Change on the menu

Higher standards, more choice and greater flexibility could all soon be on the menu for the customers of catering services in the health sector. Addressing delegates to the Healthcare Estates and Facilities Management Association conference held in Telford in May, health minister John Denham confirmed that a series of initiatives are on their way – all designed to improve the catering offered at hospitals and other health sector facilities across the UK, (TheFB, June, p10).

Already, catering firms say they are confident that the reforms will open up further opportunities for them, as hospital catering shifts towards the provision of hotel style room service as a result of the government action to raise standards.The initial stages of the government shake-up have already begun, with the creation of a patients food group that will oversee the process of improving catering in National Health Service hospitals. The Audit Commission and the Commission for Health Improvement, set up in November to promote good practice and quality care across all services, have been enrolled to examine NHS trusts across the UK. They will recommend improvement of hospital service standards, including catering. A large part will involve benchmarking to allow hospitals to compare how they are doing, before sharing with each other areas of good practice.

These moves all come as part of a wider investigation into hospital services that saw a team from business tycoon Richard Branson’s Virgin Group enrolled to investigate how the NHS can be made more user-friendly. Alongside this, the teams set up by Denham will be looking at other NHS service areas, such as cleaning, to see how they can be improved.

Some hospitals have already made considerable efforts to offer greater choice in patient services. At the York Hill NHS Trust children’s hospital in Glasgow, for example, the children are offered an a-la-carte menu that caters for vegetarians as well as offering fish and meat dishes.

But despite examples of good practice, the public still thinks hospital food ranks alongside school dinners. According to a Department of Health spokesman, this poor image needs to be addressed. By doing so the NHS is trying to move towards something that is more in line with patients’ expectations. ‘Key to this will be tailoring catering services at each hospital because patients’ views vary considerably from area to area,’ said the spokesman. Common themes that have emerged from NHS and trust surveys are poor menu descriptions, complicated ordering systems, food arriving late, lack of help with feeding, poor complaints procedures and the presentation, temperature and size of portions of food.

Catering firms are confident the reforms will open up further opportunities, as hospital catering shifts towards hotel style room service

Another issue is wastage – a problem that could be reduced with greater meal choice suggests Jon Facer, support services manager at Southend Hospital NHS Trust. The Department of Health says that underpinning any improvement in the quality of hospital food will be an undertaking that it will remain the responsibility of the nurses to ensure that the nutritional needs of patients are met – ‘also that they are able to eat the food provided and are given assistance to do so where necessary,’ the spokesman said.

Contract catering firms are confident that they will be well placed to meet the new demands, although additional services may cost more. ‘Whatever they want us to provide we can provide it, but it will all come at a price,’ says Sarah Avery, commercial director at Granada Healthcare Services.

The main obstacle for contractors, says Avery, will be provided by the need to establish contact between the wards and the catering staff. If patients want room service standards then they are going to need a phone to initiate the whole process. It is also difficult getting food from the kitchens to the patient on time without interruptions from hospital procedures, such as the doctors’ ward rounds. Procedures vary at different hospitals and on different wards so the solution is mainly about offering a flexible service. ‘It is a question of sitting down with those in charge to discuss who does what. What we need are operational procedures,’ she says. The private sector already has a foot on the ladder in providing a flexible service argues Avery.

Some Granada kitchens, for example, stay open from 8am until 7pm offering hot and cold food, made to the patients’ requirements. However, she agrees there is a need for greater choice. ‘Currently patients have two or three choices on the menu. We want to increase this and go to about six or seven choices,’ she says. Avery predicts that companies will turn to the private sector because they offer managers greater flexibility in service. Contractors also provide catering at a guaranteed price and have considerable experience in the marketplace.

The Audit Commission will use benchmarking data to reveal areas of best practice, making the lessons learned available to all hospitals

Chris Parsons, facilities director of County Durham and Darlington Priority Services NHS Trust, says he is seriously considering a move to a private catering company because he does not have the capital to provide the service in-house. Following the proposed closure of County Hospital in Durham city, the trust is now looking for a site in the Darlington area. He says it is very likely he will choose a cook/chill service provider when the initial planning stage of the project is reached in August. ‘With cook/chill the patient selects what they want from a menu and half-an-hour later it arrives at their bed.’

The private sector may be preparing itself to take on more of the work of in-house catering teams, but it is too early to predict a mass shift in this direction without first seeing the results of the government investigation, says Southend’s Facer. ‘Some hospitals may be under the impression they are fulfilling the standards expected of them, and, until they have been audited, it will be hard to say.’ The benchmarking initiative will play a big part in decision making, and Southend Hospital NHS Trust has already completed a value for money portfolio sent out recently by the Audit Commission. ‘Benchmarking is a regular occurrence at this trust and it is something that we do as a matter of routine to ensure we are achieving best value for money,’ says Facer.

Internal benchmarking is not compulsory, however, so the Audit Commission will use the data it compiles to reveal areas of best practice, making the lessons learned available to all hospitals. ‘Benchmarking and performance levels are something we have to do to know where we stand,’ says Facer.

Meanwhile, hospital trust managers may worry that an increase in service standards will mean an increase in spending, but Facer does believe this is not necessarily the case. He suggests struggling trusts should take on board some help and that the money for this can be found internally without going over budget. ‘I think there are enough trusts in the NHS who are carrying out very good practices and do it very competitively,’ he says.

For Facer it all comes down to the quality of the management: ‘If you have control of your operation you can provide a top quality service. If you have areas that are not under control costs can spiral.’ Facer thinks it is too early to predict the outcome of the government’s investigation: ‘It is hard to say what the results will be until after the audit. Brand new hospitals will be a different story to ones built 150 years ago.’ But he suspects that the big issues will lie in the areas of wastage, regional demands, individual requirements and outdated catering facilities.