Achieving gbsf with patient delivered systems

J.Ven/NC/HEFMA 1:091012

Jill Venables, Head of Facilities

Achieving GBSF with Patient Delivered Systems


Achieving GBSF with Patient Delivered Systems - Summary

What does GBS for food and catering services include? (DEFRA)

GBSF standards - additional considerations with Patient Meal Delivered Systems

Getting started, obtaining relevant information

GBSF menu engineering

Questions and concerns relating to GBSF

Cost effective menu engineering - Examples


The GBS for food and catering services includes a suite of criteria covering three

areas of sustainable procurement:

Foods produced to higher sustainability standards - covering issues such as a 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 increase consumption of fibre, fish and fruit and vegetables.

Procurement of catering operations to higher sustainability standards - including equipment, waste and energy management.

What does Sustainability mean for food and catering services? DEFRA, (2012)


Impact Area

Standard

Animal welfare All eggs, including fresh in-shell, liquid and powdered eggs, are sourced from systems that do not use conventional cages. If from a caged system, enriched cages must be used.

Seasonal produce

Where fresh produce is used, menus are designed to reflect in-season produce and in-season produce is highlighted on menus.

Fish All fish are demonstrably sustainable with all wild-caught fish meeting the FAO Code of Conduct for Responsible Fisheries (includes Marine Stewardship Council certification and Marine Conservation Society ‘fish to eat'). If caterers serve lunch and an evening meal, fish is provided twice a week, one of which is oily. If caterers only serve lunch or an evening meal, an oily fish is available at least once every 3 weeks.

Environmental production standards

At least 10% by value of primary commodity (i.e. raw ingredient) food and drink is produced to certified or assured higher level environmental standards (e.g. organic, LEAF).


Impact Area

Standard

Ethical trading At least 50% of tea and coffee is fairly traded.

Water Tap water is visible and freely available and such provision is promoted. Pre-bottled water (mineral or spring) is not included in the hospitality menu.

Reducing Salt Vegetables and boiled starchy foods such as rice, pasta and potatoes, are cooked without salt. Salt is not available on tables. At least 50% of meat and meat products, breads, breakfast cereals, soups and cooking sauces, ready meals and pre-packed sandwiches (procured by volume) meet Responsibility Deal salt targets and all stock preparations are lower salt varieties (i.e. below 0.6g/100mls).


Impact Area

Standard

Increasing Fruit and Vegetable Consumption

At least 50% of the volume of desserts available is based on fruit – which can be fresh, canned in fruit juice, dried or frozen. A portion of fruit is cheaper than a portion of hot or cold dessert. Meal deals include a starchy carbohydrate, vegetables and one portion of fruit.

Reducing Saturated Fat

Meat and meat products, biscuits, cakes and pastries (procured by volume) are lower in saturated fat where available. At least 50% of hard yellow cheese has a maximum total fat content of 25g/100g; at least 75% of ready meals contain less than 6g saturated fat per portion. At least 75% of milk is reduced fat; and at least 75% of oils and spreads are based on unsaturated fats.

Cereals At least 50% of breakfast cereals (procured by volume) are higher in fibre (i.e. more than 6g/100g) and do not exceed 12.5g/100g added sugars.


Impact Area

Standard

SMEs (Small Medium Enterprise)

Provide opportunity for separate contracts for supply and distribution; and advertise all food-related tenders to SMEs.

Reducing Landfill - Recycling

There are facilities available to staff and customers for recycling cans, bottles, cardboard and plastics.

Food Waste Any contractor must take steps to minimise food waste in its on- site operation using the guidance provided to help decide what action they will take. Contractors should set out what they will do, and feed back to clients on progress and results. The procuring authority must check whether a separate food waste collection service can be provided (see guidance on how to do so). If the service can be provided, while achieving value for money, then it should meet the best practice standard.


Impact Area

Standard

Energy Management

The on-site catering operation is run in accordance with the host building’s overall energy management policy.

