Hospitals
Hospitals
In early 2020, Alexia Robinson, Founder of Love British Food, conducted a piece of work looking into what would help considerably in making it easier for hospital trusts to source quality, sustainable food from British suppliers.
Working with Phil Shelley, Chair of the Hospital Food Review, Craig Smith, Chair of Hospital Caterers Association and Andy Jones, Chair of the Public Sector Catering 100 industry group, we came up with six recommendations, listed below. These are an extension to the recommendations in the Hospital Food Review. We went into a lower level of detail to identify exactly what would be a game-changer in enabling NHS catering managers to source the good food, from local British suppliers, that they aspire to.
We presented our findings to Dido Harding in January; in her capacity as Head of NHS Improvement. We talked them through with her in detail during a visit that Love British Food organised to Nottingham University Hospitals to see the inspirational work that Chris Neale does in sourcing all the food for their menus from local suppliers.
Due to covid-19, we delayed bringing them to Matt Hancock’s attention until November 2020, when we did so together with Craig Smith of the Hospital Caterers Association, and by which time the Hospital Food Review had been published too.
Since publishing them, our first recommendation has been taken up! Phil Shelley has been appointed to work full time for NHS Improvement. We hope that the other recommendations are adopted as quickly. They are all easy to take forward; they are simple, common sense changes to existing systems. They will help tremendously in delivering the quality food that we all aspire to providing in our hospitals, where we need to purchase quality over cost which in turn empowers recovery for our patients.
Love British Food’s recommendations:
A specialist lead at NHSI who is a caterer. This has been achieved since we recommended it!
Having a project lead that is involved in the industry is a distinct advantage – having the respect of NHS colleagues, contractors, suppliers and fellow associations brings an inclusiveness to fact finding and decision making.
Mandatory food standards: with robust audit linked ERIC data (Estates Returns Information Collection) and PLACE (Patient-Led Assessments of the Care) data that is independently ratified.
Decision making requires evidenced based data – current information collected does not dig deep enough on Soft FM services particularly catering. Accurate statistics will drive changes in behaviour around cost control and food waste auditing.
Mandate Trusts to comply with Government buying standards and support local farmers and suppliers.
Trusts need accelerated guidance and support to help them purchase prudently, using seasonal produce and sourcing food that is produced sustainably. They also need to be given the tools to help them educate their catering teams and the public.
Foodbuy to be engaged in buying sustainably.
There has been a distinct change in the way that Foodbuy has linked with Hospitals and Trusts in recent months. All caterers want the best price possible for a quality product but this must not be at the expense of choice. Purchasing with long term objectives drives sustainable decision making.
Minimum food spend to be based on the system each hospital operates, ring-fenced against CIPs (cost improvement programmes), ensuring it is index-linked.
Catering budget holders need the confidence and flexibility to manage effectively and not in fear that their provisions and equipment finances will be cut. Quality provisions empower recovery so an awareness of an index-linked budget creates assurance.
Set an ambitious target for Trusts to use a minimum of 65% British food ingredients on all menus with the aim to increase year on year.
It is difficult to drive target based procuring of British products but we must have robust specifications that require hospitals to ensure that local suppliers are offered a chance to tender for business at healthcare sites in their community. This will enhance the supply industry to work closer with us so that we flourish together.
How does food sourcing in the NHS work currently?
The NHS operates as individual hospitals that often link regionally with fellow Trusts. The catering is managed either in house or outsourced to catering services. Catering teams often span multiple hospitals. The budget for catering is decided by each Trust. The government doesn’t specify how much should be spent on food. This is decided by each hospital. This makes sense given that many hospitals specialise in certain services that could impact on how budget should be split.
Mostly NHS Trusts have their own supplier networks and are happy with these, but they can also access suppliers through the centralised NHS Supply Chain, which is contracted to Foodbuy.
There is a huge disparity between hospital food offerings with some hospitals achieving excellent standards. West Suffolk, for example, are able to attract paying customers through the staff and visitor restaurant with the quality of their food to become a revenue generator rather than a cost centre.
What are the challenges?
As Phill Shelley, the new lead at NHSI, puts it: “Catering budgets must not continually be an area for savings.” To strengthen the position means winning over Trust senior management teams to place greater value on the catering function as a significant service to the hospital.
There is a misperception that sourcing local is expensive. According to Stewart Nimmo, Catering Manager at The Queen Elizabeth Hospital Kings Lynn: “Local food used to be more expensive, but times have changed. A lot of local suppliers have come in with lower pricing for bigger contracts that have opened doors and some of the products from national suppliers have gone up in price due to increased overheads, so there is a more level playing field.”
This stems in part from Lord Carter’s review of productivity in the NHS that was published in 2015. It suggested that collating spend would save the NHS more money.
However, in the past Trusts have been disappointed by the quality of produce bought centrally and consequently have moved to localised solutions. NHS Supply Chain is aiming to regain trust in their quality to collate more spend than they currently do. It will also have to take into consideration the significant differences in culture and diet between regions, for example between London and the South West or Yorkshire. Some Trusts are collaborating on purchasing locally to collate as much spend as possible within a culturally similar area.
Another issue is that many hospitals lack fully functional kitchens, especially those built more recently, which means they have to use re-heating systems rather than preparing fresh food.
What has worked well?
