The Provision of Food, Hydration and Nutrition for Patients, Staff and Visitors Policy

The Provision of Food, Hydration and Nutrition for Patients, Staff and Visitors Policy DOCUMENT CONTROL: Version: 2 Ratified by: Estates and Facilities Sub Committee Date ratified: 4 December 2018 Name of originator/author: Head of Facilities Name of responsible Clinical Policies Review and Approval Group committee/individual: Date issued: 12 December 2018 Review date: December 2021 Target Audience All Trust Staff

Contents 1. INTRODUCTION... 4 2. PURPOSE... 4 3. SCOPE... 5 4. RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES... 5 4.1 Chief Executive... 5 4.2 Executive Director of Finance... 5 4.3 Directors, Service Managers and Modern Matrons... 5 4.4 Head of Estates and Facilities... 5 4.5 Head of Facilities... 6 4.6 Catering Manager... 6 4.7 Dieticians... 6 4.8 Nutritionist... 6 4.9 Food Handlers (ward staff, housekeepers, ward hostesses, volunteers)... 6 4.10 Procurement Team... 6 5. PROCEDURE / IMPLEMENTATION... 6 5.1 Patient Meal Service... 8 5.2 Patients Self Catering... 10 5.3 Patient Meals Provided by a Third Party... 11 5.4 Quality Assurance Patient Involvement... 11 5.5 Nutrition and Hydration Forum... 11 5.6 Commenting on the Patient Meal Service... 12 5.7 Staff / Visitor Catering Services... 12 5.8 Hospitality Catering... 13 5.9. Governance and Risk... 13 6. TRAINING IMPLICATIONS... 14 7. MONITORING ARRANGEMENTS... 14 8. EQUALITY IMPACT ASSESSMENT SCREENING -... 14 8.1 Privacy, Dignity and Respect... 14 8.2 Mental Capacity Act... 15 Page 2 of 15

9. LINKS TO ANY ASSOCIATED DOCUMENTS... 15 10. REFERENCES... 15 11. APPENDICES... 15 Page 3 of 15

1. INTRODUCTION Every healthcare provider has a responsibility to provide the highest level of care possible for their patients and this, without question, includes the quality and nutritional value of the food that is served and eaten. Food should complement patient care. By providing the right food to meet patients needs for recovery, wound healing, health and wellbeing and rehabilitation, it can lead to a positive patient experience and bring significant cost savings. The Trust Board acknowledges how essential the provision of high quality meals to patients is, and that individual nutritional needs are met. The Department of Health and Age UK have identified five required hospital food standards which are to be met by all healthcare providers and which are included in the NHS Standard Contract, forming a legally binding document. This policy addresses the five key standards, giving direction and guidance to all Rotherham Doncaster & South Humber NHS Foundation Trust (The Trust) staff associated with all aspects of patients nutrition to ensure patients are given access to excellent quality catering services. This policy also covers retail and function catering for staff and visitors with the ethos of eating for health and being a beacon for good practice in supporting staff to make healthier choices. Food provided in healthcare premises should be used as a vehicle for improvement and a role model for healthier lifestyle choices. By informing, educating and offering choices to benefit a healthier lifestyle the Trust can influence its workforce who in turn can influence those they serve in the community. It is the Trusts aim for patients to see meal times as an enjoyable experience and it is recognised that in providing these services it is essential that all current food safety regulations are met. A patient centred approach will be used to ensure a focus for individual patient s catering needs. This will ensure an appropriate healthy balanced diet is consistently delivered in an appropriate environment. The Trust recognises the challenges that are faced when catering for a wide range of patients which range from young children to the elderly. Some patients also have special dietary / cultural needs that have to be catered for. Other situations which may present themselves could include malnourished or obese patients who are admitted or develop conditions during their stay in hospital at the Trust. This policy will set out a consistent approach to address these issues. 2. PURPOSE The purpose of this policy is to set out how the five required hospital food standards will be met by the Trust. The standards are: 1. The 10 key characteristics of good nutritional care from the Nutrition Alliance Page 4 of 15

