients and clients within each diverse local health community.

Each of these events targeted key areas where patients have expressed concern:

the environment at mealtimes.
the choice agenda and support.
assistance and service at ward level.

In addition to delivering improvement, the HCA National Days were established to highlight and promote the work of the Association and its Members to a wider audience and to engage with potential Members. Participation in the HCA National Service Excellence Day was FREE and open to all, including non members - and the fact that around 30 non members participated in the event showed that these aims were clearly achieved.

So why Service Excellence?

It is widely reported that the nutritional value of an uneaten meal is NIL; however, too often little is done to address these concerns.

In 2006 the ‘HCA Good Practice Guide - Healthcare Food and Beverage Service Standards’, was published. Many highly respected and worthy publications end up on bookshelves contributing little to service improvement, so clearly the challenge was to translate this document into actions. An HCA National Service Excellence checklist was developed and promoted as part of the campaign. The checklist was mapped against the Knowledge and Skills Framework (KSF) and participation in this year’s National Day provided KSF portfolio evidence in five core and 12 specific dimensions.

Plus, this year’s event supported the work undertaken by the HCA in response to the ‘Council of Europe Resolution, Food and Nutritional Care in Hospitals’. Participating hospitals were asked to consider actions that support the ‘10 Key Characteristics of Good Nutritional Care in Hospitals’.

Many of us accept there is still a long way to go in relation to improving food, food service and nutritional intake at ward level. Recognising what needs to change is the first step to service improvement.

We hope that the HCA National Service Excellence Day and the many activities carried out by caterers across the UK, has helped to address some of these issues. However, the event must be regarded only as a start of the challenge to do more with less - and to do it better than before!

Why the HCA?

I have been asked on a number of occasions why the HCA organised this event, given the multi disciplinary responsibilities around healthcare food and nutrition. In response I am reminded of a speech delivered by Kate Priestly when she was Chief Exec at NHS Estates; when asked a similar question she replied, “because caterers deliver”.

The real value of this event was not only to improve food services for patients but also to share best practice and experiences. With this in mind please read the summary of the activities held by some of the participating hospitals which appears on the following pages.

On behalf of the HCA I would like to take this opportunity to thank the Department of Health and ISS Mediclean both for their financial support and commitment to this campaign. Thanks also to Mike Duckett, Catering Manager and his team at the Royal Brompton Hospital for their hospitality in hosting this year’s launch event.

But the biggest thank you must go to those caterers who made this event a reality. We are all very busy with many competing demands for our time, however, this event allowed us to focus on what’s important - patient care.

Serving excellence with a smile

The HCA National Service Excellence Day presented hospitals around the country with the opportunity to turn the spotlight on their food and beverage services for patients and clients, and to introduce changes and new initiatives that deliver real and sustainable improvements at ward level. Here are just some of the activities that took place.

Sonja Brine, Hotel Services Manager, Salford Royal Foundation Trust describes how all the various catering and domestic service initiatives put in place over the past three years were promoted to the public - while patients enjoyed some treats on the wards. The Catering team created a special menu for the day and provided folded napkins in hand-made Service Excellence napkin rings, a stemmed glass and a commemorative copy of the menu. Extra touches included fruit juice at lunch, fresh strawberry tarts for afternoon tea and after dinner mints at supper. “More mature patients were also offered a drop of sherry to stimulate the appetite, all helping to make the day special,” says Sonja.

A food service trolley, manned by Chef Paula Taylor and Lesley Susan, PEAT and Essence of Care Patient Representative, was placed in one of the main entrances featuring the same food that was being served to the patients. Other activities included an opportunity for the public to meet members of the Domestic Services team to ask questions and to visit a special display about cleaning and hygiene.

Sonja concludes, “The feedback was really positive. One patient said that the HCA’s National Service Excellence Day had spurred her on to change her clothes and do her hair and make-up because the special meals made her feel so much better. This really proves that food is an important part of the healing process. It begs the question: why can’t we do this every day?”

Kitchens at Gosport War Memorial Hospital, Petersfield Community Hospital, St James Hospital and Moorgreen Hospital, which cater for patients being cared for by Portsmouth and Hampshire Primary Care Trusts and Hampshire Partnership NHS Trust, used the Day to launch new improvements to their menus. Scott Jones, Head of Facilities and Environment at Hampshire Partnership Trust, reports that the menus, which were adopted at all the hospitals, now feature more seasonal, locally sourced food. They advertise the locally sourced items which have been included in the dishes, such as steak and kidney pie with meat from local butchers, flour from a local mill and Hampshire strawberries with New Forest ice cream. “The day was a real success and we had high level support at all the sites,” says Scott. “Working with local suppliers will increase the appeal of the food we serve and also reduce our impact on the environment.”

