NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST FOOD SAFETY POLICY. Documentation Control

NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST FOOD SAFETY POLICY Documentation Control Reference HS/EI/020 Approving Body Senior Management Team Date Approved 7 Implementation Date 7 Summary of Changes from General update of individual officers due to Previous Version new structure and use of contracted services. Inclusion of: Teenage Cancer Trust Units. Parents/carers provision of food to children. Foods bought / brought in by patients/relatives/carers and visitors. Access to ward kitchens. All Catering Providers to NUH. Additional special measures for pathogenic food poisoning bacteria. Supersedes Version 2 (22 May 2014) Consultation Undertaken Date of Completion of Equality Impact Assessment Date of Completion of We Are Here for You Assessment Date of Environmental Impact Assessment (if applicable) Directorate of Estates and Facilities Management; Infection Prevention and Control; Trust Health and Safety Committee Local Authority Environmental Health Officer; Nutritional Steering Committee; Patient Partnership Group; Organisation Risk Committee, Dietetics & SMT May 2016 May 2016 May 2016 1

Legal and/or Accreditation Implications Target Audience Review Date January 2020 Lead Director Author/Lead Manager Further Guidance/Information Food Safety Act 1990 Food Safety and Hygiene Regulations 2013 Chilled and frozen guidelines on cook chill and cook freeze catering systems 1989 Annex II of the EU Food Information for Consumers Regulation No.1169/2011 and Commission Delegated Regulation (EU) No. 78/2014 amending Annex II to Regulation (EU) No 1169/2011 Catering Providers, Catering Managers and Catering Staff Divisional Leads/Service Managers Matrons/All NUH Food Handlers, NUH Volunteers, Tenants, sub-contractors and third party contractors. Andrew Chatten Director Estates & Facilities Management. Extension 76171 David Preece Soft FM Performance & Quality Assurance Lead Extension 76165 Mark Fulford Performance, Quality Assurance & Compliance Officer /NUH Food Safety Lead. Extension: 55429 2

CONTENTS Paragraph Title Page 1. Introduction 4 2. Executive Summary 4 3. Policy Statement 5 4. Definitions 5 5. Roles and Responsibilities 8 6. Policy and/or Procedural Requirements 18 7. Training, Implementation and Resources 24 8. Impact Assessments 25 9. Monitoring Matrix 27 10. Relevant Legislation, National Guidance and Associated NUH Documents 30 Appendix A Equality Impact Assessment 32 Appendix B Environmental Impact Assessment 35 Appendix C Here For You Assessment 37 Appendix D Certification Of Employee Awareness 40 3

1.0 Introduction 1.1 Good food hygiene is an essential element which underpins the achievement of the highest level of quality patient care thus supporting a high level of organisational performance and enhancement of the Trust s reputation. At its basic level, good food hygiene practices help to ensure that food contamination is prevented as this could lead to illness/ harm /risk for safety to our patients, staff and visitors. The Food Safety Act 1990 and the Food Safety and Hygiene (England) Regulations 2013 (Sections 1 and 2) set out clear minimum requirements for food hygiene and safety with the fundamental objectives being the pursuit of the highest level of protection of human life and health. This policy therefore details the approach of Nottingham University Hospitals NHS Trust (NUH) to manage the risk from food hazards to protect all persons on our sites from physical contamination, chemical contamination, harmful bacterial contamination and food allergens leading to food poisoning, food-borne infection and allergic reactions. All catering providers shall develop and implement suitable and sufficient operational policies, procedures and practices to ensure food safety and hygiene standards are maintained at a 5 rating under the governments food safety ratings at all times and comply with all food safety legal requirements. Any significant changes to procedures, and polices are to be notified to the Trust. 2.0 Executive Summary 2.1.1 The key requirements to enable the Catering Providers, Nursing Divisions, Support teams, Volunteers and Food Handlers to manage food safely within NUH and ensure that the risk to patients, visitors and staff from food safety hazards is minimal. 4

NUH accepts that it has a duty to ensure all risks associated with the purchase, storage, preparation, service and disposal of food are managed and comply with legislation. Experience has shown that the rules and procedures outlined in this Policy contribute a sound basis to ensure the highest standard of food hygiene and safety. 3.0 Policy Statement 3.1.1 The Trust will: Ensure that the management of food safety is at the highest level and a five rating is maintained as part of the food standards agency s Food hygiene Ratings. In addition NUH and all catering service providers shall work towards having zero exceptions in the three main criteria of Hygiene, Structure and Confidence in Management. Aims to ensure the delivery of a fair, consistent and economic approach to the at NUH. Food Safety is applicable to all staff employed by catering providers and all NUH staff. Accepts its moral and legal responsibilities to set and maintain the highest levels of food safety and hygiene across NUH catering premises and providers. Acknowledges its responsibility to comply with all relevant legislation with respect to food hygiene and safety. 4.0 Definitions Ambient Temperature: The temperature of the surrounding environment; commonly used to mean room temperature. Bacteria: Single celled living organisms; some may spoil food and some may cause illness. 5