2. Nutrition and Hydration Digest (The British Dietetic Association) 3. Malnutrition Universal Screening Tool MUST (British Association of Parenteral and Enteral Nutrition BAPEN) or equivalent validated nutrition screening tool 4. For staff and visitors catering: Healthier and More Sustainable Catering Nutrition Principles (Public Health England) 5. Government Buying Standards for Food and Catering Services from the Department of Environment, Food and Rural Affairs 3. SCOPE This policy applies to all patients, staff and visitors who use catering services provided by the Trust. It also covers the patient meals provided by the inhouse catering service, out sourced service providers, self-catering facilities and retail catering. This policy does not include food safety issues which are covered by the Food Safety Policy. 4. RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES 4.1 Chief Executive The Chief Executive Is accountable for ensuring that patients have a positive and safe experience during their stay, which includes the provision of food, hydration and nutrition. This duty is delegated to Directors, Managers, Supervisor and all staff 4.2 Executive Director of Finance The Executive Director of Finance is accountable for ensuring that systems and processes are in place, through delegation to the appropriate service managers to ensure the standards are met. The Director of Finance will also ensure adequate financial provision for food and beverages to meet individual patient needs. 4.3 Directors, Service Managers and Modern Matrons Directors, Service Managers and Modern Matrons will ensure clinical staff are appropriately trained and competent in meeting the nutrition and hydration needs of patients. 4.4 Head of Estates and Facilities The Head of Estates and Facilities is responsible, through delegation to the appropriate managers, for ensuring that the patient meal service and retail catering are in line with the standards set out within this policy. Page 5 of 15

4.5 Head of Facilities The Head of Facilities is responsible for ensuring that the patient meal service and retail catering are in line with the standards set out within this policy. 4.6 Catering Manager The Catering Manager is responsible for overseeing the production of the food service, and that all catering personnel adhere to the standards relating to patient nutrition, allergens, and healthy eating options. 4.7 Dieticians Dieticians are responsible for leading on the nutrition and hydration for patients in line with the Nutrition and Hydration Digest (The British Dietetic Association) and working in close partnership with catering and care teams. 4.8 Nutritionist The Nutritionist will work closely between the catering department and the Dieticians, providing advice, guidance and training on patient nutrition to ensure the policy is maintained 4.9 Food Handlers (ward staff, housekeepers, ward hostesses, volunteers) Food Handlers have an important role in supporting patients to make the right decisions when eating for health and ensuring compliance when food handling (including allergen awareness, providing meals suited to cultural beliefs, food safety etc.) 4.10 Procurement Team The team have a responsibility to monitor and review the suppliers to the catering department to ensure all purchases are compliant with the government buying standards, and that the Trust is receiving value for money from its suppliers. 5. PROCEDURE / IMPLEMENTATION All Trust staff involved in patient care has a responsibility to follow the procedures, processes and standards as identified in this policy. Directors, Service Managers and Modern Matrons, in conjunction with the Head of Facilities, Ward Staff, Allied Health Professional leads and Dieticians will ensure the following are achieved: - Ensuring that the Malnutrition Universal Screening Tool (MUST) is completed by a qualified member of the nursing team (band 5 or above) within 24 hours of a patient being admitted. The tool should be repeated as directed by the outcome score of the previous screening. Page 6 of 15

- In-patients are provided with a personal care support plan and where appropriate, will have the opportunity to have personal input to identify their nutritional care and fluid needs and how they are to be met - Those using Trust services are involved in the planning and monitoring arrangements for food and beverage provisions - Facilities and services are designed to be flexible and centred on the needs of the people using them - High quality food is served / provided, to meet individual patient s nutritional needs and significantly contributes to the patient s wellbeing - Any allergies / special dietary needs are to be highlighted and communicated to the Catering Department and the Trust Dietetics Service, should there be a consequential nutritional need. - All food handlers are trained in allergen management, including the provision of allergen information - A Trust wide Food Safety Policy is up to date and implemented which assists in ensuring compliance with current regulations/ legislation and demonstrates duty of care - The design of menus and content are appropriate to the patient group and approved by a registered Dietician - The Trust wide Dietetic Service is available to provide dietary advice to patients and carers where deemed appropriate following completion of the MUST screening. Patients requiring nutritional support will have a nutritional action plan implemented. This will include providing high energy snacks between meals, whole milk and dairy products, and the encouragement of an enriched diet. - Dieticians are available to provide advice and support to ward and catering staff - Dieticians and clinical colleagues lead on the development, implementation and monitoring of local and national policies as part of clinical governance, developing relevant and workable guidelines, protocols and training to support service improvement on nutritional care - All patients are given information, help and guidance and are encouraged to select healthy and nutritionally balanced meals. - Help is given with eating and drinking to those people identified as vulnerable - All staff associated with the patient catering services (including ward staff) are competent and appropriately trained to a standard Page 7 of 15

