Public Accounts Committee
PAC(4) 16-13 – Paper 1
Update to the Report of the National Assembly for Wales Public Accounts Committee on Hospital Catering and Patient Nutrition
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PAC Report Recommendations
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Current Position |
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1 |
We recommend that the Welsh Government issues supplementary guidance to all NHS bodies in Wales clearly stating that the protected meal times policy should not be used to exclude relatives and carers from providing assistance with eating to patients, and that where relatives and carers wish to assist at mealtime that they are actively encouraged to do so by ward staff.
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A Chief Medical Officer/Chief Nursing Officer letter was issued in March 2012 reminding all NHS bodies in Wales that protected mealtimes are an integral part of the All Wales Nutrition Care Pathway 2009, and that all hospitals are required to comply.
The letter clearly stated that protected meal times policies should not be used to exclude relatives and carers from providing assistance with eating to patients, and that where relatives and carers wish to assist at mealtime they should be actively encouraged to do so by ward staff.
The letter also drew attention to examples of best practice from across Wales which are showcased on the Hospital Nutrition and Catering Framework website, based on the Health in Wales intranet site (formerly HOWIS).
We are currently working with the Hospital Caterers Association, who will be launching a campaign focussed on the importance of protected mealtimes in the summer, to ensure that appropriate messages are communicated.
The 2012 Fundamentals of Care Audit identified that all LHBs/Velindre NHS Trust have protected mealtimes policies and that 86.4% of wards have protected mealtimes with the remaining 13.6% in the process of introducing them.
The LHBs/Velindre NHS Trust have all reported that their protected meal times policies do not exclude relatives and carers from providing assistance with eating to patients, and that where relatives and carers wish to assist at mealtime they are actively encouraged to do so.
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2 |
We recommend that the Welsh Government ensures that local health boards provide the Wales Audit Office guidance note ‘Eating Well in Hospital—What You Should Expect’ to every hospital patient in Wales at the point of admission. |
A number of LHBs were already including information similar to that contained in Wales Audit Office guidance note ‘Eating Well in Hospital—What You Should Expect’ in the packs that they issue to patients on admission.
A Chief Medical Officer/Chief Nursing Officer letter was issued in March 2012 to all NHS bodies in Wales clearly stating where LHBs/Velindre Trust were not following this practice they were required to either incorporate this information on nutrition into their patient admission materials or to issue the Wales Audit Office guidance note ‘Eating Well in Hospital—What You Should Expect’ to every hospital patient in Wales at the point of admission. A link has been provided to the PDF to those organisations utilising the Wales Audit Office publication, to enable them to print copies locally.
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3 |
We recommend that the Welsh Government takes action to ensure that the progress of NHS organisations in delivering their own action plans is rigorously monitored and made publicly available.
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NHS bodies are responsible for monitoring the delivery of their individual catering and nutrition action plans, and progress should be scrutinised by NHS Boards via their Audit Committees. The Welsh Government requires health bodies to include their action plans and updates on progress on their websites. Welsh Government officials monitor this commitment and there is 100% compliance.
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4 |
We recommend that the Welsh Government monitors the progress of NHS bodies in delivering its guidance, including sourcing local food which contributes to a healthy balanced diet for patients where possible.
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The auditing of compliance with the All Wales Nutrition Care Pathway and the All Wales Nutrition and Catering Standards for Food and Fluid Provision for Hospital Inpatients are carried out across all relevant NHS bodies via the Annual Fundamentals of Care Audit process. The Fundamentals of Care Standard 9 – Eating and Drinking has been mapped against the Doing Well Doing Better: Standards for Health Services in Wales: Standard 5 – Citizen Engagement and Feedback; Standard 8 – Care Planning and Provision; and Standard 14 – Nutrition. This ensures that the audit process covers the whole of the Pathway and the Nutrition and Catering Standards.
Since 2009 NHS organisations are required to undertake a full audit of all their hospital wards/departments on an annual basis and submit the results to the Chief Nursing Officer/Nurse Director for Wales. The electronic system underpinning the audit tool can analyse and generate reports from the data entered at ward level. It also enables each ward to develop action plans to address any issues causing concern as well as building on areas of good practice. NHS bodies report a variety of mechanisms for sharing the results with relevant staff groups. The introduction of an independent validation mechanism for the Fundamentals of Care Audit process is currently being explored.
Compliance in hospital wards across Wales with the Fundamentals of Care Audit Standard 9: Eating and Drinking, (You will be offered a choice of food and drink that meets your nutritional and personal requirements and provided with any assistance that you need to eat and drink) has increased from an average of 82% in 2009 to 92% in 2012 (see annex 1 for a detailed breakdown by LHB/Velindre NHS Trust).
A summary of the 2011 Fundamentals of Care Audit results were published on the Welsh Government website, the Older Peoples Commissioner website and the Community Health Council Website. The 2012 results will be published by end of May 2013.
Any issues which arise from the audit are addressed by the Chief Nursing Officer in her regular meetings with Directors of Nursing.
