Care Homes
Are care homes expected to source locally?
The simple answer is no, despite the great benefits and additional supply chain complexity caused by Brexit.
How does it work currently?
Care homes are, in fact, only a small proportion of care services for the elderly. Most people prefer to stay in their own homes and receive care there for as long as possible. The management of most care homes and home care services is private, run by a range of small independent businesses, large groups, charities and agencies. There are also some fully publicly-funded care homes run by local authorities.
The range of management styles and size of business means that there is no standard procurement practice for care homes or care services. Where care homes are fully publicly-funded they are managed by local authorities and “piggy back” off the schools contracts.
What are the challenges?
Appreciation of the importance of good nutrition is growing across the public sector but in many areas is still wide of the mark. The Care Quality Commission which regulates care homes, care services and hospitals amongst other services expects the following for food and drink:
“You must have enough to eat and drink to keep you in good health while you receive care and treatment.”
The focus on the CQC Fundamental Standards page is on quantity rather than quality and appeal. There is some nutritional guidance offered in the form of the Eatwell Guide, but Sophie Murray, Head of Nutrition and Hydration at Sunrise Senior Living, is concerned that the guide is misleading, especially when it comes to sources of carbohydrates. She doesn’t think that many care homes have nutritional guidance in-house and adds that “regulators aren’t necessarily trained in nutrition and dining, so they might not spot where there are food quality gaps and instead look for issues around malnutrition and resident feedback, both crucial but not nutrition-centred. If someone was using Smash or low meat percentage composite, it probably wouldn’t get picked up as an issue.”
The fragmentation of the care sector has meant that there is considerable inconsistency in procurement practices with some small independents ordering directly from supermarkets and paying retail prices. “A small hotel with similar volumes is likely to have a more effective procurement practice,” Sophie Murray explains. Meanwhile, other care homes are able to benefit from the nutritional advances made in high uptake products, like ice cream, designed in collaboration with Brakes and their supplier partner, Callestick Farm, for hospitals with bigger contracts. The fact that the care sector is not working together on procurement means that they are not driving product innovation with local suppliers to support their nutritional needs in the same way as other sectors. They also won’t be benefiting from bulk discounts to the same extent.
Sue Cawthray, NACC National Chair says that the Meals on Wheels service in the UK which in some cases supports those using home care services, has been particularly important during the pandemic. In some areas it is funded by local authorities and is often the first thing to be cut from their budgets. There are private operators too around the country in various guises who work within local communities and during the pandemic there have been many pop up services and the NACC during their Meals on Wheels annual campaign highlighted the importance of these vital services that not only assist with access to good nutrition but also the prevention of social isolation.
What has worked well?
Drawing on their existing body of nutritional knowledge, the NACC has started its own guide for nutritional menu planning which includes Love British Food advice on local sourcing. However, there is a concern that the NACC is not reaching the care homes that need their help most as members tend to be those who have already recognised the importance of food and catering.
At Sunrise Senior Living, Head of Nutrition and Hydration Sophie Murray has been working with the Head of Dining Services to ensure seasonal menu cycles that play to the strengths of British produce and support the nutrition of residents. While increasing the quality of their menus, Sunrise Senior Living keeps costs down through careful menu yield management Sophie says “it doesn’t increase our spend, we just have to be clever with menu cycles. If you have a stew for lunch, you incorporate the same vegetables in the soup of the day and use the dry spices to vary the flavour. Peelings from some fruit and vegetables are also a great source of fibre. Bowel problems and constipation are a big problem in care homes.”
For meat Sunrise Senior Living works with Donald Russell, knowing that the majority of their meat will be British. Some meats, such as lamb, can be cost prohibitive, but others like beef you can get good value from British sources. Sunrise also works closely with Brakes sourcing both high nutritional ice cream and a dairy shake from British producers. This year for British Food Fortnight, Sunrise ran a competition focused on seasonal British apples in their care homes that generated lots of support and interest among both residents and catering staff.
What can be learnt from other public sector caterers?
Collaborative and flexible procurement frameworks, such as those managed by Scotland XL and TUCO, could provide a blueprint for how the care sector could work better together for improved procurement outcomes without reducing the independent choices of each business.
Prisons, like care homes, are providing residents with all meals 24/7. This offers a prime opportunity for collaboration with nutritional researchers. Prisons are working with academics to better understand the effects of nutrition on depression and violence. Off the back of this research they are working with their supplier, Bidfood, to develop high value nutritional food that appeals to prisoners. If prisons can do this for £2.15/day/person with many adult male appetites, it ought to be possible for care homes with budgets of £3-6/day/person with much smaller elderly appetites.
Nutritional regulations in Scotland are driving progress in schools and funding has been given to Food For Life Scotland to support and encourage schools in developing better catering practices.
Key recommendations
- The Care Quality Commission should inspect all care services menu planning, including basic nutritional recommendations. Their inspection should be guided by a set of nutritional standards agreed by nutritionists and dieticians in the sector, such as the new NACC menu planning guide as well as the BDA digest equivalent for hospitals.
- Savings can be made on reducing waste in exchange for higher quality ingredients. Seasonal menu cycles designed for multi-purpose use of fresh ingredients are excellent tools for increasing savings.
- Procurement frameworks should be encouraged to consider multi-purpose use of ingredients, nutritional value and likely uptake when assessing the price of proposals. We should be paying for nutritional impact not quantity of food.
- Nutritional training or access to nutritionists should be mandatory to all care catering services in care homes and include leadership teams.
- Competitions should be run to celebrate successes and encourage more talented chefs into the sector.
- Financial support should be provided to the NACC to develop flexible procurement frameworks similar to those in TUCO and Scotland XL that allow for supply only and distribution only models as well as regional lots. This can accommodate private and publicly-funded care homes.
- Direct relationships with local producers should be encouraged through Meet the Buyer events.
- Farm-to-fork training with suppliers to engage and enthuse care sector chefs.
- Care homes could also collaborate with local councils on the use or development of local distribution hubs as seen in Dumfries and Galloway.