Food and Drink

Strategy

2017 to

2020

WLMHT Food and Drink Strategy 2017 – 2020 Page 2 of 13

Document History

Date: 4 April 2017

Title of Strategy: Food and Drink Strategy 2017 – 2020

Author: Jennifer Holmyard

Review: February 2018

Summary: Outlines food and nutritional needs for service users, staff and visitors.

Action required: Ratified at TMT (31/5/17)

Previously been discussed at: Physical Health and Environment Committee

Next steps: Produce corresponding KPIs (Appendices)

KPI Review October 2017

Relationship to the board assurance framework

Are any existing risks in the board assurance framework affected?

No

Risk reference: N/A

Do you recommend making a new entry in the board assurance framework (e.g. Trust-wide level 1 risk)?

No

Index

Page No

Statement from Chief Executive 3

Introduction 4

Aims & Objectives 5

Pledge 7

Nutrition and Catering Services 7

Self-Catering 9

Staff Nutrition 9

Redevelopment 10

Sustainability 11

Resources 12

References 12

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Statement from the Trust’s Chief Executive

Welcome to our first food and drink strategy which outlines our on-going ambition to provide nutritious food and plenty of available drinks to our service users, visitors and staff.

It is shown that service users who are well-nourished and hydrated recover more quickly from illness; have fewer complications and have a shorter stay in hospital. We therefore have a responsibility as a healthcare provider to support service users, visitors and staff to maintain a healthy lifestyle by providing and promoting healthier food choices. In addition, staff that are fit and well themselves, have a positive impact on the clinical outcomes and overall experience of our service users.

Our Food and Drink Strategy has been developed by our facilities team, nutrition and dietetics service, catering contractor Outsourced Client Solutions (OCS), and our service users and carers. They have worked together to embed the recommendations of the Hospital Food Standards Panel Report published by the Department of Health, in conjunction with Age UK, in August 2014. This report recommended the implementation of five key standards to ensure hospitals consistently deliver high quality food and drink:

1. The 10 Key Characteristics of Good Nutritional Care from the Nutrition Alliance 2. Nutrition and Hydration Digest (The British Dietetic Association) 3. Malnutrition Universal Screening Tool (British Association of Parenteral and

Enteral Nutrition) or equivalent validated tool 4. Healthier and More Sustainable Catering – Nutrition Principles (Public Health

England) for staff and visitor catering 5. Government Buying Standards for Food and Catering Services from the

Department of Environment, Food and Rural Affairs

The Trust must comply with the mandatory Food Standards guidance as part of its legally binding NHS Standard Contract. This means our commissioners are clear on what they expect of the food we provide and can hold the Trust to account if we do not measure up. The Trust will be monitored on delivering these standards through the annual Patient-Led Assessments of the Care Environment (PLACE) organised by the national Health and Social Care Information Centre.

This strategy reviews how we currently meet these standards and identifies where improvements can be made and how these will be addressed in three main areas:

Meeting the nutrition and hydration needs of service users

Healthier eating choices for the whole hospital community

Sustainable procurement of food and catering services

Carolyn Regan Chief Executive

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Introduction As a mental health and community services Trust we want to continue to deliver great care for every service user and continue to make improvements to all our service lines. This includes the provision of nutritious food and ready access to drinks. What we eat and drink has a significant impact on both our physical and mental health and wellbeing. As such, food in our hospital and community services should support the health of all service users, visitors and staff. In addition, the food experience should be positive and enjoyable. Nutrition charity BAPEN’s evidence shows that one third of all hospital admissions are already at risk of malnutrition.

Service users In England around 62% of adults in the general population are overweight or obese; but people with mental health conditions are even more at risk of excess weight gain. Over 90% of our long-stay female service users, and more than 80% of males, are classed as overweight or obese. In addition, excess bodyweight confers a higher risk of developing type 2 diabetes, heart disease and cancers. As a result, we have a greater percentage of diabetics as inpatients than in the general population. Additionally excess weight can affect the sustainability of steady work, an individual’s self-esteem, motivation and mental wellbeing; all of which affect our service users’ recovery outcomes. In addition to their mental health issues, many of our service users also suffer from poor physical health conditions related to their obesity. It is therefore particularly important to promote healthy eating and create awareness about nutrition to assist them in making long term changes to their diet and lifestyle. Adequate hydration is equally essential to help prevent urinary tract infections and kidney damage. Water intake, which is essential to health and is one of the six basic nutrients, can be found in food and fluids, but is often overlooked. This can result in vulnerable individuals missing out on the support they need to help maintain a healthy level of hydration. The Hospital Food Standards report on criteria for food and drink standards in NHS hospitals, issued in 2014, was developed primarily for acute hospitals. However, mental health hospitals have additional requirements, particularly as service users are more likely to be younger than the average acute patient or have different requirements due to their confined living environment if they are in a forensic setting. While increased levels of physical activity are important for the health of many people, reduction in calorie consumption is vital for weight management. The Government has advised a “calorie reduction pledge” which provides a mechanism for the food and drink industry to support the population to meet the calorie reduction challenge.