Catering Providers: All catering business that conducts their service within NUH premises either under contract, renting space or providing a voluntary service. Cleaning: The process of making something clean. Detergent a product that helps remove dirt and dust. Disinfection - when this process is carried out correctly it should reduce the levels of food poisoning bacteria down to a safe level. Contracted Services: All catering services which are contracted out, subcontracted or third party contractors that operate within NUH premises, either agreed by the trust or the trusts primary contractor. Contract Caterers: Businesses providing catering services under contract to NUH. CPK: Central Production Kitchen providing cook freeze meals to patients, restaurants and retail. The unit is based on City campus. Cross-contamination: The transfer of a contaminant from one contaminated product such as raw meat to another previously uncontaminated product such as ready-to-eat food. Due Diligence: A defence under section 21 of the Food Safety Act 1990 that every practicable measure was taken to avoid committing an offence under the act. Applications of the provisions of the act (d) section 21 (defence of due diligence); Food Hygiene (England) (no 2) Regulations 2013. EHO: Environmental Health Officer / Enforcement Officer. A person employed by a local authority who enforces food safety legislation. Environmental Hygiene: Those practices that are conducive to providing a healthy environment. For example: infection control, good ventilation, good sanitary facilities and natural lighting. Food: Any substance or product, whether processed, partially processed or unprocessed, intended to be or reasonably expected to be ingested by humans; includes drinks and ice. 6

Food-Borne infection: An infection caused by pathogens (food poisoning bacteria) that are carried by food but are not dependent on it. Food contamination: The presence in food or the process of transferring to food any unwanted material, object of substance. Food handler: Any person that handles wrapped or unwrapped food at any stage from delivery /production to disposal. Food hygiene: All the processes involved in keeping food safe to eat. E.g. temperature control and recording, cleaning, exception reporting, good personal hygiene and food safety training. All the guidelines are contained within the Food Safety Management System (FSMS). Food Hazard: Microbiological, chemical or physical contaminant that might cause harm to the consumer Food Poisoning: Is any illness, caused by, or thought to be caused by, pathogens or toxins in food. The term is sometimes also used as a simple general term for all kinds of illness related to food. Food Safety: The protection of human health by preventing edible substances (defined by law) from becoming hazardous and by minimising the risks from those hazards. Also used to indicate the absence of harm to people from food. Food Safety Management System (FSMS): A system that incorporates HACCP, Monitoring, Standard Operating Procedures and training to ensure that food does not cause adverse human health effects. FSMS is an integral part of the food safety policy but due to its complexity cannot be included in full in the policy. Hazard Analysis and Critical Control Points (HACCP): The system for identifying, assessing and controlling hazards and risks associated with food and drink. High risk food: A product intended for consumption, either cold or reheated but without further cooking. It is capable of supporting 7

pathogenic, bacterial growth and, if contaminated, has a definite potential for causing food poisoning. Critical Control Point (CCP s): The point at which the exercise of control over one or more factors could eliminate a hazard or minimise risk from it. (ie. The point where control matters the most.) Pathogenic micro-organism: A micro-organism that can cause illness or harm. Personal hygiene: Hygiene practices performed by an individual which ensures food is protected against contamination. Primary contractor: Main contractor that delivers Catering services under the catering contract. Also responsible for the management of catering sub-contractors and third party contractors. Providers: Third party catering business and suppliers to NUH. Sanitising: Application of heat and/or chemicals using (detergent and disinfectant) to reduce food poisoning bacteria to a safe level. Simulant Block: A plastic block that simulates a piece of food in a fridge or freezer. The block can be connected to probe thermometer or is directly linked to a computer monitoring system. STS: Supply Training & Services: Consultancy for food safety matters. TCMT: Trust Contract Monitoring Team Tool Box Talks: A weekly meeting by catering managers to their teams to discuss timely topics. 5.0 Roles and Responsibilities 5.1 Committees: 5.1.1 The Trust Board is responsible for ensuring that arrangements are 8

in place so that it can be assured about compliance with this policy. 5.1.2 5.1.3 5.1.4 5.2 5.2.1 TCMT shall ensure that divisions shall comply with this policy through its contract monitoring schedule. The Trust Board has ratified this and is accountable for the activities of food safety within NUH. The Trust Board will receive assurance that the requirements of current Food Safety Legislation are met through the annual report from the Nutrition Steering Committee to the Clinical Effectiveness Committee (CEC) and the annual declaration to the Care Quality Commission against its standards derived from the Health and Social Care Act 2006. The Trust Board delegates the responsibility for Food Safety to the Chief Executive. Individual Officers: Chief Executive The Chief Executive will, on behalf of the Board, be responsible for ensuring all current Food Safety Legislation is complied with and all stages of production, processing and distribution of food satisfies the relevant hygiene requirements and that there are effective arrangements for food safety within NUH. The Chief Executive delegates the implementation of this to the Director of Estates and Facilities Management, divisional and corporate directorate management teams for the food handlers under their direct control. 5.2.2 Director of Estates & Facilities Management The Director of Estates and Facilities Management has overall responsibility for ensuring that NUH catering services, catering contract providers, authorised outside caterers and voluntary sector partners comply with this. Third party catering providers shall adhere to the policy while monitored by their service provider. The Director of Estates & Facilities Management is responsible for 9