Smoothies were also the talk of National Service Excellence Day at Calderdale Royal Hospital, where Chef Rachel Marsh demonstrated how to make them to patients and visitors on the children’s ward. Four different flavours were prepared using a wide variety of healthy ingredients and samples were handed out to an eager audience. One little boy, who had been refusing to eat since an operation two days earlier, was tempted to taste one of the smoothies.

Friarage Hospital in Northallerton, launched a long stay patient menu on the medical wards providing patients with a wider meal choice during their stay to reduce ‘menu fatigue’. Hotel Services also raised awareness of the benefits of water and introduced an initiative to provide all patients with jugs of chilled water at their bedside table. Carol Tarren, Hotel Services Manager, said, “By participating in the Day of Service Excellence we made a significant statement about the value we place on patients’ well being and our commitment to provide the very best in the NHS food and beverage service.”

Tina Lamb, Hotel Services Manager at North Devon Community Hospital, reports that they focused on Protected Mealtimes to mark HCA National Service Excellence Day.

Vanessa Newton, Quality Assurance Manager, Royal Preston Hospital, reports that catering staff at Chorley and South Ribble and Royal Preston Hospitals - both part of the Lancashire Teaching Hospitals NHS Trust - put on special themed menus for some of their wards. The Royal Preston focused on the children’s ward, preparing special Dinosaur Fun Meal Boxes filled with healthy nutritious food. Colouring books and crayons were also given to the children.

Chorley and South Ribble Hospital held a curry day for patients on the mental health wards, with Indian food and music helping to provide an authentic atmosphere.

The Catering Team and Ward Managers at Queen Elizabeth Hospital, Woolwich, served smoothies to patients to encourage them to take more vitamins. “Some of the patients have problems swallowing and do not always get the required amount of vitamins and it was agreed that the quality branded raspberry and cranberry smoothies were an excellent way to add to their nutritional intake,” says Terry Hopkins, Catering Services Manager.

Angie Fredericks, Retail and Marketing Manager, Worcestershire Royal, describes how the patients’ dining room was transformed into a restaurant with an Anglo-Italian themed menu and appropriately laid tables. “The tiramisu went down a treat and staff said they had never seen so many patients coming to the dining room to eat,” she says. The children were not forgotten: Barney Bear was on hand to issue invitations to the youngsters on Riverbank Children’s Ward to join him for a Teddy Bears’ Picnic at supper time.

The catering team together with the nursing teams, Infection Control, Clinical Practice Development and patients at Northern General and Royal Hallamshire Hospitals, Sheffield celebrated Excellence Day by highlighting the importance of hand hygiene for patients. Individually wrapped refreshing hand wipes were introduced to patient meal trays at mealtimes and according to Emma Wilson, Head of Catering, Sheffield Teaching Hospitals NHS Foundation Trust, they were well received. “We recognised that some patients are too poorly or bed bound to be able to wash their hands before a meal so they, in particular, would benefit from this service,” she explains. “This positive trial will be fed into the recently established Trust Clinical Assurance Toolkit as an area of excellent practice for each ward.” The development of increased patient choice and service was also highlighted at the Northern General Hospital where a new ward block for 160 patients opened in May.

The Facilities Department at Hillingdon Hospital in Uxbridge has worked with Matrons to undertake nutritional and food serve audits to help them achieve Best Practice at mealtimes for patients. Anne Byrne, Hotel Contracts Manager, says, “We used the day to demonstrate that with good communications between the team servers and nursing staff around individual patient needs, patients were eager to eat and given assistance where needed. It all adds up to a gold star service. Moving towards a combined easy-to-follow audit tool will reduce both paperwork and time and promote strong team working between facilities and nursing.”

According to Aiman Abu-Hassan, Catering Manager at Broadgreen Hospital, Liverpool, a number of initiatives concerning food issues have already been implemented to meet patients’ expectations and deliver the highest standards in service. The fifth of July provided an opportunity to remind staff of the importance of such initiatives which include a Nutritional Group, comprised of catering, medical and support staff, which meets monthly to discuss food issues at ward level, Protected Mealtimes and regular training and refresher courses. “We put a catering stand on one of the wards in the Cardiothoracic Centre and talked to patients, relatives and nursing staff about the various initiatives. We also played a DVD about Protected Mealtimes and nursing staff felt it was very helpful in explaining to visitors why we have this system,” said Aiman.