Catering Equipment

Domestic refrigerators and freezers - it meets Energy Efficiency standard A and meets standards on greenhouse gases. Commercial refrigerators and freezers - it meets the latest Enhanced Capital Allowance criteria and meets standards on GHGs. Covers for refrigerated units – it meets the latest Enhanced Capital Allowance criteria Domestic electric ovens – it meets Energy Efficiency standard A, at varying energy efficiency indices depending on cavity size. Domestic dishwashers – it meets Energy Efficiency standard A, at varying energy efficiency indices for overall energy efficiency, drying and cleaning performance.


Impact Area

Standard

Catering Equipment Cont/d …

Kitchen taps – have flow rates of not less than 5l/min delivered through either automatic shut off, screw down/lever, or spray taps; and non-flow rate elements shall meet the Enhanced Capital.

Allowance Scheme (ECA) Water Technology List criteria. Paper Products The minimum mandatory Government Buying Standards for paper

products apply where relevant: Tissue paper (for example kitchen and toilet tissue and hand towels) must have 100% recycled content, to include only genuine recovered fibre (i.e. no ‘mill broke’), in accordance with NAPM definition.


PDMS is predominantly either cook-chill/freeze; it is estimated that approximately

50% of hospital operate either a cook chill or cook freeze system Commons, (2005).

All the GBSF standards are applicable to your catering operation; however, there are several additional considerations for a PDMS.

Reducing Salt - 50% of ‘Ready Meals’, soups and pre-packed sandwiches must meet Responsibility Deal Salt Targets. ● At least 75% of ready made meals must contain 6g or less of saturated fat per portion. ‘Ready Made Meals’ are your main course items. ● A minimum of 10% of raw ingredients procured is either certified organic or LEAF. This means 10% of raw foods and beverages only. ‘Ready Meals’ (all products) are not raw ingredients!

GBSF Standards + Additional Considerations for a Patient Delivered Meal System (PDMS)


● 50% of meats and meat products purchased for patients salads etc must meet Responsibility Deal Salt Targets. ● 50% of the volume of desserts must be fruit based. ● 50% of hard yellow cheese must have a maximum total fat content of 25g per 100g.

75% of milk procured for patients and retail must be reduced fat (semi-skimmed). This does not apply to patients who are nutritionally ‘at risk’.

75% of oils and spreads are based on unsaturated fats. This does not apply to patients who are nutritionally ‘at risk’.

50% of breakfast cereals must be higher in fibre (more than 6g per 100g) and must not exceed 12.5g of sugar per 100g.

GBSF Standards + Additional Considerations for a Patient Delivered Meal System (PDMS)


Cereals More than 6g/100g Fibre

Less than 12.5g/100g Sugar

GBSF MET

Bran Flakes 13 22.8 X

Shreddies 9.5 15.49 X

Porridge (Made with milk & water) 0.8 2.4 X

Corn Flakes 0.9 8.2 X

Rice Krispies 0.7 10.4 X

Special K 2 17.8 X

Shredded Wheat 9.8 0.6

Weetabix 9.7 4.9

Ready Break 8 1.9

GBSF Compliant - 50% Breakfast Cereals are higher than 6g/100g of fibre and do not exceed 12.5g/100g of sugar


GBSF Compliance - Tips to Get Started

Collect key information from relevant sources

Websites:

Department of Health Website

Improving Hospital Food

Healthier and more sustainable catering: A toolkit for serving foods to adults. ● Responsibility Deal Salt Targets

DEFRA Website (direct link from the DH’s Website)

list of the GBS standards

Reports - Schools & Hospitals & checklists from the reports

NHS Supply Chain - Supplier catalogues for ‘ready made meals’ for the three main suppliers; TVF, Apetito & Anglia Crown. NHS Supply Chain have ‘product flagged’ the catalogues and highlighted the products that comply to GBSF.