ensuring that food safety issues within all catering services (Internal and External) are highlighted to the relevant NUH risk management committee. This responsibility will extend to proposed programmes of work relating to food safety risk management for consideration as part of the annual business planning process which will be submitted to the Investment Governance Committee and Performance Management Team as appropriate. This will include the management of the food related components of the Trust s Capital Programme and future allocation of sufficient funding to ensure compliance with the Policy. At an operational level the Director of Estates & Facilities Management will; Ensure, through the Head of Trust Contract Monitoring Team that senior management and line managers within catering services develop, implement, maintain and monitor procedures related to HACCP principles. Ensure through senior management and line management structures full staff participation from catering staff in food safety training. Ensure that agreed programmes of investment in food safety are properly accounted for in the Trust s annual business plan. In line with delegated authority, the Director of Estates and Facilities Management has chosen to devolve the day to day duties to the Soft FM Performance and Quality Assurance Lead who is responsible for food safety within catering service but accepts that he retains accountability as the Director of Estates and Facilities Management. 5.2.3 Head of Trust Contract Monitoring Team. The Head of Trust Contract Monitoring Team will ensure: The primary contractor is performing as per catering contract under the current food safety legislation and to the terms set in the catering contract. Compliance with food safety and hygiene is reported annually to the Nutrition Steering Committee and against the relevant assurance frameworks. That the Nutrition Steering Committee is 10

informed of all outstanding actions on matters of Food Safety and the EHO reports, via the Menu, Diet and Food Service Work stream. That the EHO is kept informed and updated on all matters, both legal and best practice associated with food safety. All catering / retail business operations, either NUH or third party occupiers will be registered with the local council and provide high levels of food safety in compliance within the regulations. All catering providers are meeting a score of 5 in the government s food safety rating scheme. That where necessary, food safety risks are recorded on the NUH Risk Register and to the appropriate risk management committee, The, all relevant statutory requirements and other Trust policies are monitored and reviewed at least annually. All catering providers procure all food and ingredients that are fit for human consumption only from approved suppliers who are registered in accordance with the food registration regulations. 5.2.4 Soft FM Performance and Quality Assurance Lead The Soft FM Performance and Quality Assurance Lead will ensure: The primary contractor is performing as per catering contract under the current food safety legislation and to the terms set in the catering contract. The Trust Contract Monitoring Team shall ensure: The primary contractor is performing as per catering contract under the current food safety legislation and to the terms set in the catering contract. This will be ensured thorough monitoring of the contract against the scope of the contract and the service parameters. 5.2.5 Head of Estates / Contracted Services (Operational Maintenance) The Head of Estates / Contracted Services will ensure that the buildings and equipment are maintained in good order and in line with all relevant regulations. Sufficient resources will be provided by NUH / contracted services supplier to ensure compliance and issues or gaps should be highlighted immediately to ensure funding 11

can be sought to close the gaps. 5.2.6 EFM Capital Projects Manager The EFM Capital Projects Manager will ensure that all work which has implications for Food Safety on new and existing Trust buildings are carried out to a satisfactory technical standard and conforms to all prevailing statutory and mandatory Food Safety Legislation including the Control of Contractors Policy. 5.2.7 Head of Regulatory and Property Head of Regulatory and Property Services (Property and Land) will ensure that when letting contracts, a clause is inserted to ensure that lessors conform to the Trust s. 5.2.8 Divisional Teams Each Divisional team (Divisional Director and, by delegation, Divisional nurse) will: Take responsibility for food hygiene in their areas and ensure all stages of production, processing and service of food under their control satisfy the requirements laid down in this Food Safety Policy. Disseminate the policy details and allocate responsibility for implementation to local service managers and staff. Ensure that food hygiene and safety matters are included in management team briefings/meetings. Ensure all food handlers are aware of their specific responsibilities for food hygiene. Ensure that, where necessary, food hygiene risks are reported on the risk register. Ensure that all food handlers have completed mandatory food safety training with refresher every 3 years. 5.2.9 Matrons/Ward Sisters / Charge Nurses/ Nursing staff. Matrons and Ward Sister / Charge Nurse will: Promote the highest standards of environmental and personal hygiene necessary to prevent food poisoning and potential contamination of food at a ward/department level. 12

Ensure that staff and volunteers are competent to work safely and comply with this through food safety training and Nutrition Link Professionals. Ensure effective management of food hygiene within the ward areas and ward kitchens by ward sisters / charge nurses, which include the implementation of this. Ensure ward kitchens are in a condition that promotes good food safety. Where minor new works is required the ward shall fund the works unless it is captured in a capital refurbishment project. Ensure that Nutritional Link Professionals have food safety responsibilities and are trained to foundation level 2 in food safety, updated yearly and promote good practice. Ensure by delegation that all foodstuffs are to be adequately stored and a rotational stock control practice followed. Ensure food brought in by patients and their relatives is managed in accordance with this policy Appendix 5 Food bought / brought in by patients. Drugs, samples or blood for transfusion shall not be stored in fridges or freezers used for patients food to avoid crosscontamination. All Ward staff has access to a copy and have read the `Food Hygiene at Ward level` document. Patients, visitors and staff are surveyed annually to comment on the safety and quality of food, through patient satisfaction surveys and friends and family cards. Ward staff involved in patient s nutrition shall communicate with patients, dietitians, food service staff and their own team on all matters relating to all aspects of food safety inclusive of allergens. Also understand the legislation and how to manage it. 5.2.10 Head of Catering / Manager (Catering providers) The Head of Catering / Manager (Catering providers) will ensure that: Food providers and handlers are provided with suitable advice on all aspects of food safety and hygiene through the implementation and monitoring of appropriate management systems to ensure that all food is safe, wholesome and fit for human consumption. Establish standard operating procedures to ensure food safety is tracked from delivery and production through to disposal in all NUH food businesses. 13

