REPORT SUMMARY SHEET. Meeting: SMT and Trust Board. Title: Food Hygiene Annual Report 2013/14. Lead Director: Director of Acute Services

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1 REPORT SUMMARY SHEET Meeting: SMT and Trust Board Date: Title: Food Hygiene Annual Report 2013/14 Lead Director: Director of Acute Services Corporate Objectives: Provide safe, high quality care Make the best use of resources Maximise independence and choice for patients and clients Purpose: For approval/assurance. This report sets out the Trust s position with regard to Food Hygiene during the year 1 April 2013 to 31 March It also advises Trust Board of the controls and systems in place to support the delivery and maintenance of food safety standards and compliance with food hygiene legislation in all Trust facilities. Summary of key areas: The Trust s 2013/14 self-assessment score against the Food Hygiene Controls Assurance Standard was substantive at 89%. 55 of the Trust s food registered premises are rated 4 or 5 under the National Food Hygiene Rating Scheme. The Trust has now embedded the process of microbiological testing which provides verification in respect of HACCP plans. Food safety awareness training has been developed for Nursing staff to help reduce the risk of listeria in hospitals and it is available as e-learning. Weekend catering services in Daisy Hill Hospital have been enhanced with the introduction of longer opening times and a move to a more convenient location. Following the implementation of the Strategy for Good Nutritional Care for Adults in all Care Settings in Northern Ireland , the Dieticians have carried out reviews of the nutritional content of in-patient menus at Craigavon, Daisy Hill and Lurgan Hospitals. The Trust replaced 21 patient meal delivery trolleys at a cost of c 181k and an additional c 203k was spent on new/ replacement cooking and dishwashing equipment.

2 The Trust is reviewing the catering services provided by St Luke s production kitchen due to the changes in the patient and staff profile on the St Luke s site. To mark Nutrition and Hydration week, the Trust served afternoon tea on Wednesday 19 March 2014 in a selection of wards in all hospital. Dieticians and Speech and Language Therapists also organised a presentation on MUST (Malnutrition Universal Screening Tool) and National Descriptors. Food Hygiene Annual Report 2013/14 Page 2 of 18

3 FOOD HYGIENE Annual Report 2013/14 Food Hygiene Annual Report 2013/14 Page 3 of 18

4 CONTENTS PAGE Page No. 1.0 Strategic Context Operational Context Governance Arrangements Monitoring and Audit Arrangements Training Service Improvements.. Nutrition and Hydration Week Key Priorities for 2014/15... Appendices Appendix 1 - Survey Action Plan Appendix 2 - National Food Hygiene Ratings Food Hygiene Annual Report 2013/14 Page 4 of 18

5 1.0 STRATEGIC CONTEXT Hospital and community catering services are an essential part of patient and client care. Safe, good quality, nutritious meals play a vital part in patients /clients rehabilitation and recovery. Effective catering services are dependent on effective planning and the co-ordination of a range of processes involving menu planning, procurement, food production and distribution of meals to patients/clients. The Trust has a legal obligation to comply with the provisions and requirements of food safety legislation and the requirements of the local Environmental Health Department. The Trust must also comply with the following guidelines and standards:- Department of Health Chilled and Frozen Guidelines on Cook-Chill and Cook-Freeze Catering Management Executive Circular HSS (PDD) 1/94 Management of Food Services and Food Hygiene in the Health and Personal Social Services Chief Medical Officer letter Key Steps for Minimising the risk of Listeriosis from High Risk Ready to Eat Foods 28/10/2008 Chief Environmental Health Officers Group NI (CEHOG) Guidance 8 February 2011 relating to Minimising the Risk of Listeriosis Food Standards Agency E-coli O157 Control of Cross-Contamination Guidance February 2011 DHSSPS Controls Assurance Standard on Food Hygiene DHSSPSNI Nursing Care Standards for Patient Food in Hospital DHSSPSNI Strategic Framework for the Delivery of Health and Social Care Catering Services DHSSPS Strategy for Good Nutritional Care for Adults in all Care Settings in Northern Ireland OPERATIONAL CONTEXT The Trust has 56 registered food premises and the main methods of food production used are traditional cook serve (cooked from raw ingredients and served hot) and cook chill (conventionally cooked and blast chilled). There are 5 main production kitchens which supply meals for in-patients, clients and staff, namely:- Craigavon Area Hospital Lurgan Hospital Daisy Hill Hospital St Luke s Hospital South Tyrone Hospital Food Hygiene Annual Report 2013/14 Page 5 of 18