Product Description Ori

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Type of Meal Standard or Specialist

Responsibility Salt target

Fish In Batteryes yes

MSC Alaskan Pollock

Yes Yes n/a yes yes yes Standard

Salt responsibility less than 1.13 (meal centre)

Fish Fingersyes yes

Atlantic Cod, Loinless Block - MCS Rating 3 Yes Yes n/a yes yes yes Standard


Braised Liver & Onions yes yes n/a Yes Yes n/a yes yes yes StandardSalt responsibility less than 1.13 (meal centre)

Braised Liver & Bacon Hotpot yes yes n/a Yes Yes n/a yes yes yes StandardSalt responsibility less than 1.13 (meal centre)

Meatballs In Tomato Sauce yes yes n/a No No n/a yes yes yes StandardSalt responsibility less than 1.13 (meal centre)

Faggots In Onion Gravy yes yes n/a Yes No n/a yes yes yes StandardSalt responsibility less than 1.13 (meal centre)

Vienna Steaks In Gravy yes yes n/a No No n/a yes yes yes StandardSalt responsibility less than 1.13 (meal centre)

Cornish Pastiesyes yes n/a No Yes n/a yes yes yes Standard

Salt responsibility less than 1.00 (Cornish Pasty)

Chicken In Mustard & Coriander Sauce yes yes n/a Yes No n/a yes yes yes Standard


Chicken A La King yes yes n/a Yes Yes n/a yes yes yes StandardSalt responsibility less than 1.13 (meal centre)

Chicken Pie (With Bacon)yes yes n/a Yes No n/a yes yes yes Standard

Salt responsibility less than 0.75 (meat based pastry)

Curried Chicken yes yes n/a Yes Yes n/a yes yes yes StandardSalt responsibility less than 1.13 (meal centre)

Chicken Korma yes yes n/a Yes Yes n/a yes yes yes StandardSalt responsibility less than 1.13 (meal centre)

Sweet & Sour Chicken yes yes n/a Yes Yes n/a yes yes yes StandardSalt responsibility less than 1.13 (meal centre)

Chicken Casserole yes yes n/a Yes Yes n/a yes yes yes StandardSalt responsibility less than 1.13 (meal centre)

Chicken Escalopes yes yes n/a No Yes n/a yes yes yes StandardSalt responsibility less than 1.13 (meal centre)

Chicken & Pasta With Tomato & Herbs yes yes n/a Yes Yes n/a yes yes yes Standard

Salt responsibility less than 1 13 (meal centre)

http://www.supplychain.nhs.uk/


GBSF Compliance - Getting Started

Collect suppliers lists - NHS Supply Chain are ‘product flagging’ other suppliers highlighting compliance. 3663 can also identify products that meet GBSF.

Prepare a spreadsheet for your retail areas and patient feeding.

Input current products/menu items to highlight compliance/non-compliance.

For Patient Delivered Meal Systems - select your supplier from the NHS Supply Chain and engineer a new menu.

Don’t forget to include Responsibility Deal Salt Targets for pre-packed sandwiches and cooked meats etc (Protein salad options), ensure 50% of desserts are fruit based.

When ‘menu engineering’ it is functional to input salad, sandwich and fruit based dessert options first and then build in the main course items to ensure balance.


LUNCH MONDAY WK 1 Saturated Fat (g) Reducing Salt LUNCH TUESDAY WK 1 Saturated Fat (g) Reducing Salt LUNCH WEDNESDAY WK 1 Saturated Fat (g) Reducing Salt LUNCH THURSDAY WK 1 Saturated Fat (g) Reducing Salt LUNCH FRIDAY WK 1 Saturated Fat (g) Reducing Salt LUNCH SATURDAY WK 1 Saturated Fat (g) Reducing Salt LUNCH SUNDAY WK 1 Saturated Fat (g) Reducing Salt

TOTAL READY MEALS 0% 0% TOTAL READY MEALS 0% 0% TOTAL READY MEALS 0% 0% TOTAL READY MEALS 0% 0% TOTAL READY MEALS 0% 0% TOTAL READY MEALS 0% 0% TOTAL READY MEALS 0% 0%