Procure all food and ingredients that are fit for human consumption only from approved suppliers that are registered in accordance with the food registration regulations. All ingredients and foodstuffs are within their stated expiry date and free from damage and pest infestation and have been stored and transported at the correct temperature and are suitable for consumption. Shall ensure that all food is handled, stored, prepared and cooked in accordance with all the legal requirements. Shall ensure that all and any food issued has been kept at the required safe temperature at all times including but not limited to storage prior to preparation, during cooking, during transfer and at the point of service around the facilities. All foods are transported through the facilities in the appropriate method paying particular attention to high risk food which shall be transported in a thermos container or thermos cover. All food suppliers comply with this policy by including the requirement in all tender documents. For arranging supplier assessment visits by suitably qualified staff prior to contracts being placed. All food premises are registered with the Local Authority Environmental Health Department. All areas are audited by the local EHO`s. That the EHO is kept informed and updated on all matters, both legal and best practice associated with food safety. All risks associated with food preparation, distribution, delivery, handling and service are assessed and control measures introduced and, where necessary, reported to the relevant risk committee and heads of service. All Food operatives are provided with information and training commensurate with their responsibilities. All matters relating to food safety are shared with trust teams and relayed to the Catering Teams through `Tool Box Talks` or similar systems. Ensure that the Trust s and Codes of Practice are implemented within all patient food service areas and ward Kitchens. Patients, visitors and staff are surveyed annually to comment on the safety and quality of food, through patient satisfaction surveys. That the Head of Contract Performance and Quality Assurance is informed of all outstanding actions on matters of Food Safety. 14

Ensure that their services and any subcontracted catering services will be subject to an annual audit of their premises and food safety and hygiene systems by EHO inspection reports and site visit by the catering providers audit team. Ensure, as best practice, to provide nutrition information and allergens, nutrition data for all foods provided by the NUH dietetic leads which must be reviewed annually. Ongoing due diligence is carried out on allergen checks with bought in foods and ingredients with support from dietetics department. No foods shall be served within the trust unless the allergen content of foods has been assessed, communicated and shared with dietetics department. This can only be achieved by sharing the nutritional information in the first instance. Shall ensure all catering areas and equipment used in connection with the catering service in accordance with the NSPA 2007 standards and the food safety management system. Shall ensure waste arising from all aspects of the catering service is managed, segregated and disposed of safely in accordance with trust waste management policies and procedures. Ensure disposable cutlery where used is strong and robust and shall not present a physical hazard or a risk to the consumer. 5.2.11 The Retail Catering Ensure that the Trust s and Codes of Practice are implemented within all the catering outlets. Ensure that the contract caterers FSMS is implemented within all the catering outlets. Audit the catering premises as per schedule to ensure compliance and identify any specific training needs required. Ensure that all authorised outside caterers will be subject to an annual audit of their premises and food safety and hygiene Systems by EHO inspection reports and a site visit by the catering providers audit team. Ensure that all catering facility areas and associated equipment are maintained, clean, sanitised, free from packaging and fully functional. Report to the Head of Catering / Manager (Catering providers) on matters of food safety, who will report through the contract to the Head of the Trust Contract Monitoring Team. 15

5.2.12 Trust Lead for Food Safety. Trust Lead for food Safety will: Report to the Soft FM Performance and Quality Assurance Lead Liaise with the catering providers on matters of food safety. Report to the Food, Nutrition and Menu work stream on matters of food safety. Liaise with the EHO on matters of food safety. Liaise with STS on matters of food safety. Advise the trust on matters relating to food safety. Act as the gate keeper for the NUH food safety management systems and provide updates in line with any legislation changes. Ensure all monitoring on food safety is in line with the guidance set. Ensure that the biannual NUH multidisciplinary catering audit is delivered. Check for legislation updates through news, media, official publications and the food standards agency. Record, investigate and assist to resolve food safety matters in partnership with wards and catering providers. Ensure nursing teams and catering provider s food safety incidents and risks are managed through Datix in particular reporting of foreign bodies. Advise ward teams on appropriate Food Safety Management Systems (FSMS) for their areas that doesn t fall within the remit of the catering providers. Update the trust intranet page for food safety. Deliver food safety training material for foundation level 1: food safety training and deliver food safety level 2 training for nutrition link nurses that has been funded by the divisions requiring the training. 5.2.13 5.2.14 Volunteer Services Manager. The Volunteer Services Manager will ensure that all Volunteer food handlers are aware of and trained in accordance with this Policy. Patient & Public Involvement (PPI) The Trust Patient Partnership will be involved in the reviewing and updating of this Policy. Relevant information about the contents of this policy will be available for patients and carers via the intranet. 16

