NHSScotland National Catering and Nutritional Services Specification: Half Yearly Compliance Report Results for July Dec 2016 March 2017
National Catering and Nutritional Services Specification: Half Yearly Compliance Report: Results for July - December 2106 Contents page 1. Introduction... 1 2. Background... 2 3. Findings... 3 Appendices... 8 Appendix 1: Definitions... 9 Appendix 2: Methodology... 11 Appendix 3: Approach to Reporting... 12 Version 1.0 Published
National Catering and Nutritional Services Specification: Half Yearly Compliance Report: Results for July December 2106 1. Introduction This report provides monitoring data on compliance with the requirements set out in the NHSScotland Food in Hospitals National Catering and Nutrition Specification for food and fluid in hospitals in Scotland 2008. It includes data on: the 14 NHSScotland Operational Boards; 2 Special Health Boards Golden Jubilee National Hospital and the State Hospitals Board for Scotland. NHS National Services Scotland-Scottish National Blood Transfusion Service (NSS-SNBTS) and Scottish Ambulance Service (SAS) do not conduct any reviews as they have no in-patient catering services. The report indicates the status of each NHS Board using a traffic light system as follows: Colour Des cription Green compliance above 90% Amber compliance between 70% and 90% Red compliance below 70% Version 1.0 Published Page 1 of 12
National Catering and Nutritional Services Specification: Half Yearly Compliance Report: Results for July December 2106 2. Background The nutritional wellbeing of the patient population in hospitals remains a priority issue for NHSScotland. The Food in Hospitals National Catering and Nutrition Specification for food and fluid in hospitals in Scotland 2008 was developed to ensure that the catering and nutritional services were clear as to the requirements of the new specification. Catering and nutritional services are an essential part of the multidisciplinary approach to tackling the issues affecting the nutritional wellbeing of the patient population. For a definable improvement in the nutritional standards to be delivered in a consistent and effective manner it is crucial for nutrition to be embedded into everyday practice. There must be a culture of Nutritional well-being is everybody s business, with integration of best practice into routine activities. In November 2007, Health Facilities Scotland (HFS) was commissioned to develop a self-assessment audit tool for the NHSScotland National Catering and Nutritional Services Specification. This was developed in consultation with the HFS Catering Services Advisory Group and a range of stakeholders within NHSScotland. Trials of the system were completed in June 2009. Compliance monitoring in this context is defined as the ongoing assessment of the outcome of catering and nutrition processes to assess the extent to which the Food in Hospitals (FiH) specification has been implemented in Scottish Health Boards, to identify any remedial action which is required and to provide an audit trail. The ultimate aim of this monitoring exercise is to drive up standards of nutritional care experienced by patients. Version 1.0 Published Page 2 of 12
National Catering and Nutritional Services Specification: Half Yearly Compliance Report: Results for July December 2106 3. Findings This report covers the period July - December 2016 for all NHS Boards in Scotland which operate in patient catering services. Boards have been advised by Health Facilities Scotland (HFS) that no standard can be passed until all the required evidence is available and documented for audit purposes. Scores should therefore be robust and evidence based. Key Findings Pan Scotland the overall compliance result has increased with a small percentage of 1.0%, from 96.0% to 97.0%; the pan NHSScotland average results by category e.g. menu planning etc are all Green (over 90% compliance with the specification); all Health Boards in Scotland have achieved a Green overall result (result over 90% compliance) in this six month period; the number of Amber results (compliance between 70% and 90%) is 13 which is an increase from the previous 12; there are no Red results (compliance under 70%); The Facilities Support Team (FST) in HFS is available to support Health Boards in NHSScotland with Nutritional compliance results. Page 9 of this report shows more increases in performance than the previous six monthly return. Health Boards may wish to engage early with the FST to identify if there is action which can be taken over the next few months to reverse this emerging trend. Version 1.0 Published Page 3 of 12
National Catering and Nutritional Services Specification: Half Yearly Compliance Report: Results for July December 2016 NHSScotland Health Boards 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% Version 1.0 Published Page 4 of 12
National Catering and Nutritional Services Specification: Half Yearly Compliance Report: Results for July December 2016 Nutrition Results by Category 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% Nutritional needs of population Menu planning Food based standards Menu planning guidance Therapeutic Diet Provision Special & Personal Diets Patient Experience Totals Version 1.0 Published Page 5 of 12