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Staff Obesity and poor diet are also important issues in the promotion of staff health and wellbeing in the NHS. The Trust, therefore, has a role in providing an environment that facilitates healthier choices and behaviours to its workforce. This is particularly important for shift workers, who may be more prone to poor eating habits if healthier choices are unavailable or limited. Being a good role model to those we care for is set out in our duty of care standards and staff who make unhealthy choices are not demonstrating this ethos. As major purchasers and providers of food and catering services, we also recognise that we have a duty and opportunity to make sustainability a high priority in our service delivery and decision-making processes to support waste reduction, high standards of food production and lowering our carbon footprint. This strategy builds on work already undertaken by the Trust, and should be viewed with reference to the following strategies and policies:

Food Nutrition and Hydration Policy

Health and Wellbeing Strategy

Environment/Sustainability Policy

Aims and objectives Our strategy aims to outline a realistic range of food options that offer service users the choice to have healthy options alongside choices to meet the needs of our diverse community at West London Mental Health NHS Trust. Providing only healthy options will not reflect the community and where shopping and purchasing habits may be unhealthy or unbalanced, we have the

opportunity during a service user’s inpatient stay to support the promotion of healthier choices throughout their recovery journey. By offering service users roles in and around purchasing, stocking, selling and producing food we aim to educate and develop an understanding around appropriate nutrition and making healthier choices, as well as helping them prepare for their reintegration back into their community.

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Objectives

To offer advice and support to develop service users understanding of their food

choices/behaviours and how this can be modified to support their optimal health and

well-being.

To offer education throughout a service users stay to ensure that choices are well

informed to maximise their health and wellbeing.

To consider all the available food options to make service users aware of their

choices.

To use the national traffic light system labelling in all of our activities and outlets and

include advice from Department of Health.

A standard to be agreed that on-ward activities should be no more than one third

food orientated and which encourages non-food activities

Cooking methods and ingredients should be aiming to use low calorie methods and

avoid less healthy traditional methods. Frying food needs to be minimised and

alternatives offered such as continental breakfasts - muesli, fruits, yoghurts etc., and

at lunchtime - wraps, salads etc.

The aim of a ward community meal should be to provide a simple meal that can be

eaten by service users and staff together as a group, encouraging and facilitating co-

production, joint working and team working. In rehabilitation wards, a community

meal with a greater emphasis on self-catering and individual life skills development

should include healthy eating principals.

Work towards offering healthier takeaway options.

Encourage service users to prepare different styles of foods and educate them on

world foods based on healthy eating principals.

To stock vending machines with 85% healthy snacks, water and flavoured low calorie

fizzy drinks; and 15% non-healthy.

Provide and stock our own machines in all buildings by the end of 2017, this will

require other options to be removed and other vending machines to be sourced.

Increase the range of chilled items available in onsite cafés and open at lunchtimes

to offer options for staff and visitors. Consider making work roles available for service

users at the commercially relevant times.

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Strategy pledge

Reformulation: Recipe/menu changes to decrease energy density, fat and sugar in

products, or substituted with other lower calorie ingredients, whilst still continuing to

support our service users’ needs when they require a modified diet. We are taking

this approach with our fresh cook services and carefully selecting healthier options.

Some service users may, because of frailty or poor appetite, require foods that are

energy dense and high in calories, and we will supply a suitable diet for those who

meet this criterion.

Portion Size: We are ensuring that meals are the right portion size to meet the

needs of our various service users. In some cases this may mean larger portions of

the right health promoting foods.

Encouraging consumers to choose healthier options: Promotion of smaller

portion sizes to encourage downsizing, other substitution options to favour lower

calorie options – discouragement of multi and large packs in trust retail outlets;

consideration of positioning and amount of higher calorie stock.