TOTAL SANDWICHES (RS) 0% TOTAL SANDWICHES (RS) 0% TOTAL SANDWICHES (RS) 0% TOTAL SANDWICHES (RS) 0% TOTAL SANDWICHES (RS) 0% TOTAL SANDWICHES (RS) 0% TOTAL SANDWICHES (RS) 0%

TOTAL COOKED MEATS (RS) 0% TOTAL COOKED MEATS (RS) 0% TOTAL COOKED MEATS (RS) 0% TOTAL COOKED MEATS (RS) 0% TOTAL COOKED MEATS (RS) 0% TOTAL COOKED MEATS (RS) 0% TOTAL COOKED MEATS (RS) 0%

TOTAL VOLUME OF DESSERTS 0% TOTAL VOLUME OF DESSERTS 0% TOTAL VOLUME OF DESSERTS 0% TOTAL VOLUME OF DESSERTS 0% TOTAL VOLUME OF DESSERTS 0% TOTAL VOLUME OF DESSERTS 0% TOTAL VOLUME OF DESSERTS 0%

GBSF Menu Analysis - Patient Menus Week 1.

GBSF Menu Engineering


GBS Menu Analysis - Patient Menus Week 1. LUNCH MONDAY WK 1 Saturated Fat (g) Reducing Salt LUNCH TUESDAY WK 1 Saturated Fat (g) Reducing Salt LUNCH WEDNESDAY WK 1 Saturated Fat (g) Reducing Salt LUNCH THURSDAY WK 1 Saturated Fat (g) Reducing Salt LUNCH FRIDAY WK 1 Saturated Fat (g) Reducing Salt LUNCH SATURDAY WK 1 Saturated Fat (g) Reducing Salt LUNCH SUNDAY WK 1 Saturated Fat (g) Reducing Salt

Tomato Soup YES Cream of Leek & Potato Soup YES Golden Vegetable Soup YES Cream of Tomato & Lentil Soup YES Minestrone Soup YES Mulligatawny Soup YES Mushroom Soup YES

Fruit Juice Fruit Juice Fruit Juice Fruit Juice Fruit Juice Fruit Juice Fruit Juice

Chicken Breast & Stuffing in Gravy 1.5 YES Roast Beef & Yorkshire Pudding 2.1 YES Roast Turkey in Gravy 1.3 YES Roast Lamb in Gravy 2.6 YES Fish in Batter 1.1 YES Stewed Steak & Dumplings 3.4 YES Roast Pork in Gravy 1.8 YES

Steak & kidney Pie 8.9 YES Fish in Parsley Sauce 2.6 YES Chilli Con Carne & Boiled Rice 5.1 YES Fish in Cheese Sauce 6.1 YES Chicken a La King 3.9 YES Minced Lamb Bolognaise 2.9 YES Chicken Korma & Boiled Rice 4.7 YES

Mushroom & Bean Stroganoff 4.6 YES Plain Omelette 3.5 YES Vegetable Lasagne 10.4 YES Vegetable Goulash 2.3 YES Cauliflower & Broccoli Pasta 8.5 YES Plain Omelette 3.5 YES Lentil Cottage Pie 3.3 YES

TOTAL READY MEALS 67% 100% TOTAL READY MEALS 100% 100% TOTAL READY MEALS 67% 100% TOTAL READY MEALS 67% 100% TOTAL READY MEALS 67% 100% TOTAL READY MEALS 100% 100% TOTAL READY MEALS 100% 100%Egg Mayo & Sliced Egg S/W (white) YES Cheese Sandwich YES Cream Cheese & Chive Sandwich YES Egg Sandwich YES Cheese Sandwich YES Egg Mayo Sandwich NO Cheese Salad Sandwich YES