Findings (continued) National Catering and Nutritional Services Specification: Half Yearly Compliance Report: Results for July December 2016 Nutritional Compliance Results Dec 16 Nutritional needs of population Menu planning Food based standards Menu planning guidance Therapeutic Diet Provision Special & Personal Diets Patient Experience NHS Scotland 93.2% 96.6% 99.8% 93.8% 96.0% 98.0% 97.9% 97.0% NHS Ayrshire & Arran 88.9% 98.8% 100.0% 91.7% 92.3% 100.0% 100.0% 97.2% NHS Borders 100.0% 98.9% 100.0% 97.2% 94.9% 100.0% 100.0% 98.9% The State Hospital 77.8% 100.0% 100.0% 83.3% 92.3% 83.3% 100.0% 94.2% Golden Jubilee 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% NHS Fife 95.6% 100.0% 100.0% 96.7% 100.0% 99.2% 100.0% 99.3% NHS Greater Glasgow & Clyde 100.0% 100.0% 100.0% 93.1% 100.0% 100.0% 100.0% 99.6% NHS Highland 98.1% 98.4% 100.0% 97.2% 97.9% 97.7% 96.7% 98.3% NHS Lanarkshire 97.2% 95.2% 96.6% 100.0% 94.2% 100.0% 100.0% 96.9% NHS Grampian 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 95.5% 99.5% NHS Orkney 88.9% 96.8% 100.0% 100.0% 92.3% 100.0% 100.0% 97.1% NHS Lothian 95.6% 89.4% 99.5% 90.8% 95.4% 94.2% 95.5% 94.1% NHS Tayside 78.9% 92.3% 100.0% 92.5% 93.1% 100.0% 94.5% 94.0% NHS Forth Valley 100.0% 100.0% 100.0% 100.0% 92.3% 100.0% 100.0% 99.0% NHS Western Isles 88.9% 83.9% 100.0% 83.3% 88.5% 95.8% 100.0% 91.3% NHS Dumfries & Galloway 100.0% 94.2% 96.0% 100.0% 92.3% 100.0% 100.0% 97.5% NHS Shetland 88.9% 100.0% 100.0% 83.3% 92.3% 100.0% 100.0% 97.1% Totals Compliance Key less than 70% 70% - 90% 90% or higher Each category in the table is explained in detail in Appendix 1 Version 1.0 Published Page 6 of 12
National Catering and Nutritional Services Specification: Half Yearly Compliance Report: Results for July December 2016 Changes in score from July 16 Nutritional needs of population Menu planning Food based standards Menu planning guidance Therapeutic Diet Provision Special & Personal Diets Patient Experience NHS Scotland +0.7% +1.7% +1.1% +0.2% +1.2% +0.3% +0.5% +1.1% NHS Ayrshire & Arran 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% NHS Borders 0.0% -0.0% 0.0% -0.0% +0.0% 0.0% 0.0% +0.0% The State Hospital -22.2% 0.0% 0.0% -16.7% 0.0% -16.7% 0.0% -4.8% Golden Jubilee 0.0% 0.0% 0.0% +8.3% 0.0% 0.0% 0.0% +0.5% NHS Fife 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% NHS Greater Glasgow & Clyde 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% NHS Highland +11.2% +6.9% +5.0% +6.0% +4.4% +4.8% +4.0% +5.9% NHS Lanarkshire 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% NHS Grampian 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% NHS Orkney 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% NHS Lothian -0.7% -2.6% +0.7% +1.3% -0.1% -1.0% -0.4% -0.7% NHS Tayside -3.3% 0.0% 0.0% +2.5% +2.3% 0.0% -0.9% +0.0% NHS Forth Valley 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% NHS Western Isles 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% NHS Dumfries & Galloway 0.0% 0.0% +0.5% 0.0% 0.0% 0.0% 0.0% +0.1% NHS Shetland 0.0% +16.1% 0.0% -8.3% +7.7% 0.0% 0.0% +5.3% Totals Change Key Reduction in score over last 6 months Score is unchanged Increase in score over last 6 months Each category in the table is explained in detail in Appendix 1 Version 1.0 Published Page 7 of 12
National Catering and Nutritional Services Specification: Half Yearly Compliance Report: Results for July December 2016 Appendices Appendix 1: Definitions Appendix 2: Methodology Appendix 3: Approach to reporting Version 1.0 Published Page 8 of 12
Appendix 1: Definitions National Catering and Nutritional Services Specification: Half Yearly Compliance Report: Results for July December 2016 Nutritional needs of population This section lays out the nutrient requirements of a general hospital population which a hospital catering service is required to meet. Unlike food service in other institutions such as schools or prisons, the hospital population s nutritional and dietary needs are much more diverse. These will vary according to a number of factors, including individuals age, physical condition and/or illness. Each age group of the population has different nutritional requirements, e.g. children have specific needs to facilitate growth and development whilst adult requirements are necessary to achieve or maintain good health. In terms of health, at one end of the scale there are short-term admissions where an individual s normal diet is not interrupted, while at the other end of the scale long-term illness and or treatments that adversely affect a patient s food intake and have negative effects on their health are also commonplace. Menu planning Menu planning and food-based standards have been set to assist hospitals achieve the nutrient standards detailed in Section 2 and also a number of the standards set in NHS Quality Improvement Scotland (NHS QIS) Clinical Standards 2003 Food, Fluids and Nutritional Care in Hospitals. These standards also aim to ensure that patients differing dietary needs are catered for and thus maximise opportunities to ensure nutritional needs can be met. They, for example, specify the energy requirements of a main meal that a healthy eating choice should be offered. The number of courses at meals, portion sizes should be available etc. Food based standards Food based standards are known to contribute to a diet of good nutritional quality and have been set to assist hospitals achieve the nutrient standards detailed in Section 2. They, for example, specify that a selection of bread should be offered at each meal, the menu should provide the opportunity for at least 5 servings of fruit and vegetables each day and fish should be offered twice a week etc. Menu planning guidance With awareness that 80-100% of patients in hospitals rely completely on food provided by the catering service for their nutritional support, it is important to remember that many of the problems which arise in the Version 1.0 Published Page 9 of 12