The Patient Public Steering group (PPG) will be informed of the Policy and associated documents and updated via sharing of information with the head of patient public Involvement. Members of the catering management team will attend the monthly meeting of the group PPI periodically and the PPG monthly. 5.2.15 Nutrition Steering Committee The Nutrition Steering Committee will ensure that there are written policies and procedures to support the provision and delivery of food and nutrition to hospital patients and actively promote the Trust-wide implementation of these. Information and actions shall be shared with the Clinical Effectiveness Committee. 5.2.16 All Catering Providers. All catering providers shall. Have a robust food safety management system (FSMS) following the rules of Hazard Analysis & Critical Control Points. Abide by their company FSMS. Maintain a food safety rating of 5. Share annually with the Trust s Lead for food safety their EHO report. Shall engage and participate in the biannual Trust Catering Audit. 5.2.17 Environmental Health Officer / Practitioner The EHO shall visit as scheduled from the official food hygiene rating guidance. Due to hospital patient food production and feeding being high risk this will be not less than annually. Retail, suppliers and third party catering providers shall be visited as per the official food hygiene rating guidance that has been agreed. The inspection reports shall be made available to the NUH when requested. Any breaches shall be escalated through the trust via the nutrition steering committee 17

6.0 Policy and/or Procedural Requirements 6.1.1 Food Safety Food and Drink must be fit for human consumption. It is imperative that all food and drink is managed safely as not to put further risk on patients, visitors and staffs health. No food that is either past its use by or best before date shall be served to patients, visitors or staff. The Food Safety Management System (FSMS) is the main body of evidence to support the compliance with the food safety act and food safety regulations and to meet the requirements of the food safety policy. The policy can only highlight some of the main points and therefore the catering providers FSMS & bespoke NUH FSMS shall be read in conjunction with this policy. These documents can be produced on request. In Summary The four main Hazards associated with contamination of foods are. 1. Bacterial contamination food spoilage bacteria and food poisoning bacteria (Pathogenic). 2. Physical contamination 3. Chemical contamination 4. Allergens. 6.1.2 Food Hygiene Ratings (Food Standards Agency) The FSMS shall ensure that the 3 key requirements of the Food Standards Agency s food safety ratings scheme are adhered to. These are. 1) Hygiene 2) Structure 3) Confidence in management. Key points: FSMS` All NUH catering providers / sites are subject to the standards laid out in the policy and the FSMS 18

All food provided shall meet the standards set in the catering providers FSMS in accordance with the food safety legislation. Best practice shall be the norm rather that exception. All foods shall be fit for human consumption. Temperature control is the key element to protect food from harmful hazards along with good standards, effective procedures, thorough cleaning, timely maintenance and well trained staff. The key process steps that are identified in the food safety management system are. A Planning a Food Service K Sandwich production B Purchase L Cooking C Delivery M Cooling D Chilled Storage N Vacuum Packing E Frozen Storage O Portion / Packing F Dry Storage P Blast Freezing G Defrosting Q Holding Freezer H Decanting R Picking I Preparation S Dispatch / Transport J Repack Hazard Analysis and Critical Control Points (HACCP) is the legal system documented in the management of food safety. SOPs support all aspects of the safe management of food from its origin and supply, to delivery cooking, final consumption and any arising waste as part of the FSMS. All Hazards shall be identified and managed safely throughout the system using temperature control, SOPS, monitoring, recording and reporting as part of the HACCP system. It is a legal and moral obligation that all staff shall not contaminate the food either by physical, chemical or biological contamination e.g. Staphylococcus aureus bacteria from human hands, nose etc. Considerations across all HACCP steps include: Recording & monitoring of temperatures and standards, safe management of food wastage, safe management of pest control and safe management of cleaning. 6.1.3 Food Poisoning Bacteria Special attention must be paid to all food poisoning (pathogenic) bacteria, as the bacteria can only be seen through a microscope 19

and are the main reason for food poisoning cases. Food Poisoning and food spoilage bacteria are noted in the relevant FSMS and further information can also be found http://www.food.gov.uk/ The Food Standards Agency requires hospitals to make take additional special measures to a few of the pathogenic food poisoning bacteria. 6.1.4 Escherichia coli O157. It is recognised that NUH recognise the particular issues with this pathogenic food poisoning bacteria. Some of the key measures to control E.coli are: Identification of separate work areas, surfaces and equipment for raw and ready-to-eat food. Use of separate complex equipment, such as vacuum-packing machines, slicers, and mincers for raw and ready-to-eat food. Hand washing should be carried out using a recognised technique. Anti-bacterial gels must not be used instead of thorough hand washing. Disinfectants and sanitisers shall meet officially recognised standards and should be used as instructed by the manufacturer. All considerations shall be taken with reference to other pathogenic food poisoning bacteria which is issued specifically by the Food Standards Agency (FSA) 6.1.5 Listeria Listeria monocytogenes has been found in a range of chilled readyto-eat foods, such as prepacked sandwiches, pâté, butter, soft mould-ripened cheeses, cooked sliced meats and smoked salmon. Vulnerable people should avoid soft mould-ripened cheese, such as Camembert and Brie, soft blue cheese, and all types of pâté, including vegetables. Listeria Keeping Food Safe guidance and Preventing Listeriosis in Hospitals & Nursing/Care Homes. This information shall be included in the FSMS as a SOP. The documents from the Food Standards Agency must be adhered to as part of this policy. 20