Turkey Salad Sandwich NO Tuna Salad Sandwich YES Egg Mayo & Bacon Sandwich NO Ham Sandwich NO Beef Sandwich NO Chicken Salad Sandwich YES Ham Sandwich NO

TOTAL SANDWICHES (RS) TOTAL SANDWICHES (RS) TOTAL SANDWICHES (RS) TOTAL SANDWICHES (RS) TOTAL SANDWICHES (RS) TOTAL SANDWICHES (RS) TOTAL SANDWICHES (RS)Mackerel Salad YES Chicken & Pasta Salad YES Cottage Cheese Salad YES Cous Cous Salad YES Rice & Bean Salad YES Cream Cheese & Chive Salad YES Scotch Egg Salad NO

Cottage Cheese & Pineapple Salad YES Cheese & Egg Salad YES Pork Pie Salad YES Beef Salad NO Sausage Roll Salad YES Italian Chicken Pasta Salad YES Mackerel Salad YES

TOTAL COOKED MEATS (RS) TOTAL COOKED MEATS (RS) TOTAL COOKED MEATS (RS) TOTAL COOKED MEATS (RS) TOTAL COOKED MEATS (RS) TOTAL COOKED MEATS (RS) TOTAL COOKED MEATS (RS)Creamed Potatoes Creamed Potatoes Creamed Potatoes Creamed Potatoes Creamed Potatoes Creamed Potatoes Creamed Potatoes

Roast Potatoes Saute Potatoes Boiled Potatoes Roast Potatoes Chipped Potatoes Saute Potatoes Roast Potatoes

Cabbage Cauliflower Sprouts Cabbage Mushy Peas Julienne Carrots Country Vegetables

Sweetcorn Peas Cauliflower Peas Mixed Vegetables Garden Peas Carrots

Chocolate Sponge Rhubarb Crumble Blackcurrant Frangipane Baked Lemon Tart Sticky Toffee Pudding (Contains Dates) Apple Pie Bakewell Tart

Vanilla Ice-Cream Vanilla Ice-Cream Vanilla Ice-Cream Vanilla Ice-Cream Vanilla Ice-Cream Vanilla Ice-Cream Vanilla Ice-Cream

Cheese & Biscuits Cheese & Biscuits Cheese & Biscuits Cheese & Biscuits Cheese & Biscuits Cheese & Biscuits Cheese & Biscuits

Thick & Creamy Yoghurt Thick & Creamy Yoghurt Thick & Creamy Yoghurt Thick & Creamy Yoghurt Thick & Creamy Yoghurt Thick & Creamy Yoghurt Thick & Creamy Yoghurt

Banana Apple Banana Apple Banana Apple Banana

Orange Pear Orange Pear Orange Pear Orange

Fruit Cocktail in Natural Juice Peaches in Natural Juice Pears in Natural Juice Fruit Cocktail in Natural Juice Peaches in Natural Juice Pears in Natural Juice Fruit Cocktail in Natural Juice

Mandarins in Natural Juice & Ice Cream Pineapple in Natural Juice Fruit Cocktail in Natural Juice Mandarins in Natural Juice & Ice Cream Pineapple in Natural Juice Fruit Cocktail in Natural Juice Mandarins in Natural Juice & Ice Cream

TOTAL VOLUME OF DESSERTS TOTAL VOLUME OF DESSERTS TOTAL VOLUME OF DESSERTS TOTAL VOLUME OF DESSERTS TOTAL VOLUME OF DESSERTS TOTAL VOLUME OF DESSERTS TOTAL VOLUME OF DESSERTS

100% 100% 50%100% 100% 100% 50%

50% 50% 50%

50% 100% 50% 50% 50% 50% 50%

50% 50% 50% 50%

GBSF Menu Engineering


Monday Week 1. Lunch Monday Week 1. Evening Meal

Tomato SoupFruit Juice

Chicken Breast & Stuffing in Gravy Shepherds PieSteak & kidney Pie Fish in Parsley SauceMushroom & Bean Stroganoff Vegetable Goulash

