Care Quality Commission:

Meeting Nutritional Needs

Ian Robinson

General Manager, Hotel Services.

Salisbury NHS Foundation Trust.

“ In dwelling upon the vital importance of sound observation, it must never be lost sight of what observation is for.

It is not for the sake of piling up miscellaneous information or curious facts, but for the sake of saving life and increasing health and comfort.”

Outcome 5:

1. A choice of suitable and nutritious food & hydration, in sufficient quantities to meet service users’ needs;

2. Food & hydration that meet any reasonable requirements arising from a service users’ religious or cultural background; &

3. Support, where necessary, for the purposes of enabling service users to eat & drink sufficient amounts for their needs.

Food an integral part of healthcare, not a support service

• See the ‘whole mealtime experience’ not just food• Challenge attitudes & perceptions of hospital food• Challenge the culture & ‘value’ good food• Clarify responsibilities around food & nutritional

care• Establish ‘ownership’ at ward level

1. PAY AS MUCH ATTENTION TO THE ENVIRONMENT AS TO THE FOOD AND THE PATIENT.

2. MINIMISE EATING ALONE — THE MORE PEOPLE THE BETTER.

3. EAT IN A COMFORTABLE SITUATION WHENEVER POSSIBLE.

4. PROVIDE CHOICES — BUT ONLY WHEN YOU CAN DELIVER THEM.

5. PROVIDE APPROPRIATE MEALS IN TERMS OF FOOD COMBINATIONS AND PREFERENCES.

“We can never improve the perceived quality of institutional food until we address peoples expectations of it”.

Dr Herb Meiselman. US ArmyDr John Edwards. Bournemouth University

The Healing Environment Masterclass - 2004

Why Patients Don’t Eat

• Managing Food Waste (2005)Organisational, Food, Patient

Clinical reasonsAssistance related issuesEnvironmentalMeal Service issuesFood.

Undertake Observational Audits……

Promote Innovation & Creativity

• Recognise & Champion best practice • Promote effective collaborative working • ‘Flexi Menus’• Small Appetite Meals• Gold Trays, Green Trays & Gold Tops!

“Good Organisations grow by innovation & risk taking, the risk of doing things differently.

Focus on the outcomes you want & work backwards”

Harry Cayton Director for Patients and the Public2003

Access to food, that meets needs & expectations

• Access & scope of food service• Assistance – Mealtime Assistants• Texture modification – Puree/Easy Chew• Service Development

Management processes that Support food & nutrition

• Establish Food & Nutrition high on Trust board

agendas• Promote Clinical Leadership• Ensure PPI Involvement/Empowerment• Network – across organisations/professions• ‘Effective’ Nutritional Steering Groups• Increase organisational capacity through staff development• Establish organisational ‘values’ with identifiable supporting behaviours• Motivate & support Caterers …….

Support & Promote ‘Champions for Change’

• Leadership, Know what to change ……….. Measuring service quality - ‘Servqual’

Servqual = Expectation minus perception.

Ensure performance measurement is both qualitative & quantitative.

“This was never going to be about me giving the hospital a bunch of recipes and teaching some chefs how to cook, this is bigger than that, this is about changing the context of mealtimes”

Heston Blumenthal

Mission Impossible, Channel 4

Engage with Stakeholders

Information, Engagement, Empowerment…..

• Through PPI Involvement• Stakeholder access & participation• Information – menus, web, tray covers, press…..• ‘Community’ focused service.

Summary

• Empower Patients• Develop capacity (to deliver expectations)• Develop teams & effective collaborative working • Ensure assistance at mealtimes• Improvements in the ‘whole meal experience’• Challenge attitudes & perceptions & change the culture around food & mealtimes• Develop guidance & Policy• Champion best practice!

“We have to introduce a continual, sustainable and radical approach in which we make incremental changes every single day.

Better Hospital Food isn’t about introducing a better recipe for shepherds pie, it’s about

changing everything”

Loyd Grossman OBE

Chair of the Better Hospital Food Panel

Thank You

Ian RobinsonGeneral Manager, Hotel ServicesSalisbury NHS Foundation Trust01722 336262