Satiety enhancers: Potential to increase the content of satiating ingredients to

decrease overall energy intake. Promoting foods that have more dietary fibre and

other ingredients that help people feel fuller for longer.

Balance of Options: A greater proportion of healthier products in shops, vending

machines and menu items. Procurement and default options offered are healthier

options: low fat milks reduced fat cheeses, spreads; low fat meats; etc.

Inform and educate: Menu coding, labelling in retail outlets, dietary coding on

vending machines.

Nutrition and catering services We contract to one supplier, OCS, to provide our catering services for all of our London sites offering a mixture of fresh-cook and cook-chill menus. Broadmoor Hospital, our site in Berkshire, remains with an in-house catering service offering fresh-cook menus. We ensure OCS and other suppliers adhere to our strategic objectives through regular contract monitoring. Menus are reviewed every six months so that not only do they give the service user a varied experience but they also guarantee that the ingredients can be bought seasonally, and are sourced as locally as possible – thereby complying with our sustainability objectives. Service user satisfaction feedback or food requests are taken into consideration.

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To encourage a positive mealtime experience and allow service users time to enjoy their meals ‘Protected mealtimes’ will be observed in the Trust. All non-emergency clinical activity stops, the ward is tidied and service users are made ready for meals. It gives service users ‘space’ to eat and enjoy their meals. It also gives hostesses and clinical staff time to give assistance to those who need help with mealtimes. Assessments of nutritional and hydration intake, eating/swallowing ability and Activities of Daily Living (ADL) skills may need to occur during protected meal times. Key points:

Provide mealtimes that are free from avoidable and unnecessary interruptions.

Create a quiet and relaxed atmosphere in which service users are given time to choose and enjoy meals.

Provide time and space to support healthy meal choices and support those who need assistance when eating.

Recognise and support the social aspects of eating.

Provide an environment conducive to eating that is clean tidy and welcoming.

Focus the ward activities into the service of food.

Emphasise to all staff, service users and visitors the importance of mealtimes as an integral part of care, rehabilitation and treatment.

Adult inpatient and day service users and those attending services where food or drink is provided will routinely be screened for aspiration and risk of choking by ward staff as part of the admission assessment. Service users will be offered a review of their eating/drinking at planned junctures and referred to a Registered Dietitian where there is a need to assess and manage a condition responsive diet, such as diabetes or cardiovascular disease. Menus will be diet coded, including allergen information, to assist service users and staff to select food and drinks appropriate to meet their nutritional needs and cultural needs. Where needs cannot be met from the menu, an alternative and appropriate meal will be provided.

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Self-catering This is viewed within the forensic service as a positive and normalising part of service user’s recovery and preparation for community living. Service users’ practical skills and knowledge are assessed by qualified Occupational Therapists through a cross ward group program community access and individual kitchen assessments. The self-catering process includes assessment and interventions to address all aspects of this life skill, such as budgeting, menu planning, shopping skills, use of public

transport in addition to use of kitchen equipment and awareness of food hygiene, preparation and safety issues. Opportunities for service users to self-cater is graded and individualised according to their need and stage of recovery, with regular reviews and monitoring and an increase of frequency when appropriate. Dieticians support service users and the multi-disciplinary team to encourage appropriate and individualised dietary choices for optimised health.

Staff nutrition The prevalence of obesity has been identified as a national problem. The Health at Work Team has seen a steady increase in referrals over the last five years in musculoskeletal conditions, many of which are related to obesity. Prevention and Management of Violence and Aggression (PMVA) fitness is becoming a problem within the workforce as increasing numbers of staff are unable to pass the PMVA training due to musculoskeletal problems often secondary to obesity. The Occupational Health Advisors/Physician offer advice to staff in relation to healthy eating and exercise during consultations, wherever possible and relevant. They run annual health and wellbeing sessions for staff at the main Trust sites, where there is information about healthy eating and exercise with a Registered Dietitian in attendance. There is a need for further interventions in relation to weight management advice and funding is secured for a Registered Dietitian at one session a week. We use our noticeboards and the exchange to promote healthy eating and exercise in line with national campaigns.