6 A total of approximately 13,000 patient/client meals and 8,000 staff meals (based on lunches and teas) are produced in the main production kitchens on a weekly basis. 3.0 GOVERNANCE ARRANGEMENTS 3.1 Managerial Accountability The Trust s Chief Executive has overall accountability for food hygiene within the Trust. The Director of Acute Services is the designated Executive Director with lead responsibility for Food Hygiene. The Assistant Director of Acute Services, Functional Support Services, is responsible for ensuring that appropriate systems and processes are in place to ensure that food is sourced, stored, prepared, distributed and served in safe and hygienic conditions which comply with current food safety legislation and that appropriate monitoring and audit arrangements are in place. Locality Support Services Managers, who report to the Assistant Director of Acute Services, Functional Support Services, have a professional responsibility for the provision of catering services within the Trust. 3.2 Trust Food Hygiene Committee The purpose of the Food Hygiene Committee is to ensure maintenance of food safety standards and compliance with food hygiene legislation in all Trust facilities. The Committee meets on a quarterly basis and it is chaired by the Assistant Director of Acute Services, Functional Support Services. The Committee includes representatives from Support Services, Estates Services and Environmental Health. The Food Hygiene Committee is a sub-committee of Senior Management Team (SMT) and any food hygiene issues will be reported to SMT by the Director of Acute Services and escalated on to Trust Board if appropriate. 3.3 Trust Food Hygiene Policy A Trust Food Hygiene Policy was approved by Senior Management Team on 16 April It was last reviewed in January 2014 and it is next due for review in January Food Hygiene Annual Report 2013/14 Page 6 of 18

7 3.4 Food Hygiene Controls Assurance Standard The DHSSPS issued a Controls Assurance Standard on Food Hygiene in April 2006 (updated April 2010) with a requirement for Trusts to achieve substantive compliance. 4.0 MONITORING AND AUDIT ARRANGEMENTS 4.1 Internal Audit Arrangements Food Hygiene Controls Assurance Self Assessment In 2013/14, a self-assessment of the Trust s position against the Food Hygiene Controls Assurance Standard was undertaken. The overall score for the self-assessment was substantive at 89%. The Food Hygiene Controls Assurance Working Group has been meeting during 2013/14 to take forward and implement the actions required to maintain and further improve compliance with the Controls Assurance Standard. This group sits as a sub group of the Trust Food Hygiene Committee and it is chaired by a Locality Support Services Manager HACCP Plans There are HACCP (Hazard analysis and critical control points) plans in place for all kitchens which have been agreed by the Environmental Health Officers. Community facilities follow the Food Standards Agency Safe Catering Pack as their HACCP plan. The Food Standards Agency updated the Safe Catering Pack in February 2013 and the updates have been distributed to community facilities that are involved in the preparation and service of food to clients. The HACCP system applies to all stages of the food chain, through procurement, delivery, storage, production and service. HACCP is used to control steps in the business which are critical in ensuring the preparation of safe food and the primary advantage of HACCP is that it is a preventative rather than a reactive approach to hazard identification and control in the food handling environment. Corrective actions to be taken are specified in HACCP and all staff are trained on HACCP. There is an embedded process of verification checks aligned to HACCP in all areas and non-compliances are escalated to the respective Locality Support Services Manager and the Assistant Director of Acute Services, Functional Support Services on a weekly basis. Food Hygiene Annual Report 2013/14 Page 7 of 18

