Public Accounts Committee
PAC(4) 08-12 – Paper 2
Response to the Report of the National Assembly for Wales Public Accounts Committee on Hospital Catering & Patient Nutrition
We welcome the findings of the report and offer the following response to the seven recommendations contained within it.
Recommendation 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.
Response: Accepted
A Chief Medical Officer / Chief Nursing Officer letter has been issued to 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. In addition examples of best practice from across Wales will be collected and showcased on the Hospital Nutrition and Catering Framework website, based on ‘Health in Wales’, the organisational portal of NHS Wales, formally Health of Wales Information System (HOWIS).
Target completion date: The best practice examples will be on the website by 30 April 2012
Recommendation 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.
Response: Accepted
A number of LHB’s are already including the information contained in this leaflet in the packs that they issue to patients on admission. Where LHBs are not following this practice they will be 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. The Chief Medical Officer / Chief Nursing Officer letter referred to in the response to recommendation 1 informed NHS bodies of their requirement and provided a link to the PDF of the leaflet on the Wales Audit Office website. Compliance will be monitored by the Welsh Government on a quarterly basis as part of the regular Quality and Delivery meetings with LHBs/ Velindre NHS Trust.
Recommendation 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.
Response: Partially Accepted
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. We will require health bodies to include their action plans and updates on progress on their websites.
In addition progress against each local action plan will be monitored by the Welsh Government on a quarterly basis as part of the regular Quality and Delivery meetings with LHBs / Velindre NHS Trust.
Recommendation 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.
Response: Accepted
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, is available on every ward in every hospital via the recently introduced nursing portal. This will facilitate communication of Welsh Government guidance on hospital food.
To support the implementation of the recently introduced All Wales Nutrition and Catering Standards for Food and Fluid Provision for Hospital Inpatients a task and finish group has been established to produce All Wales Hospital Menus. Once the menus have been developed we will be able to establish all Wales procurement contracts and consider the issue of local sourcing.
The auditing of compliance with All Wales Nutrition Care Pathway and the All Wales Nutrition and Catering Standards for Food and Fluid Provision for Hospital Inpatients will be carried out across all NHS bodies via the 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. This includes 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.
Target completion date: The 2011 Fundamentals of Care Audit results will be published by 30 April 2012. The All Wales Hospital Menu will be developed by October 2012.
Recommendation 5:
We recommend that the Welsh Government provides us with details of how and when we can expect waste reduction targets to be met.
Response: Accepted
We will require 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 will be monitored via quarterly returns from NHS organisations and from the Estates & Facilities Performance Management System.
In addition, the Welsh Government is working 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. It is currently proposed that this agreement will be launched in May and all NHS organisations will be encouraged to participate.
Recommendation 6:
We recommend that the Welsh Government takes action to ensure food hygiene ratings are displayed publicly in all hospitals in Wales.
Response: Accepted
The Food Hygiene Rating Scheme in Wales is currently operated on a voluntary basis in Wales and 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. For the future the Minister for Health and Social Services has consulted on legislation which would make it a mandatory requirement for all food businesses in Wales to display their food hygiene ratings.
In the meantime the Minister for Health and Social Services has written to LHB’s requesting that all hospitals and other NHS Wales premises that have received a food hygiene rating from their Local Authority display it where it can easily be seen by consumers.
Recommendation 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.
Response: Accepted
Considerable progress has been made in addressing the improvements recommended by the Auditor General. Details of progress were included in the paper submitted to the Committee prior to the Accounting Officers witness session in November 2011.
Further developments since the witness session include:
To inform the paper submitted to the Committee in October 2011, Welsh Government officials undertook a survey of progress made by LHBs / Velindre NHS Trust against the improvements recommended by the Auditor General. The Welsh Government will require NHS organisations to provide updates on progress against the Auditor General’s recommendations in Hospital Catering & Patient Nutrition on a six monthly basis until all are discharged. The second collection of information has just begun. Once these data have been analysed a plan will be developed to implement any outstanding issues, and will be provided to the Committee by the end of May 2012.
Target completion date: 31 May 2012