Specifying local suppliers for fresh produce tenders
The hospitals that have achieved the most with local sourcing and the quality of their food offering have separated their fresh produce from their ambient and frozen categories and only opened their fresh produce tenders to local suppliers within a certain radius. There are a number of benefits to working with local suppliers on fresh produce. Stewart Nimmo explains, “Local suppliers don’t move as much stock so what you get tends to be fresher. They are also better at responding to last minute requests and adapting to your requirements. We can get fresh vegetables every day of the week if we wanted it, whereas nationals would offer us a weekly slot.”
Brod Pooley, Facilities Manager of West Suffolk NHS Foundation Trust, comments about the butcher they use 3 miles from the hospital. “If we want a certain quantity, we can get it. If we need more quickly, it’s easy to pop down the road. This means we aren’t cooking a 4kg joint of meat when we only need 2.5kg and it enables us to reduce our food waste.”
The procurement process for both hospitals was very similar. This is how Brod describes the procurement process at the West Suffolk hospital. “We identified the produce we wanted to source locally: meat, dairy, bread and vegetables. We then contacted local suppliers (Suffolk, Cambridgeshire and Norfolk) that had catering business, gave them our catering usage and asked them for prices. We narrowed down the list through references, hygiene and safety, and prices. Our shortlist was requested to send samples, which one of our chefs cooked up for us to do a blind tasting. This round was decided primarily on quality.”
As a result of this process and their decision to cook as much fresh as possible, they source 75% of their food from suppliers within 30 miles of the hospital.
Developing nutritionally rich products with British producers
The Trelisk hospital in Cornwall were doing analysis of plate waste and noticed that patients often didn’t have much of an appetite, but they would always eat ice-cream. They contacted their ice-cream supplier, Callestick Farm, who make ice-cream from the free-range milk of their 300 strong dairy herd on the North Cornish coast, to see if they could boost the protein and fat content in the ice-cream as well as increasing the calories. This has now become a bespoke recipe for the NHS and is distributed locally by Callestick (70-80 hospitals and nursing homes in Devon and Cornwall) and further afield by Brakes, a Love British Food Partner. Callestick has seen a 13-15% growth year on year for the last 3 years through their partnership with Brakes and the public sector.
Operating as a revenue generator
If all hospital catering services generated revenues, we’d be in a fantastic position. How does the West Suffolk NHS Foundation Trust make it work? Brod Pooley explains, “The Trust board has always looked on us as part of the team rather than a money saving. We have at times been quite expensive, but they believe in the service they are getting. We’ve never been told we’ve got to cut our provisions cost and I’ve been there seven years now. They do sometimes ask if we can make more profit, especially through the paid restaurant. As a cook serve unit, we have quite a big area to repay.
Pre-COVID we were a very busy restaurant because we’ve got the quality right. We found that some visitors would eat after their visit before going home, which led us to expand our product offering to afternoon teas. Our idea was that, when a mother has just given birth, the father may want to do something special to celebrate with the grandparents. This was very successful and we found that other visitors took it up to celebrate patient birthdays and even our staff would offer it to other members of the team if they had done something special.
We’ve had our Food For Life Served Here Bronze Award for five years now and the Eat Out Eat Well Award, but these awards are not just due to our work in catering. It’s a combination of everything the doctors, dieticians, nurses, and porters do to help us. All our menus are nutritionally analysed and approved by our dieticians. We discuss with them the balance between nutrition and taste and we also factor in how the food arrives after the trip from the kitchen to the bedside. As it is heated in transit, it keeps cooking, so we aim to slightly undercook things like rice pudding to be the right consistency when it’s actually eaten. Nutrition is only any good if people want to eat it. That’s where the nurses and porters come in. Because they have been eating the same food, they can recommend dishes they’ve had before, which encourages those without much of an appetite. It also works the other way around. Patients will recommend food to the nurses.”
Key recommendations from hospital caterers
- Separate out the fresh produce and focus on this for local sourcing as this is where the biggest impact will be seen.
- Only invite local suppliers to tender for fresh produce.
- Look for opportunities to generate revenue from hospital catering through special occasions with visitors and staff.
- Ensure the Trust Board are well educated on the value of good catering and nutrition.
- Benchmark the current situation and focus on improving on that through measurement with the Soil Association's Food For Life Served Here (FFLSH).
- Ensure all hospitals have fully-equipped kitchens for preparing fresh food rather than reheat only.
- Consider the use of digital menus that provide nutritional, dietary and sustainability information to patients when ordering.
- Work with local suppliers to develop products to cater for specific requirements such as nutrition.
The following is a check list for NHS Trust Catering Managers to use when considering forming a new supplier relationship. This advice has been provided by the team at NHS Improvement who are working with Love British Food to promote local supply chains in the NHS.
Who should be involved to confirm commitment and avoid confusion: Catering Manager / Budget Holder / Procurement Lead?
Have you taken into consideration:
1) National Framework
2) Regional Agreement
3) Local Agreement
4) Specialist Contract
What is the benefit of the offer – quality versus cost?
Is there already a reference site, particularly healthcare?
Has the supplier achieved the necessary audit certification, preferably STS?
Is the Trust in a position to choose freely when purchasing locally?
Has a credit check taken place with the proposed company?
Has there been a tasting session or a visit to the supplier or reference site?
Discuss the length of the contract with agreed KPI’s and possible extension if there is suitable success.