8 4.1.3 Microbiological Testing The Trust has a contract for microbiological testing in place since April 2013 to verify HACCP plans. Testing is carried out on high risk ready to eat foods, food contact surfaces/equipment and staff hands. The frequency of testing at each hospital is on a risk basis. During 2013/14 the process has been embedded in all hospitals and the table below shows the number of tests conducted across the Trust and the results. Result Food Contact Surface Hand Satisfactory Borderline 11 N/A N/A Unsatisfactory Totals Non-conformance procedures are in place for dealing with Borderline and Unsatisfactory results. The corrective actions depend on the type and level of micro-organism (bacteria) detected and they can include checking / reviewing production processes, temperature controls and cleaning standards, reassessing product risks and switching supplier / product, retraining staff and re-enforcing the importance of hand hygiene with staff. The foods and contact surface that tested Unsatisfactory were retested and they all retested Satisfactory with the exception of the items outlined in the table below. The table also includes management s response. Food Management Response Coleslaw Switched to a ready-made product. Cooked Chicken Tuna Salad Changed to an alternative supplier. Staff were re-trained and practices monitored. Food Hygiene Annual Report 2013/14 Page 8 of 18

9 4.1.4 Food Hygiene/ Safety Audits Food hygiene/ safety audits are undertaken by Managers/ Assistant Managers/ Supervisors on a weekly/ monthly basis. Corrective action from these audits is followed up with relevant staff at the time of audit Food Hygiene Practice Audits Food Hygiene Practice Audits are undertaken in the main production kitchens by the Training and Quality Officer, Support Services. These audits are carried out to ensure staff are complying with Food Hygiene practices. During 2013/14, 12 audits were undertaken and any issues identified during the audits were addressed with staff at the time. The reports from these audits are shared with the Locality Support Services Managers and the Assistant Director of Acute Services, Functional Support Services. The audits are also discussed at the Food Hygiene Committee Sub Group which is a sub group of the Trust s Food Hygiene Committee. In addition, the Locality Support Services Managers undertake unannounced audits in the main production kitchens in the other localities and reports are shared with the Assistant Director of Acute Services, Functional Support Services Patient Locker Checks During 2013/14 the Trust has continued to check patient lockers to ensure patients are not storing high risk foods in their lockers for later consumption in line with recommendations from the Public Health Agency following the Listeria outbreak in Complaints During 2013/14 there were 3 complaints received by the Trust with regards to catering services. Details of the complaints are shown in the table below. Location Nature of Complaint Response Daisy Hill Hospital Lurgan Hospital Complainant unhappy regarding the lack of catering facilities on the premises. Complainant unhappy with menu choice. The opening hours of the Ground Floor Coffee Bar were reviewed as part of a review of the overall catering services provided at Daisy Hill Hospital and have been extended. Review of in-patient menus completed and new menu implemented June 2014 which includes additional main courses, sides and light meals. Food Hygiene Annual Report 2013/14 Page 9 of 18