The Domestic Department at Derriford Hospital in Plymouth introduced the colour coded tray system on its Bracken ward, which enables both the domestic and nursing staff to see at a glance which patient requires assistance with eating. Red trays indicate help is needed and blue trays mean no assistance is required. Derriford’s Keith Carter says, “Bracken Ward proactively implements Protected Mealtimes and all departments work together to make sure the meal experience for patients is as enjoyable and stress free as possible.” Domestic supervisors also visited all the wards to monitor how Protected Mealtimes is working and to carry out an audit of crockery and cutlery.

Northampton General Hospital’s catering and production managers had already identified the need to change patient menu choices and improve specialist dietary recognition at the patient’s bedside. So they chose the HCA National Service Excellence Day to launch the new menus and inform clinicians and support staff of the importance of food to aid patient recovery. Brian Willett, Hotel Services Manager, says that a central information point display was set up in the hospital’s Cyber Café and details about the Council of Europe’s ‘10 Key Characteristics of Good Nutritional Care’ were also available. Emphasis was given to Patient Food Service in Action, ensuring that changes and improvements were also being implemented on the ward. A particular focus was the host or hostess food service delivery, which all the hospital wards have.

Michelle Clement, Trust Catering Manager, East Sussex Hospitals NHS Trust, reports that they used the day to promote the services offered at their hospitals. “Display stands were based in both staff restaurants and the main entrance at Conquest and East District General Hospitals. They advertised and promoted some of the good work that we have implemented so far, such as Protected Mealtimes, snack boxes, special dietary menus and food services training. We’ll now be looking at more ways to achieve excellence including the presentation of food on the plate, and the feasibility of introducing hand wipes and coloured serviettes.”

Patient Catering Services are being developed further at Kingston Hospital in Surrey thanks to a new PFI contract for the new Surgical Centre. Sherry Russell, Assistant General Manager, says the contract has enabled the hospital to introduce the Bedside Booklet for all patients so they can make informed decisions about their meal preferences - and it was distributed on HCA National Service Excellence Day. Sherry says, “The book is helping to streamline the service. It also includes a simple calendar to assist nursing staff when they take the patients’ orders.” Each ward was also issued with an up-to-date nutritional folder which provides data for the 392 dishes on the menu.

Simon Redford from the Catering Department at Leicester General Hospital reported that the hospital’s 600 patients enjoyed a taste of summer with their evening meal as all were served a bowl of fresh strawberries and ice-cream.

Stella Gardener, Trust Catering Manager at Southampton General Hospital, reports that a new Children’s Menu was launched on Service Excellence Day in response to a patients’ survey and comments from youngsters that they would like more pasta and ‘grown-up’ dishes. A tasting session was held on the Children’s wards giving patients, parents, ward staff, doctors and nurses a chance to sample some of the new dishes which include Pasta Bolognaise, Vegetable Risotto, Sweet ‘n’ Sour Chicken and Poached Fish in Cheese Sauce.

Stella says, “The launch was such a success we have now started a monthly Children’s Catering User Group where patients, parents and ward staff can give us feedback and ideas to further improve the service.”

The Wimbledon-inspired treat was also offered to patients at County Durham and Darlington Hospitals with their afternoon cuppa. Ron McKenzie, Head of Facilities at Darlington Memorial, reports that a new menu card format was introduced on 5 July too. “It’s a sustainable improvement that will benefit patients and clients,” he says. “The menu will reduce the time lag between choosing the meal and delivery as they will be scanned twice a day. Patients can also fill in a short questionnaire about both lunch and supper. The lunch menu questions focus on respect and dignity, hand washing and overall care and the supper menu is about the meal service and cleanliness.”

New crockery and trays were launched at Nottingham University Hospitals on HCA National Service Excellence Day. John Hughes, Catering Manager, says, “We wanted to do something that would have a lasting impact rather than just for the day so we brought forward our project to renew all the patient and retail crockery with the NHS logo. The trays feature our new Trust name ‘Nottingham University Hospitals.’ The new look crockery has had an instant impact on food presentation and has given the food service team a product to be proud of.”

Not all wards at Staffordshire General Hospital utilise the services of ward hostesses, so the catering department took the opportunity of the HCA National Service Excellence Day to highlight and promote the valued role they play in the patients’ recovery plan - with a view to other wards developing this service. Robert Willatt, Assistant Catering Manager, notes: “All Trust staff were invited to come to hostess-assisted wards to see for themselves the advantages an assisted meal service offers to patients. Display boards and handouts were prepared and staff were on hand to answer any questions about the duties they perform.”