commensurate with their role and duties including food service and hygiene, as detailed in the Trust s Food Safety Policy. Ward staff are required to collate menu orders using the electronic patient meal ordering system and encourage patients in making their own menu choices to meet their nutritional needs. Adopting this practice will reduce levels of waste - Patient menu cycles will be a minimum of a 3 week cycle. Whenever possible patients should select their choice of foods from the menu, although some patients may need assistance to make choices in line with their nutritional needs. Unless there are very exceptional circumstances meal ordering should take place no more than 48 hours before consumption. - Menus will reflect current healthy eating standards for the whole Trust population, for example, 5 portions of fruit and vegetables per day and contain between 1810-2550 kcal (energy) and 56g protein per day for a nutritionally well adult - An average complete meal (starter, main and dessert) comes to approximately 500 kcals, whether vegetarian or non-vegetarian - Chilled drinking water should be available to all patients by means of access to a patient kitchen or from water coolers located on the wards - Procurement of foods produced to higher sustainability standards, covering issues such as food produced to higher environmental standards, fish from sustainable sources, seasonal fresh food, animal welfare and ethical trading considerations - Foods procured and served to higher nutritional standards, to reduce salt, saturated fat and sugar and increased consumption of fibre, fish, fruit and veg - The procurement of catering operations to higher sustainability standards, including equipment, waste and energy management 5.1 Patient Meal Service Patient breakfast and snacks are provided at ward level from ward provisions. All main meals for patients will use a delivered meal service which forms part of the Trust s bespoke catering system. Ingredients are sourced through approved suppliers and are delivered fresh and frozen into the Tickhill Road Hospital site central production unit on a daily basis. The central production unit operates a cook freeze system which involves meals being freshly prepared and cooked by a team of dedicated catering staff. Dishes which can be frozen are then blast chilled and blast frozen to lock in the freshness and taste. Dishes which are best served fresh are made Page 8 of 15

on the day of the service using fresh ingredients (for example salads, sandwiches, pasta salads etc.) The catering department use historical data to carefully plan production to ensure minimal waste and ensure menus meet customer requirements. Patient meals are delivered to the wards by members of the catering team. Food orders are picked and packed daily and transported in insulated boxes approximately 90-120 minutes prior to the meal service. The hot dishes are cooked at ward level in regeneration ovens, and cold dishes are stored in the adjoining chiller unit. The cooking cycle for hot dishes is 90 minutes and the ovens are programmed to cook the meals to temperature in time for the planned meal sitting. The temperature of the cooked food must reach 75⁰c before being served. If the temperature is not achieved, then the oven is to be boosted until the correct temperature is achieved. It is the responsibility of the food handler at ward level to ensure that all food safety requirements are checked and recorded. This system offers the following benefits: - Safe tried and tested catering systems that is a NHS nationally recognised system of food delivery - Ensures food can be served at the correct temperature - Meets current catering legislation - Consistent quality product is served - Offers the wards (patients) a greater degree of flexibility of meal choice To enhance the patient meal time experience, protected meal times operates on all wards. This allows for a raised awareness of the importance of food and hydration. During this time, all clinical activity should cease to allow for patients to enjoy their meal. Where funded, ward staff may be permitted to dine with the patients to promote a positive meal time experience and to encourage patients to eat a healthy balanced meal. Meal times are displayed on the catering information boards located in each ward and the meal service will be within the following times: Breakfast 07.00 09.00 Lunch 12.00 13.30 Evening Meal 16.30 18.00 Patients will be encouraged to eat in ward dining areas in an environment that enhances the patient meal experience. The catering team are trained to deliver all meals to the highest standard possible. The way meals are presented can have a huge impact on the Page 9 of 15