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Redevelopment

St Bernard’s Forensic Services Fresh-cook meals were introduced in the Orchard in January 2016 and the Three Bridges Medium Secure facility in February of the same year. The catering focus group were attended by service user representatives from each ward, OCS, Facilities, Redevelopment team and the Service User & Carer Engagement Coordinator. Together the group developed fresh-cook menus and menus that reflect client groups e.g. ethnic meals; healthier menu options; and themed monthly meals. In addition fresh-cooked takeaways have been introduced once a week – which is designed to be a healthier option than takeaways from the community. Menu cards have been introduced where service users can choose their own meals in advance, to improve service user satisfaction and enhance the service user experience. Our catering partners OCS provide updates to staff on food serving practice to ensure service users receive the correct portion sizes and range of meal items for appropriate nutrition. At every meal, standards are monitored regularly to ensure that the quality of food is maintained.

Broadmoor High Secure Services The Catering Department operate a four weekly, freshly produced rolling menu which is reviewed and amended yearly, taking into account service users suggestions and seasonal produce.

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The catering department provides:

Weekly themed nights.

Alternative to the four week menu cycle such as salads, sandwiches and snack boxes.

Every ward has a comments, complaints or suggestions book which is reviewed monthly at the Catering Borough Forum.

In 2010, the Citrus Restaurant was built inside the secure perimeter to provide staff, students and contractors within the hospital the opportunity to purchase a cooked breakfast and a hot lunch option. A healthy choice should be available and identified on the menu at each meal service. Outside of the standard retail hours vending is available throughout the hospital and at the Learning and Development Centre for visitors and staff. When the new purpose-built Broadmoor Hospital is opened, it will be an exciting opportunity to review and elaborate on the current catering service provided for the newly redeveloped establishment. It is the intention of the department that service user involvement will increase in the new hospital. Representatives from the department will visit the wards at meal times to answer any questions and receive feedback on a regular basis. Smart questionnaires will be provided to ensure any changes made are implemented via a majority decision taking into account budgetary constraints. Service user community meetings will be attended by catering staff, which is currently held weekly.

Sustainability We aim to be sustainable advocates for food, with catering and agricultural policies that go hand-in-hand to enhance the health and welfare of all who use its services.

Principles of sustainable food:

Buy local, seasonally available ingredients as standard, to minimise energy used in food production, transport and storage.

Buy food from farming systems that minimise harm to the environment, such as produce certified by LEAF or the Soil Association.

Cease buying fish supplies identified as most ‘at risk’ by the Marine Conservation Society, and buy fish only from sustainable sources – such as accredited by the Marine Stewardship Council (MSC).

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Reduce the amount of foods of animal origin(meat, dairy products and eggs), as livestock farming is one of the significant contributors to climate change, and eat meals rich in fruit, vegetables, pulses, whole grains and nuts. Ensure that meat, dairy products and eggs are produced to high environmental and animal welfare standards.

Choose Fair-trade-certified products for foods and drinks imported from poorer countries, to ensure a fair deal for disadvantaged producers (where practicable).

Offer plain or filtered tap water in addition to bottled water, to minimise transport and package waste.

Protect staff and customer’s health and well-being by making sure meals are made up with a balanced portion of vegetables, fruit and starchy staples like whole grains, cutting down on salt, fat and oils, and cutting out artificial additives.

Our catering procurement integrates our sustainability plan, fit for purpose requirements buying only good energy rated equipment such as dish washers, refrigeration equipment and microwaves. The potential energy saving is between 10% - 20% over non-rated equipment and reduces carbon emissions. By adopting whole life costing and disposal cost analysis we can anticipate future resource shortages.

Other sustainable actions include:

Equipment cleaning carried out on a daily basis to maintain hygiene and improve equipment performance.

Scheduled maintenance for kitchen equipment and associated equipment formulated to give optimum performance levels of efficiency and minimise breakdowns in line with manufacturer’s recommendations.

Minimise water consumption by using water efficient products and measures in our daily operations, where it does not compromise function.

Staff and others who operate the catering equipment are fully trained to use the equipment correctly.

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Resources

10 key characteristics of Good Nutritional Care, NHS England

Nutrition and Hydration Digest – the British Dietetic Association

Malnutrition Universal Screening Tool – BAPEN

Healthier and More Sustainable Catering – Nutrition Principles, NHS England

Government Buying Standards for Food and Catering Services, Defra

References

Healthy Lives, Healthy people: a call to action on obesity in England. HM Government 2011

Calorie reduction pledge development tool, Public Health Responsibility Deal – Food network.