Egg Salad Sandwich Cheese Sandwich Turkey Salad Sandwich Tuna Mayonnaise Sandwich Mackerel Salad Corned Beef SaladCottage Cheese & Pineapple Salad Mixed Cheese Salad

Creamed Potatoes Creamed PotatoesSaute Potatoes Jacket PotatoCabbage Green BeansSweetcorn Sliced Carrots

Chocolate Sponge Rice PuddingVanilla Ice-Cream Vanilla Ice CreamCheese & Biscuits Cheese & BiscuitsThick & Creamy Yoghurt Thick & Creamy YoghurtBanana AppleOrange PearFruit Cocktail in Natural Juice Peaches in Natural JuiceMandarins in Natural Juice Pears in Natural Juice & Ice Cream

Starter

Main Course

Salads & Sandwiches

Desserts

Vegetables & Potatoes

GBSF Compliant

Example Patient Menu - Monday Week 1. GBSF Compliance …

Reducing Salt; soup meets Responsibility

Deal targets - GBSF MET 83% of Ready Meals on today’s menu contain less than 6g saturated fat - GBSF MET 100% of Ready Meals on today’s menu meet Responsibility Deal salt targets - GBSF MET 75% of Pre-Packed Sandwiches meet Responsibility Deal salt targets - GBSF MET 50% of Desserts are based on fruit - GBSF MET

1.5g

4.6g

5.6g 2.6g

2.3g

GBSF: At least 75% of ready meals must contain 6g or less of saturated fat. ‘Ready Meals’ are your cook-chill/freeze main course items.

GBSF: At least 50% of pre- packed sandwiches meet Responsibility Deal Salt Targets.

GBSF: At least 50% of desserts are based on fruit.


Questions & Concerns You may Have

Will I be able to source sufficient products/produce to be compliant? Yes! NHS Supply Chain have already identified and product flagged many products that comply with GBSF and are continuing to work with suppliers. As demand grows supply will change to meet demand.

How much work is involved? Time taken to research products and re-engineer menus can be considerable, however help is at hand. Handouts, spreadsheets, contacts.

Will GBSF be more costly? I am currently on a tight budget.

Re-engineering menus to ensure GBSF compliance could prove to be be more expensive. Experience tell us that quite often ‘ready meals’ containing less saturated fats can cost more, reduced fat cheese does in fact cost more!

● Example; cost effective menu engineering


Ready Made Product In-house Production

Creamed/Mashed Potato

Average supplier cost = £0.21 per portion HEY provides approximately 1000

portions per day Total cost per day = £210.00 Total cost per annum = £76,650.00

Fruit Crumbles

Average supplier cost = £0.46 per portion HEY provides approximately 1400

portions a week Annual cost = £33,488.00

Creamed/Mashed Potato

Average in-house production cost = £0.11 per portion

Total cost per day = £110 £40,150 per annum Saving of £36,500

Fruit Crumbles

Average in-house production cots = £0.15 per portion

Total cost per week = £210.00 Annual cost = £10,920 Saving of £22,568

2 in-house products generate a cost saving of £59,068

in-house products can be enhanced to increase kcal and protein for nutritionally at risk patients.


Hull and East Yorkshire Hospitals NHS Trust - therapeutic diets are produced

in-house within our diet bay. ● We have developed a range of ‘energy dense’ foods for patients who are nutritionally at risk. Our ‘energy dense’ range is unique containing very high levels of both kcal and protein. ● All our products are made from natural, wholesome ingredients and contain no protein enhancers, preservatives or colourings. ● Patients who are ‘at risk’ could consume up to 2000 kcal per meal and 70g protein. ● Food Tasting - during lunch please try our ‘energy dense’ soups and desserts; soups contain up to 555 kcal and 12g protein, desserts contain up to 700 kcal and 10g protein.

Therapeutic and Energy Dense Food Provision


Malnutrition in England The cost of doing nothing

Health & Medicine

Achieving gbsf with patient delivered systems