overall meal experience and plays a large part in the wellbeing and recovery process. The Trust catering team are encouraged to have a positive attitude to the meals which are served and to take pride in meal appearance and presentation. Staff are aware of how important their role is to ensure food served is placed on the plate in an attractive and appealing manner. A wellpresented appetising meal will tempt patients to eat and promotes a positive meal experience. The catering team cater for patients with cultural and special dietary requirements which are suitably coded to enable patients to make an informed choice and assist ward staff who advise patients. Dieticians will provide ward staff with information on healthy eating appropriate to the patient group, in order to help them in encouraging / supporting patient in their menu selections. Guidance is also available from the Trust Nutrition (Promoting Good Nutrition for Patients) Policy. The catering team provide allergen information on all menu items and this can be found on the catering intranet site. Advice can be sought on ingredients in all dishes by contacting the catering department. In line with the HCA s Good Practice Guide, a minimum of 7 beverages are offered over the day at ward level, with both hot and cold beverages being available at all times At least two snacks a day are provided either mid-morning or afternoon and one in the evening (provided at ward level). Patient menus will be reviewed regularly by the Facilities Department, involving ward staff, patients / representatives and dieticians. Recipe and menu analysis is undertaken by an experienced registered dietician who appropriately interprets both the input of data and the results, and are aware of food regulations. Sensitive guidance about suitable snack foods and drinks is available to all patients and their visitors, to minimise the possibility that high calorie food and drink snacks will be given to them. 5.2 Patients Self Catering Where there is a need identified by clinical staff that patients would benefit from self-catering activities, the Catering team will support these initiatives whenever possible. The assistance will consist of advice on menu planning, equipment, and food safety etc. Any wards embarking on this practice must ensure the storage, preparation, cooking and service is supervised by a competent person who has a formal food safety qualification. Information on all aspects of catering can be obtained from the Catering Manager Page 10 of 15

When self-catering takes place, ward staff must ensure a record is made and retained of what food has been produced and eaten for traceability purposes. This would also apply where wards send out for takeaway meals. 5.3 Patient Meals Provided by a Third Party Where patients receive their meals from a third party, (e.g. a contract catering company), the Head of Purchasing, Dieticians and the Head of Facilities will ensure the quality of the service provided is based on the principles of this model. The Trust will develop clear and concise service level agreements and carry out regular monitoring of these services. Wherever possible, ward staff should discourage patients relatives and friends from bringing high risk foods into the care setting. Where this cannot be achieved, the ward manager should refer to the Trust Food Safety Policy to ensure correct storage / re-heating procedures are followed. The nurse in charge has the responsibility to log all food items eaten by the patient which has been brought in from external sources. 5.4 Quality Assurance Patient Involvement Assurance that the catering service consistently meets the needs of patients will be monitored using the following methods: Internal checks and audits carried out by Facilities staff Annual Patient Led Assessments of the Care Environment (PLACE) audits of all in patient areas of which food and the patient meal service is one of the six domains which is audited Nutrition and Hydration Forum group meetings with representatives from dieticians, nursing, catering, patient representatives and health and wellbeing lead Patients invited to sample new dishes prior to them being introduced onto the menu By invitation, Facilities/Catering staff to attend patient user group meetings Facilities team to liaise with patient representatives, e.g. PALS/Patient Advocates/Ward Managers, with regards to meal service developments Catering manager to attend ward meetings where catering services are discussed Where appropriate, patient catering surveys are carried out 5.5 Nutrition and Hydration Forum Bi-monthly Nutrition and Hydration meetings take place with a focus on providing a quality catering service for patients and ensuring good standards of nutritional care are provided. Page 11 of 15

The Head of Facilities chairs the meetings with representation from Dieticians, Nutritionist, Clinical Staff, Catering Staff, Patient Advice and Liaison Services (PALS), Health and Wellbeing Lead and Patient Representatives are invited to attend these meetings. Complaints, compliments and IR1s are discussed, agreeing lessons learned and providing feedback and actions being taken to improve service delivery. 5.6 Commenting on the Patient Meal Service Patients, their representatives or ward staff who wish to comment on the catering service should in the first instance contact the Catering Manager. If it involves a problem or complaint, this should be reported as soon as possible to allow for immediate investigation to take place. Patients are given the opportunity to feed back on the catering service by completing the catering feedback questionnaire which can be found in the catering information board with additional copies available from the ward host/hostess. All patients should be issued with or have access to the Trust s Mealtime Journey leaflet which provides them with information on the meal time experience. (Document reference number DP7844/05.15) 5.7 Staff / Visitor Catering Services For many people, the majority of their time is spent at work, therefore the workplace is an ideal place to promote healthy lifestyles and encourage healthier eating. It is also part of an employer s responsibility to help keep staff healthy and look after their well-being whilst in the workplace. The Trust wants to ensure that it is committed to providing staff with healthy food choices at work and are compliant with the Health and Wellbeing CQUIN requirements around healthy eating in retail catering outlets. In this way, the Trust s catering department will provide healthy food choices in their restaurants, vending facilities and function catering menus. The Health and Wellbeing CQUIN for retail catering covers the following: The banning of price promotions on sugary drinks and foods high in fat, sugar or salt The banning of advertisements on NHS premises of sugary drinks and foods high in fat, sugar or salt The banning of sugary drinks and foods high in fat, sugar or salt from checkouts Ensuring that healthy options are available at any point including for those staff working night shifts Reduce the total volume of sugar sweetened (sugar added) beverage sales (this can be no greater than 10% of total sales) Any sugar sweetened beverages which are still sold, to be no more than 330ml pack size Page 12 of 15