10 Craigavon Area Hospital Complainant unhappy with the way food was served to patient on ward. Completed a review of the supper service by Ward Assistants Compliments During 2013/14, catering services received 35 compliments relating to the high standard of food, excellent menu choice and the quality of food service. A breakdown of the compliments received is as follows: Craigavon Area Hospital - 14 Bluestone Unit - 6 Lurgan Hospital - 5 St Luke s Hospital - 4 Daisy Hill Hospital - 4 South Tyrone Hospital Routine Quality Checks The Catering Departments undertake routine quality checks of patient food delivered to ward level to assist with the verification of HACCP plans. As part of these checks they speak to a small sample of patients to ensure they are happy with the quality of the meals. If any negative comments are received these are followed up at the time with the Catering staff Patient Meal Survey Functional Support Services has a rolling programme of annual service user surveys to support continuous improvement and Personal and Public involvement. A survey was carried out in hospitals across the Trust in December 2013 to seek patient views on the services provided by Domestic, Catering, Laundry and Portering Services. Patients were chosen at random and 185 questionnaires were completed (80 Craigavon, 52 Daisy Hill, 23 South Tyrone, 15 Lurgan and 15 the Bluestone Unit). Overall patients were satisfied with the catering service provided, however several areas for improvement were identified and an action plan was developed to address these issues (see Appendix 1). 4.2 External Audit Arrangements Environmental Health Officer Food Hygiene Inspections District Councils have a responsibility for inspecting food businesses and enforcing food safety legislation and responding to food complaints from the public. Each year, Environmental Health Officers visit catering premises across the Trust to inspect hygiene and food safety practices and audit compliance with food safety legislation. The frequency with which a food business facility is inspected depends on the risk rating it is given by Environmental Health. Food Hygiene Annual Report 2013/14 Page 10 of 18

11 During 2013/14, a total of 27 Environmental Health inspections were carried out within the Trust. These covered the main production kitchens and ward kitchens in hospitals as well as a number of community facilities. A number of issues were identified as non-compliant with current food safety legislation during 2013/14 and all of them have been addressed with the exception of replacement floor covering for the back of the servery at Craigavon Area Hospital which requires funding. Additionally the Environmental Health Officers make recommendations on good practice albeit not required to comply with statutory regulations. However, the Trust does action these recommendations and all of them were completed for 2013/14. The Environmental Health Officers also take random food samples from the main production kitchens for bacteriological testing. During 2013/14 6 food samples were taken and 5 samples were satisfactory and 1 sample was borderline. A breakdown of inspections and samples taken per locality is shown in the table below. No. of EHO Inspections & Food Samples per Locality Inspections Food Samples Armagh/Dungannon 12 0 Craigavon/Banbridge 6 0 Newry/Mourne 9 6 Total 27 6 Following the Listeria outbreak in Northern Ireland in 2008 the Trust established a Joint Working Group with local Environmental Health Officers as a forum for sharing of knowledge and best practice. During 2013/14 the group continued to meet and assist the Trust in developing procedures for dealing with nonconforming microbiological test results National Food Hygiene Rating Scheme The National Food Hygiene Rating Scheme is run in partnership by the Food Standards Agency and local authorities. Under this scheme all food businesses are given a rating which shows how well the business is meeting the requirements of food hygiene legislation. 55 Trust registered food premises are Food Hygiene Annual Report 2013/14 Page 11 of 18

12 eligible to receive a rating under the scheme and the table below shows a summary of the ratings. Rating June There is a reduction in the number of facilities rated a 5 compared to last year because the number of Trust registered food premises decreased as Environmental Health removed some of the Trust s Supported Living facilities from their inspection programme. The table at Appendix 2 gives the rating for each individual facility. A rating of 5 means the level of compliance is Very Good and 4 means Good Beef / Beef Products During 2013/14 there have been authenticity tests on beef / beef products carried out in Trusts across the region as part of the assurance process agreed by BSO with the main supplier following the horsemeat scandal in Random samples from the Southern Trust were tested in November 2013 and there were no negative results reported from this regional testing programme RQIA Inspections The Regulation and Quality Improvement Authority (RQIA) inspect ward kitchens when conducting Hygiene Inspections and any recommendations are addressed within the ward action plans. 5.0 TRAINING 5.1 Food Safety The Trust has continued to deliver a rolling programme of food safety training to food handlers within Support Services. Certified and refresher food safety training is delivered in-house by the Training and Quality Officer, Support Services. There are approximately 200 staff employed within catering services and 97% of these staff have undertaken certified food safety training. The remaining 3% comprises of agency staff that have recently commenced work with the Trust. These staff received induction training on commencement and their formalised training will follow as soon as possible. Food Hygiene Annual Report 2013/14 Page 12 of 18