To support the implementation of the All Wales Hospital Menu Framework LHBs have jointly funded the appointment of a procurement dietitian post within NHS-Shared Services Partnership – Procurement Services. The dietitian, who took up the post in February, is supporting the establishment of all Wales procurement contracts for the dishes on the Framework, which will consider the issue of local sourcing.
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5 |
We recommend that the Welsh Government provides us with details of how and when we can expect waste reduction targets to be met.
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The Welsh Government required all NHS organisations to achieve an overall average of ten per cent or less waste in relation to untouched meals across their hospital sites by the end of 2012-13. Compliance is being monitored through their action plans and by the Estates & Facilities Performance Management System. The LHBs/Velindre NHS Trust have put measures in place to reach this target and evidence from the 2011-12 EFPMS returns demonstrate that progress is being made.
In addition, the Welsh Government has worked with the Department for Environment, Food and Rural Affairs (Defra), Scottish Government, Northern Ireland and the Government sponsored body WRAP (Waste and Resources Action Programme) to develop a voluntary agreement for the Hospitality Sector. This includes a waste reduction target of five per cent for food and packaging waste by 2015. It also includes a target for an increase in the rate of food and packaging waste being recycled, composted or sent to anaerobic digestion by 2015 (a target is currently being agreed with industry). The agreement will cover hospital catering, both for patient and non patient services. The agreement was launched in May 2012 and all NHS organisations are encouraged to participate.
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6 |
We recommend that the Welsh Government takes action to ensure food hygiene ratings are displayed publicly in all hospitals in Wales.
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Since October 2010 the Food Hygiene Rating Scheme in Wales has operated on a voluntary basis in Wales. It is run by Local Authorities in partnership with the Food Standards Agency. Local Authorities undertake inspections of food businesses to check they meet the requirements of food hygiene law. Based upon this inspection, the local authority calculates the rating and sends a sticker with the food hygiene rating to the food business. The food business is encouraged to display the sticker at the premises; all ratings are also published on the Food Standards Agency website.
Following a consultation in 2012 the Welsh Government decided to introduce legislation to make it a mandatory requirement for all food businesses in Wales to display their food hygiene ratings in Wales. The Food Hygiene Rating (Wales) Act 2013 received Royal Assent on the 4 March 2013 and will come into force from November 2013. This will cover hospital catering.
As an interim measure the former Minister for Health and Social Services wrote to all Chief Executives and Chairs of Health Boards and NHS Trusts in February 2012 about the FSA voluntary scheme. The letter asked all hospitals and other NHS Wales premises that had received a food hygiene rating from their Local Authority to display it where it could easily be seen by consumers.
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7 |
We ask that the Accounting Officer provides us with a plan of how and when the Welsh Government and Local Health Boards will have made the improvements recommended by the Auditor General. |
A plan was produced and sent to the Chair of the Public Accounts Committee in August 2012.
The current position on the Auditor General’s recommendations for the Welsh Government is detailed in the second part of this report.
Progress regarding the implementation of the Auditor General’s recommendations for the LHBs/Velindre NHS Trust in his national report Hospital Catering and Nutrition has been monitored by the Welsh Government through biannual reports from the LHBs/Velindre NHS Trust. In reports received in April 2013 all LHBs/Velindre NHS Trust report that they have implemented most of the recommendations and highlight ongoing work to ensure that they maintain compliance. This is reflected in the increased compliance with the Fundamentals of Care Audit Standard 9 as detailed in Annex 1. The Welsh Government will continue to monitor the NHS bodies’ compliance and will raise any issues of concern with individual LHBs/NHS Trust.
The outstanding actions from the Welsh Government and the LHBs/Velindre NHS Trust are connected to the full implementation of the National Catering IT solution by the NHS Wales Informatics Services (NWIS) and NHS-Shared Services Partnership – Facilities Services (NWSSP-FS) formerly Welsh Health Estates and also the development of the All Wales Menu Framework. See sections 2 and 3 below for further detail of ongoing progress on these agendas.
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AGW Report Recommendations for the Welsh Government
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Current Position |
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1 |
The Welsh Government develop and issue standard all-Wales nursing documentation to promote consistent nutritional screening and care planning, and to help ensure that important areas, such as oral health, are properly considered.
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The All Wales Nutrition Care Pathway, Food Record Chart and revised Daily and Weekly Intake Chart are being used as standard nursing documentation across Wales. The new mouth care bundle, launched in 2012 and is being rolled out across Wales, includes a standardised assessment tool and care planning guidance.
A sub group of the Free to Lead, Free to Care Post Implementation Group was established to review all nursing documentation with a view to standardising it across Wales. A standardised nursing reporting dataset is now available on the NHS E-Governance manual website. NHS Wales Information Services are currently working with the Office of the Chief Nursing Officer to adapt the reporting dataset to a digital format.
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2 |
The Welsh Government review the feasibility of introducing a national database of standard, nutritionally assessed menus as a means of avoiding duplication of effort across NHS organisations and making the best use of limited dietetic resources.