Confectionary and packet sweet snacks are in the smallest standard single serving portion and do not exceed 250kcal Savoury snacks are only available in packets of 30g or less At least 75% of pre-packed sandwiches available contain 400kcal or less per serving and do not exceed 5g of saturated fat per 100g The Trust recognises that the provision of retail catering services can enhance the facilities and provide a valuable service to staff and visitors. Dining and coffee shop outlets will be in an appropriate location with an environment which is fit for purpose, with assurances that all relevant legislation and regulations are being met. Retail prices in the catering outlets will be reviewed annually to take account of any variation in the purchase price of the goods bought in and pay costs. Standardised retail prices for staff and visitors will apply to all outlets across the Trust. 5.8 Hospitality Catering All hospitality catering will be provided solely by the Trust s in-house caterers. The Trust will not pay for any catering provided by external companies on Trust premises. Any hospitality provided by the catering department will be charged to departmental budgets. Locally sited beverage machines are the responsibility of the host department and should be routinely cleaned, maintained and replenished. All products must adhere to the current CQUIN requirements as in section 5.7. 5.9. Governance and Risk This policy, supported by the Hazard Analysis of Critical Control Points (HACCP) and the Food Safety Policy will enable the Trust to achieve compliance with all relevant legislation, codes of practice etc., and fits within the Trust s organisational governance and risk management framework. All catering units (including ward kitchens) will be subjected to regular internal management hygiene audits and any adverse findings acted upon promptly. All catering units (including ward kitchens) will be subject to an external inspection carried out by the Local Environmental Health Officer. Any corrective action will be acted upon promptly. Scheduled patient meal service audits will be carried out at the point of service by appropriate health professionals and Facilities staff which will examine: The appropriateness of the meal times The food, temperature, presentation and quality Any patients comments Cleanliness of items used in the meal service Un-served food (waste) Page 13 of 15

The catering provision for the Trust will be subjected to a Patient Led Assessment of the Care Environment (PLACE) audit on an annual basis which will include food tasting in addition to a number of organisational questions around the provision and delivery of the meal service. Any major adverse findings from PLACE relating to food will be recorded in an action plan devised by the Head of Facilities and submitted to the relevant managers for action. 6. TRAINING IMPLICATIONS As a Trust policy, all staff need to be aware of the key points that the policy covers. A number of means to delivery and share this policy include: Team Brief Trust wide mail drop Team meetings One to one meetings / Supervision Posters CPD sessions Weekly Newsletter Trust wide email Special meetings Group supervision Practice Development Days Local Induction 7. MONITORING ARRANGEMENTS Area for Monitoring How Who by Reported to Frequency Compliance with Policy CQUIN Compliance PLACE Audits Data gathering PLACE Teams (Facilities Led) Catering Management Head of Estates and Facilities. Trust Board CQUIN Project Manager and NHS England Yearly Quarterly 8. EQUALITY IMPACT ASSESSMENT SCREENING - The completed Equality Impact Assessment for this Policy has been published on this policy s webpage on the Trust s policy website. 8.1 Privacy, Dignity and Respect The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi s review of the NHS, identifies the need to organise care around the individual, not just clinically but in terms of dignity and respect. As a consequence the Trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be Indicate how this will be met No issues have been identified in this Page 14 of 15

considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided). policy 8.2 Mental Capacity Act Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals capacity to participate in the decision making process. Consequently, no intervention should be carried out without either the individuals informed consent, or the powers included in a legal framework, or by order of the Court Therefore, the Trust is required to make sure that all staff working with individuals who use our service are familiar with the provisions within the Mental Capacity Act. For this reason all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act 2005 to ensure that the interests of an individual whose capacity is in question can continue to make as many decisions for themselves as possible. Indicate How This Will Be Achieved. All individuals involved in the implementation of this policy should do so in accordance with the Guiding Principles of the Mental Capacity Act 2005. (Section 1) 9. LINKS TO ANY ASSOCIATED DOCUMENTS Food Safety Policy Hazard Analysis of Critical Control Points (HACCP) Nutrition (Promoting Good Nutrition for Patients) Policy 10. REFERENCES NHS staff health and wellbeing: CQUIN guidance (Department of Health) 2016 The Hospital Food Standards Panel report, August 2014 11. APPENDICES None. Page 15 of 15