13 Food safety training is also provided to Domestic Assistants who have food handling duties at ward level. 5.2 E-coli Guidance During 2013/34 there was a range of training provided to staff in respect of the E-coli O157 Control of Cross-Contamination Guidance. In May 2013 Catering Managers attended training delivered by Environmental Health as part of their ongoing development. Environmental Health also ran a series of training sessions in the Southern area which were attended by staff from various hospital and community settings. In addition, in-house training was provided to staff from community facilities in Newry and Mourne locality. 5.3 Food Safety Awareness for Nursing Food safety awareness for Nursing staff has been finalised and made available to staff as e-learning. This training was developed for Nursing staff involved in the service/storage of food to patients and to reduce the risk of further outbreaks of listeria in hospitals. 6.0 SERVICE IMPROVEMENTS 6.1 Catering Services extended at Weekend in Daisy Hill Hospital Weekend catering services in Daisy Hill Hospital were reviewed and they have been enhanced with the introduction of longer opening times and a move to a more convenient location. From March 2014, the catering service provided at the weekend moved from the main dining room to the Ground Floor Coffee Bar, near the entrance and is open from 8.30 am to 5.30 pm on Saturdays and Sundays, providing a more accessible and extended service for staff and visitors. 6.2 Nutritional Analysis of In-Patient Menus Following the implementation of the Strategy for Good Nutritional Care for Adults in all Care Settings in Northern Ireland , the Dieticians have carried out reviews of the nutritional content of in-patient menus at Craigavon, Daisy Hill and Lurgan Hospitals. An Action Plan has been developed at Daisy Hill to take forward the recommendations from this review and Action Plans are being completed for Craigavon and Lurgan Hospitals. A menu analysis is also planned for South Tyrone Hospital. The findings from this review have been taken into consideration in the revision of the in-patient menus at Lurgan Hospital which were implemented in June New Equipment During 2013/14 the Trust replaced 21 patient meal delivery trolleys at a cost of c 181 and an additional c 203k was spent on new/ replacement cooking and dishwashing equipment. Food Hygiene Annual Report 2013/14 Page 13 of 18

14 The replacement meal trolleys will improve temperature control helping to reduce the risk of food borne infections such as listeria and the new equipment will enhance food production processes and result in a safer working environment. 6.4 Catering Services at St Luke s Hospital The Trust is currently reviewing the catering services provided by St Luke s production kitchen due to the changes in the patient and staff profile on the St Luke s site and the review is expected to be complete by December NUTRITION AND HYDRATION WEEK 2014 The Trust took part in Nutrition and Hydration week from March. The week was a UK joint initiative by Patient Safety First, the National Association of Care Catering (NACC) and Hospital Caterers Association (HCA). The aim was to highlight good nutrition and hydration practices, service excellence, promote protected mealtimes and much more. To mark the event the Trust served afternoon tea on Wednesday 19 March in a selection of wards in all the hospitals (Stroke and Rehab Ward in Daisy Hill; 4 South and Ramone Ward 2 Medicine in Craigavon; Wards 1 and 2 in South Tyrone; Ward 2 in Lurgan). This involved the use of volunteers in some areas. Dieticians and Speech and Language Therapists also organised a presentation on MUST (Malnutrition Universal Screening Tool) and National Descriptors and this was carried out in each of the hospitals during the week. 8.0 KEY PRIORITIES FOR 2014/ Open a new ground floor coffee bar in the main foyer in Bluestone Unit by August 2014 that will offer beverages, tray bakes and scones, and light snacks. 8.2 Take forward the recommendations from the Dieticians review of the nutritional content of in-patient menus. 8.3 Develop and implement an action plan in respect of the new Food Information Regulations in relation to allergy information for foods sold non-prepacked which comes into effect in December An action plan will be developed by September Complete review of catering services provided by St Luke s production kitchen by December Food Hygiene Annual Report 2013/14 Page 14 of 18