Additional measures must be taken with suppliers of bought in Sandwiches to ensure the suppliers are abiding by strict Listeria monitoring procedures inclusive of foods send to laboratories for sample testing and swab testing of working areas during production. 6.1.6 Cleaning All food areas, food rooms, kitchens, food service areas, transportation and equipment used for food shall be kept at a high standard of cleanliness inclusive of using detergents, disinfectant and sanitisers. All areas and equipment shall have a cleaning schedule to include daily, weekly, monthly and periodic cleaning, which must be at a frequency to promote good food hygiene standards. All areas must be deep cleaned at a minimum of twice per year. All areas shall have task list to supplement the cleaning schedules to include how to clean, what to clean with and the use of personal protective clothing. All areas shall have a sufficient deployment of staff to maintain a high standard of cleanliness for areas and equipment. Where catering staff cannot clean then the relevant manager shall employ the services of the approved contractor for cleaning services and/or a private cleaning contractor to facilitate the cleaning to the required standard. Staffing levels and budgets shall be made to the appropriate level to ensure effective cleaning is carried out and maintained. 6.1.7 Maintenance and Condition of fixtures, fittings and equipment All food areas, fixtures and fittings and equipment shall be maintained to a high level which meets the standards set in the food safety regulations. Materials within food rooms shall be robust, non-porous and easy to clean. Where the condition of fixtures and fittings are not at an acceptable food safe standard then the appropriate NUH Minor New Works request shall be submitted with the relevant funding stream by the division responsible for that area. Issues shall be dealt with in a timely manner. Where fixtures and fittings have been damaged by water ingress the job shall be reported and then completed by the primary 21

contractor under the current contractual terms. Where fixtures and fittings are damaged, the job shall be reported and then completed by the primary contractor under the current contractual terms. As not to pose any risk to food safety any equipment that is not fit for purpose shall be removed from use and disposed of within the correct waste stream. 6.1.8 Pest Control The contracted pest control services shall monitor for the signs of pests, deal with any sightings or infestations as per pest control contract. All pest control services that are contracted out, subcontracted or third party contractors that operate within NUH premises, either agreed by the trust or the trusts primary contractor shall ensure that any catering areas are free from all pests inclusively. The catering staff, supervisors and managers shall ensure that any signs of pests or sightings shall be reported to the pest control team. The catering managers shall ensure that maintenance issues or poor housekeeping is addressed as not to entice any pests. The contracted pest control services shall liaise with the NUH Infection, Prevention and Control team and the NUH Contract Monitoring team where required. 6.1.9 Personal Hygiene Any person working in a food handling area is to maintain the highest level of personal cleanliness, following good personal hygiene practices and is to wear suitable, clean and, where necessary, protective clothing. Any person working in food handling must adhere to the trust uniform policy. No person suffering from or being a carrier of a disease likely to be transmitted through food or afflicted for example with infected wounds, skin infections, sores or diarrhoea is to be permitted to handle food or enter any food handling area in any capacity if there is any likelihood of direct or indirect contamination. Any person so affected and employed in a food business and who is likely to come 22

into contact with food is to report immediately to their line manager the illness or symptoms and if possible their cause. Staff shall be 48 hours symptom free before returning to work. Hand hygiene is one of the most effective actions in preventing food poisoning and maintaining the highest standards of food hygiene. To facilitate effective hand hygiene, food handlers working in clinical environments must be bare below the elbow when undertaking food handling duties. Hands must be decontaminated. For further information refer to the Hand Hygiene Policy located on the NUH Policies and Procedures and Guidelines intranet site. Cloth oven gloves are used for heat protection and not hand hygiene. Blue water proof dressing shall be used for cuts and abrasions. Skin conditions will be assessed by the line manager and appropriate action taken for staff either cover of hands with protective disposable gloves or given non-food duties. 6.1.10 Monitoring / Recording / Reporting The FSMS shall be the vehicle for monitoring, recording and reporting of food safety. Daily, weekly, monthly, periodic recording, monitoring, reporting undertaken inclusively as part of legal HACCP requirements. Records shall be kept for a maximum of one calendar year. Contracted suppliers: The policy shall be read in conjunction with the NUH Catering Service Specification inclusive of any contract Performance Payment Mechanism (PPM). The policy shall be read in conjunction with the NUH FSMS. 6.1.11 Teenage Cancer Trust Units. The two areas (QMC & City Campus) that are specifically under the management of the Teenage Cancer Trust shall follow the rules of hygiene set out in the SOP Food Safety Teenage Cancer Trust In summary covers the responsibilities of both nursing and patients in relation to storing, cooking and reheating foods in a more homely environment. However the trust must take responsibility to ensure the rules of hygiene in place and are communicated with the patient 23