National Catering and Nutritional Services Specification: Half Yearly Compliance Report: Results for July December 2016 provision of nutritionally balanced food are potentially preventable with good planning. Planning a menu effectively requires the collection of a wide range of information and input from numerous groups within a hospital. Therapeutic diet provision A Therapeutic diet is modified from a normal diet and is prescribed to meet a medical or special nutritional need. It is part of clinical treatment and in some cases can be the principal treatment of a condition. NHS Quality Improvement Scotland (NHS QIS) Clinical Standards 2003 Food, Fluids and Nutritional Care in Hospitals Standard 4 states Patients are given a choice for all food and fluid provided, including therapeutic and texture modified diets and food and fluid is provided at the correct temperature and texture. In addition, when planning therapeutic diets, it is essential to have accurate knowledge of the nutrient and ingredient composition of all dishes and individual menu items to determine their suitability. This makes the use of standardised, analysed recipes crucial in the delivery of appropriate food. Special and Personal diets Special diets refer to those meeting cultural or religious needs, while Personal diets are those meeting personal preferences. Any organisational structures, policies, procedures and practices are required to treat ethnic minorities fairly and equally. This applies to all public bodies including the NHS and is therefore applicable to the hospital catering service. Although a standard hospital menu meets the majority of patients cultural and religious food needs, there are some patient groups with alternative needs. A patient s personal dietary needs must be met when they also require a therapeutic diet. NHS Boards and menu-planning groups must gather sufficient information on the diverse dietary needs of the populations they are serving and ensure inclusive attitudes and practices to food service provision to ensure all individuals needs are met. Patient experience NHSScotland is committed to delivering patient-centred care which is respectful, compassionate, and responsive to individual patient needs, values and preferences. Nutritional care is an important component of the overall patient experience that develops when the patient has contact with NHS services. By listening to patients, carers and staff, the programme will help achieve the goal of world class nutritional care that is focused firmly on patient experience. Version 1.0 Published Page 10 of 12
Appendix 2: Methodology National Catering and Nutritional Services Specification: Half Yearly Compliance Report: Results for July December 2016 Over the year, NHSScotland Boards will monitor all catering facilities. Each half yearly report covers monitoring of all catering facilities/areas within a NHSScotland Board area. Compliance is assessed within NHS Boards using a standardised monitoring template. The essential components to the monitoring system are that: audits are carried out on a routine basis by the individual Board Nutritional Teams ensuring that all patient groups and areas within the Board are covered; audits are carried out by multi disciplinary teams, to ensure that all aspects of the nutritional wellbeing of the patient population are met and complied with; the 53 standards within the audit tool are all evidenced based to ensure that a robust audit trail is in place at all times which can be validated (if required) by external or internal agencies, peer group reviews or public reviews; each standard can be assessed in 3 individual ways: - fully achieved; - partially achieved; - not achieved. if the standard is not fully achieved it is a requirement of the Monitoring model that an action and a responsibility is recorded; each Board is required to record by agreed hospital or catering production centre and the agreed site scores are calculated to record an overall Board score. The overall Board score is sent to HFS; the Boards retain the individual scoring sheets for each location and each hospital as well as retaining the evidence base for each standard; the evidence base is available for inspection by Health Improvement Scotland (QIS); all patient groups and all locations (including PFI hospitals) are scored by each Board. NHSScotland Boards report their results to Health Facilities Scotland on a half yearly basis in June and December. From the data received, the monitoring tool produces a score for all Boards. Version 1.0 Published Page 11 of 12
National Catering and Nutritional Services Specification: Half Yearly Compliance Report: Results for July December 2016 Appendix 3: Approach to Reporting Boards carry out Self Assessment Results sent to HFS Draft Report produced by HFS Sent to Boards for Comment Comments received and 2nd Draft Report produced by HFS Sent to SGHD and Boards for final comment Publication Date Version 1.0 Published Page 12 of 12