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To support the implementation of the nutrition and catering standards, introduced in September 2011, caterers and dietitians across Wales have been working together to produce an All Wales Hospital Menu Framework. Phase one, consisting of dishes for a standard diet, was completed and launched at the end of January 2013. The Menu Framework consists of a range of specified dishes supported by a database of nutritionally analysed recipes. It allows some local flexibility to accommodate different requirements of hospitals and their patient groups. The aim is to provide modern menus to enhance the overall patient experience, whilst meeting the nutritional requirements of all patients.
All Health Boards are in the process of revising their current menus and introducing the agreed menu items, using the standardised recipes. Work is also underway on the all Wales contract specifications, to ensure that they meet the nutrition standards and to enable all the ingredients required to be on the all Wales contract.
The next phase, which will be completed by the end of December 2013, will include the following:
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3 |
The Welsh Government, through WHE, develop a clear model for costing patient and non-patient catering services that is consistently applied across all NHS organisations to allow meaningful comparisons of hospital catering costs across Wales to be made.
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The implementation of the National Catering IT solution is being taken forward by the NHS Wales Informatics Services (NWIS) and NHS-Shared Services Partnership – Facilities Services (NWSSP-FS) formerly Welsh Health Estates.
The introduction of a National Catering IT System could deliver substantial benefits to the NHS in Wales:
NWIS and NWSSP-FS are currently carrying out research to consider the best way forward. Visits and meetings have been held with companies looking at whether they are able to provide the necessary solutions and what benefits they can offer. More visits are planned. The proposal is for NWIS to submit an Outline Business Case (OBC) to the Welsh Government by 7 October. The OBC will be scrutinised when received and when all issues have been addressed will be submitted to the Minister for Health & Social Services for approval.
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4 |
Local and national targets are set for food wastage; as a guide NHS organisations should aim to ensure that wastage from unserved meals does not exceed 10 per cent.
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As above in section 5. |
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5 |
The Welsh Government bring together all the relevant policy guidance in respect of hospital catering and patient nutrition into an updated national framework; the production of an updated national framework should be developed by a multidisciplinary policy group for catering and nutrition, which brings together staff from the various branches of the Welsh Government that have responsibilities for these services.
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An intranet website has been developed that brings together all the policy guidance that covers hospital catering and patient nutrition. The ‘Hospital Nutrition and Catering Framework’ website, based on Health in Wales intranet site, is available on every ward in every hospital via the nursing portal.
The content of the website is overseen by the All Wales Hospital Nutrition Co-ordinators Group which consists of senior lead nurses, dietitians, speech and language therapists, caterers and relevant Welsh Government officials.
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6 |
The Welsh Government promote the importance of the EFPMS data as a tool for monitoring service delivery and ensure that sufficient guidance and training on data definitions are available to staff in NHS bodies who submit information. |
The EFPMS data set in relation to catering has been reviewed and updated with NHS bodies. Meetings have been held to ensure that there is a detailed understanding of the data definitions and it is being consistently applied. The Welsh Government continues to monitor NHS bodies’ compliance.
As part of the EFPMS consultation with Health Boards/Trusts it was agreed that a performance target of 10% would be introduced in relation to food waste. There is also now a data field for the total cost of food waste.
Changes to the EFPMS data definitions, including those for catering and nutrition have been completed in line with the recommendations from the Wales Audit Office and the Public Accounts Committee. NWSSP-FS, in discussion with Welsh Government, considers if there is any need for changes to data definitions on an annual basis.
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7 |
Welsh Government staff involved in catering and nutrition should make more collective use of EFPMS data, alongside data collected from the annual Fundamentals of Care audits, as a mechanism for providing information on local implementation of national policy objectives.
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The need to make better and collective use of the EFPMS data has been reinforced in meetings with NHS bodies. The All Wales Catering Group continues to meet to ensure that data is discussed and compared on a national basis.
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Annex 1
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Operational Score % compliance |
User Experience % score |
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2009 |
2010 |
2011 |
2012 |
2009 |
2010 |
2011 |
2012 |
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Abertawe Bro Morgannwg University LHB
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75 |
89.6 |
90.8 |
90.7 |
80 |
93 |
92.3 |
93.1 |
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Aneurin Bevan LHB
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81 |
87 |
89 |
90 |
90 |
89 |
94 |
92.7 |
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Betsi Cadwaladr University LHB
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84.6 |
85.5 |
90.7 |
89.8 |
89.8 |
93.2 |
92 |
93.1 |
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Cardiff And Vale University LHB
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75 |
90.08 |
90.5 |
90.01 |
79.1 |
91.7 |
90.7 |
91.8 |
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Cwm Taf LHB
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75.5 |
85 |
87 |
89 |
90.05 |
88 |
95 |
93 |
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Hywel Dda LHB
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81.5 |
87.4 |
88.4 |
91 |
88.5 |
92.1 |
93.1 |
94 |
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Powys Teaching Health Board
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82 |
92.8 |
94 |
91.8 |
92 |
95.1 |
93 |
97.3 |
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Velindre NHS Trust
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74.7 |
81.7 |
88.7 |
95 |
74 |
87.3 |
91.9 |
87.5 |