users and that all reasonable measures have been taken to show due diligence in a food poisoning case. 6.1.12 Parents/Carers provision of food to children Whilst in hospital the parent /carer often takes responsibility for the food provision for their children, however it is the responsibility of parents and nursing in relation to storing, cooking and reheating foods in a more homely environment. However the trust must take responsibility to ensure the rules of hygiene are communicated with the parent/carers and that all reasonable measures have been taken to show due diligence in a food poisoning case. 6.1.13 Foods bought / brought in by patients/relatives/carers and visitors. Food that is food brought in for consumption in the wards must adhere to the SOP: foods bought / brought in by patients. Where provision of food cannot be delivered under the current service there may be exceptional circumstances where the ward manager can give instruction to the relative / carer to provide a meal to the patient using the facilities of the ward kitchen, which wouldn t be dissimilar to the provision for parents and carers providing a meal to a child. 6.1.14 Access to ward kitchens All patient ward kitchens shall be used only for the supply of the patient s food services either by nursing teams, contracted catering providers and mealtime volunteers. Administration / Clerical staff and Doctors must use alternative welfare facilities provided by NUH, however access to hot and cold water shall not be denied. Staff must be aware that access to ward kitchens at busy times is not permitted. All persons entering a ward kitchen shall wash their hands. Relatives, visitors and carers shall use the welfare facilities provided by the trust or the various catering outlets located across the trust. 7.0 Training, Implementation and Resources 7.1 No specific training required for the food safety policy, however 24

catering teams, volunteers, support teams and divisions shall ensure staff who handle food are trained in aspects of food safety relating to their work which shall be inclusive of SOPS within the FSMS. In addition covering foundation level 1 and 2 in food safety and food allergen awareness where applicable. 7.2 Implementation: Divisions awareness via the Trust Intranet and Trust Briefings. 7.3 Resources - Training resources. Study leave form submitted or identified with staff appraisal. Nursing Development shall arrange training for Nutritional link nurses and volunteers in partnership with the trust lead for food safety. Divisions are charged for each member of staff attending the planned training session for certificated foundation level 2 in food safety. Food Safety training level 1and Allergen training are free via the trust intranet. http://nuhnet/human_resources/learning@nuh/pages/foodsafetyandhygiene. aspx 8.0 Trust Impact Assessments 8.1 Equality Impact Assessment This policy has been impact assessed and has been found to be neutral with regard to its impact upon specific equality groups and positive in its corporate impact to promoting valuing diversity and implementing equality of opportunity. Considerations have been made for the provision of specialist diets including food safety and any additional costs. 25

8.2 Environmental Impact Assessment Environmental impact assessment has been undertaken on this draft and has not indicated any additional considerations necessary. 8.3 Here For You Assessment A Here For You assessment has been undertaken on this document and has not indicated that any additional considerations are necessary. 26

9.0 Policy / Procedure Monitoring Matrix Minimum requirement to be monitored Daily recording of HACCP & FSMS Responsible individual/ group/ committee Food Handlers. Catering providers & their independent company audit body. Process for monitoring e.g. audit Monitoring of HACCP & FSMS Frequency of monitoring Responsible individual/ group/ committee for review of results Daily / Monthly Catering providers Management TCMT Responsible individual/ group/ committee for development of action plan Catering providers Management TCMT Responsible individual/ group/ committee for monitoring of action plan Catering Management. TCMT TCMT Spot checks & Audit to correspond with the details set in the Catering contracts. 27

Food safety Issues. Catering providers FSMS Daily / Monthly Catering providers Catering providers Catering providers TCMT DATIX TCMT TCMT TCMT Foreign Bodies Nutritional Steering Committee Catering Providers Reports Other outlets must be issued and follow e.g. costa, century café etc. DATIX Daily Catering providers Other outlets must be issued and follow e.g. costa, century café etc. Catering providers Other outlets must be issued and follow e.g. costa, century café etc. Catering providers Management of food safety Catering providers. TCMT Annual report Annual Catering providers. TCMT Catering providers. TCMT Catering providers. Nutrition Steering Committee (NSC) Nutrition Steering Committee (NSC) Nutrition Steering Committee (NSC) Nutrition Steering Committee (NSC) Clinical Effectiveness Committee (CEC) Clinical Effectiveness Committee (CEC) Clinical Effectiveness Committee (CEC) Clinical Effectiveness Committee (CEC) 28

Food Safety Rating Organisation Risk Committee (ORC) local Environmental Health Officer Audit Yearly or as scheduled. TCMT TCMT TCMT National standards of best practice in relation to clinical effectiveness. STS Department of Health (DoH), Care Quality Commission (CQC), NHS Litigation Authority (NHSLA), National Institute for Health and Clinical Excellence (NICE) and the Clinical Negligence Scheme for Trusts (Maternity). Audit As required Clinical Effectiveness Committee (CEC) Clinical Effectiveness Committee (CEC) Clinical Effectiveness Committee (CEC) 29