15 Appendices Appendix 1 Survey Action Plan Appendix 2 - National Food Hygiene Ratings Food Hygiene Annual Report 2013/14 Page 15 of 18

16 Appendix 1 Survey Action Plan Areas for Improvement Planned Taken / Required Timescale Bluestone Unit Patients wanted a greater menu choice for lunch. Patients did not always receive the meal of their choice. Lurgan Hospital Patients unable to understand the menu. Patients wanted a greater menu choice for lunch and evening meals. The quality and temperature of the tea. Patients did not always receive the meal of their choice. Daisy Hill Patients did not always receive the meal of their choice. South Tyrone Patients did not always receive the meal of their choice. Patient menu reviewed and additional light and main meals were introduced. Regular meetings are held between Support Services staff and Nursing and at these meetings Ward Managers have been asked to check menu choices with patients. New menu with new layout to be implemented. Additional main courses, sides and light meals included in the new menu. Flasks are already in use and practises were reviewed. Regular meetings are held between Support Services staff and Nursing and at these meetings Ward Managers have been asked to remind staff to ensure patient menus are fully completed. Send communication to wards to remind staff to ensure patient menus are fully completed at ward level. Send communication to wards to remind staff to ensure patient menus are fully completed at ward level. Complete Complete Complete Complete Complete Complete Complete Complete Food Hygiene Annual Report 2013/14 Page 16 of 18

17 Appendix 2 - National Food Hygiene Ratings (as at June 2014) Locality Facility Name Rating N&M 1 Carrickore 4 A&D 2 Dobbin St / Clover, Longstone Site 4 C&B 3 Edenvilla 4 A&D Longstone Hospital Ward Pantries 4 N&M Newtownhamilton Health Centre 4 N&M The Arc 4 A&D Woodlawn House 4 A&D Woodside Adolescent Centre 4 A&D Appleby SEC 5 C&B Banbridge SEC 5 C&B Bannvale SEC 5 N&M Binnian Lodge 5 C&B Bluestone 5 C&B Bocombra Children's Centre 5 N&M Cedar Grove 5 C&B Cherrygrove Children's Home 5 A&D Clogher Valley DC 5 N&M Cloughreagh House 5 A&D Coalisland DC (Gortgonis Citizen 5 Centre) C&B Copperfields 5 C&B Craigavon Area Hospital 5 N&M Crossmaglen Community Centre 5 N&M Crossmaglen DC (Rathkeelan House) 5 C&B Crozier House 5 C&B Crozier Lodge 5 N&M Daisy Hill Hospital 5 N&M Donard Day Centre 5 C&B Eden SEC 5 C&B Edenderry DC 5 A&D Keady DC, Annvale Road 5 A&D Lisanally Day Centre 5 C&B Lurgan Hospital 5 C&B Manor Centre 5 A&D McCague Day Centre, Aughnacloy 5 C&B Meadows Day Centre 5 N&M Millview Centre 5 1 Newry & Mourne 2 Armagh & Dungannon 3 Craigavon & Banbridge Food Hygiene Annual Report 2013/14 Page 17 of 18

18 A&D Mullinure Hospital Ward Pantries 5 A&D Oaklands 5 A&D Oakridge ISU 5 A&D Oakridge SEC 5 N&M Orchard Centre 5 A&D Orchard House 5 C&B Portadown H&CC (Ground Floor Café) 5 A&D Roxborough House 5 N&M Slieve Roe House 5 A&D South Tyrone Hospital Catering Dept & 5 D Floor A&D South Tyrone Hospital Ward Pantries 5 A&D St Luke's Hospital Main Kitchen 5 A&D St Luke's Hospital Ward Pantries 5 A&D Station Road Resource Centre 5 N&M The Laurels 5 A&D Tower Hill 5 A&D Willowbank Resource Centre 5 N&M Windsor DC 5 C&B Zest 5 Food Hygiene Annual Report 2013/14 Page 18 of 18