Minutes:
The Committee received a presentation from Lesley Russell, outlining her role as Chief Dietician in supporting nutrition at the University Hospital of North Staffordshire (UHNS). The Chair explained that Members had concerns regarding feedback and complaints that had been received about food at the hospital, and requested a general overview.
Dieticians were employed at UHNS according to their different specialities and the hospital had a nutrition policy with three key elements. The first was nutrition screening, where the risk of malnutrition was documented and the progress of patients could be tracked. Some patients were malnourished when they entered the hospital, with 30% of patients at risk when admitted. The second element was ensuring the food provided was of the right nature and the correct menus were provided. Since the trust had become a Private Finance Initiative (PFI) Trust with PFI caterers more attention had been paid to the catering service. Sodexo managed the contract, with their food manufacturing business Tillery Valley provided the catering service. The third element of the nutrition policy dealt with food not being suitable for some patients, e.g. for patients who required tube feeding. A lot of work had been undertaken by the hospital in tasting food etc. There had been problems initially, for example when the mashed potato provided was different from that given at tastings. However, there had been a lot of hard work over the years to improve the situation.
The dieticians had a lot of input into the menus at the hospital, which was important. The dietician’s biggest triumph was to introduce a hot choice for both lunch and dinner, with an increase in the range of menus. There had been three different systems before, which had been difficult to manage. All meals were cook/freeze now which was better for storage, and there were a la carte menus. Members questioned whether meals could be freshly cooked on site if required. They could be if requested, but large numbers of meals were not prepared on site due to the large volumes of patients. The screening process for nutrition was questioned and whether this was dependent upon the information provided by patients. It was objective and would depend upon BMI, the acute disease score, whether there had been recent weight loss etc. Screening would not be provided for palliative patients or for patients who refused to be subject to screening. Patients with multiple allergies would be monitored by an alert system, which would be communicated to the caterers by hospital staff if they were aware of a patient having allergies. The hospital also had an allergy menu. Wards could refer patients if they were having difficulties with a patient not eating, there were guidelines to follow and food assessment charts. A ward should pick up if there were problems with a patient’s eating habits.
Members of the Committee were interested in food waste at the hospital; the percentage of food that was supplied and not eaten and whether any food was recycled. The catering department would hold the information relating to this, but it was likely that care would have to be taken with regard to any aspects relating to food recycling in a hospital environment, due to bugs etc. The Chief Dietician would pass the query to the relevant department to provide an answer.
With regard to chronic illness, the point a dietician became involved would be dependent upon the nature of the illness and the dieticians spent a lot of time with renal patients, diabetics etc. The dieticians tended to see patients who had been referred by consultants and patients would be referred if there was a problem. Members questioned the initial checks patients received, how often further checks were undertaken and whether patients should be at a healthy level when they were discharged. Within the hospital’s policy, stable patients would be screened every week and high risk patients every two to three days. Sunday had been designated as ‘weigh day’ as it was generally quieter and the aim was to get into a weekly routine. Patients would also be supported with dietary supplements when they were discharged if required. It was questioned what was being done through the policy to promote the prevention of dietary problems. This was not contained in the policy as such, as the policy was intended for patients who were being treated in hospital, and the UHNS did not have any health promotion dieticians. What was necessary was to make every contact count, e.g. with smoking, and diet was next on the agenda.
Members questioned how the Trust dealt with elderly dementia patients who refused to eat. In recent years a lot more had been learnt about dementia and a member of staff had been seconded from Combined Healthcare. Easy to eat foods were available to patients who required them, which could be purees and easy chew foods. There was also a finger food menu for buffet style eating and there had been an attempt to get more feeding volunteers in recent years.
Members often heard the negative aspect of hospital catering and there was concern about patient’s feedback. The Patient Advice and Liaison Service provided a report regarding performance monitoring and following feedback received from patients, there had been culls of dishes on the menu.
Members questioned whether UHNS linked up with outside agencies to support patients e.g. carers/agencies looking after the elderly at home. This was considered highly desirable; there was a service level agreement with Combined Healthcare but not for care homes, which would be great to have. There were areas around the country that did liaise with outside agencies and it was acknowledged that there was a gap in service with regard to this. Members felt that this was something the Committee should look into.
It was advised that there were thirty dieticians in the Trust, of which 26 were full time staff which included provided services to South Cheshire and Stafford renal units. Two dieticians looked after GP work and there was a small paediatric team. Members questioned whether there would be a need to increase the size of the dietician team in the future. There would need to be an increase as a public health remit was needed to tackle such problems as malnutrition in the community.
The Committee thanked the Chief Dietician for her attendance at the meeting.
RESOLVED:
That the information be received.