10.0 Relevant Legislation, National Guidance and Associated NUH Documents The United Kingdom s Legislative framework and its associated regulations are further underpinned by a number of NUH policies and procedures in support of this. Food Safety Act 1990 Food Safety and Hygiene Regulations 2013 DOH Chilled & Frozen guidelines on cook chill & cook freeze catering systems 1989. The Hospital Food Standards Panel s report on standards for food and drink in NHS hospitals 2014. E.coli O157: An invisible threat to your business: FSA. Preventing Listeriosis in Hospitals FSA. Food labelling legislation: EU Consumers Regulation 1169/2011 Guidance for Management of Allergens (British Dietetic Association) 2014. Health and Social Care Act 2006 Health and Safety at Work Act (1974) Infection Prevention and Control Policy Waste Management Policy Mandatory Training Policy Uniform Policy Hand Hygiene Policy Pest Control Policy Legionella Policy Fire Policy Control of Substance Hazardous to Health Policy First Aid at Work Policy Food Hygiene at Ward Level Guidelines Duty of care act 1992 Standard of Business Conduct Policy Clinical Effectiveness Policy Nutrition Policy Risk Management Policy 30

Food Safety Regulations: Regulation (EC) No. 852/2004 on the hygiene of foodstuffs, The Food Safety and Hygiene Regulations 2013 These regulations set out the basic hygiene requirements for all aspects of our food service operations, from our premises and facilities to the personal hygiene of our staff. Food hygiene: A guide for business: Food Standards Agency 2006. Industry guide to good hygiene practice: Catering guide 1995. Food Handlers fitness to work Regulatory Guidance and best practice advice for food business operators (Food Standards Agency 2009) Good Practice Guide: Healthcare food and beverage service standards. A guide to ward level services Hospital Caterers Association. Care Quality Commission (CQC) Core Standard C15: A: Where food is provided, healthcare organisations have systems in place to ensure that Patients are provided with a choice and that it is prepared safely and provides a balanced diet. Core Standard C15: B: Where food is provided, healthcare organisations have systems in place to ensure that Patients individual nutritional, personal and clinical dietary requirements are met, including any necessary help with feeding and access to food 24 hours a day. Considerations for all core CQC standards with reference to food safety. 31

Equality Impact Assessment (EQIA) Form (Please complete all sections) APPENDIX A Q1. Date of Assessment: Insert date Q2. For the policy and its implementation answer the questions a c below against each characteristic (if relevant consider breaking the policy or implementation down into areas) Protected Characteristic a) Using data and supporting information, what issues, needs or barriers could the protected characteristic groups experience? i.e. are there any known health inequality or access issues to consider? The area of policy or its implementation being assessed: b) What is already in place in the policy or its implementation to address any inequalities or barriers to access including under representation at clinics, screening c) Please state any barriers that still need to be addressed and any proposed actions to eliminate inequality Race and Ethnicity No Impact Identified Special menus / foods are available on request and cultural Foods can be supplied with adequate notice. Sealed meals such as halal, Kosher and Allergy foods / meals are not probed for temperature control. However other foods in the same oven are and these shall be used as a guide for the safe temperature of these foods. Gender No Impact Identified N/A N/A 32

Age No Impact Identified N/A N/A Religion No Impact Identified N/A N/A Disability No Impact Identified N/A N/A Sexuality No Impact Identified N/A N/A Pregnancy and No Impact Identified N/A N/A Maternity Gender No Impact Identified N/A N/A Reassignment Marriage and No Impact Identified N/A N/A Civil Partnership Socio-Economic No Impact Identified N/A N/A Factors (i.e. living in a poorer neighbourhood / social deprivation) Area of service/strategy/function Q3. What consultation with protected characteristic groups inc. patient groups have you carried out? Policy shared with PPG. Patient menus have been shared with the PPG group and amendments made from their feedback. Q4. What data or information did you use in support of this EQIA? Not Applicable 33

Q.5 As far as you are aware are there any Human Rights issues be taken into account such as arising from surveys, questionnaires, comments, concerns, complaints or compliments? None Q.6 What future actions needed to be undertaken to meet the needs and overcome barriers of the groups identified or to create confidence that the policy and its implementation is not discriminating against any groups: None What By Whom By When Resources required Q7. Review date 34

APPENDIX B Environmental Impact Assessment The purpose of an environmental impact assessment is to identify the environmental impact of policies, assess the significance of the consequences and, if required, reduce and mitigate the effect by either, a) amend the policy b) implement mitigating actions. Area of impact Environmental Risk/Impacts to consider Action Taken (where necessary) Waste and materials Soil/Land Water Air Is the policy encouraging using more materials/supplies? Is the policy likely to increase the waste produced? Does the policy fail to utilise opportunities for introduction/replacement of materials that can be recycled? Is the policy likely to promote the use of substances dangerous to the land if released (e.g. lubricants, liquid chemicals) Does the policy fail to consider the need to provide adequate containment for these substances? (e.g. bunded containers, etc.) Is the policy likely to result in an increase of water usage? (estimate quantities) Is the policy likely to result in water being polluted? (e.g. dangerous chemicals being introduced in the water) Does the policy fail to include a mitigating procedure? (e.g. modify procedure to prevent water from being polluted; polluted water containment for adequate disposal) NA Is the policy likely to result in the introduction of procedures and equipment with resulting emissions to air? (E.g. use of a No No No No No No No No No 35