In February 2020, a brand new £3m patient catering facility opened at St Richard’s hospital in West Sussex. It’s objective was to produce patient meals for the three hospitals at the Western Sussex Hospitals NHS Foundation Trust. Matt Hancock and Prue Leith attended the highly successful launch, the fruition of a project which began in 2017 working with consultants, Neller Davies.
“The best institutional food I have ever eaten!”
“The truth is, this is the best institutional food I have ever eaten! And I’ve eaten in schools, hospitals, prisons and all over the place. I think it is amazing. I walked round and I couldn’t think of a single thing to complain about – which is not like me.” Those are the words of Celebrity Chef, Prue Leith, speaking at the opening of this patient catering facility.
But it hadn’t always been that way.
In 2017, the Trust identified that catering needed improvement. This conclusion followed an audit which found that significant patient food went uneaten. Common complaints centring around quality and temperature.
Like many modern NHS organisations, Western Sussex was formed through the merger of two previously separate Trusts – the Royal West Sussex and Worthing and Southlands Hospitals. As a result, it had two discrete and disparate catering operations. One worked from an old kitchen at Worthing hospital with equipment that was no longer fit for purpose. The second was a CPU at St Richard’s in Chichester, solely focused on food production for the one site.
The Trust’s Director of Estates at the beginning of the project recognised that something needed to be done about the food service and ordered a complete review. The primary objective was to invest in catering to improve the patient experience.
Neller Davies appointed to undertake review of patient catering facility
The Trust appointed facilities management consultancy, Neller Davies. The remit was to undertake a review of the patient catering operation, to research and develop a strategic plan. The review highlighted the age and condition of some of the equipment. It also identified some operational issues with kitchen practice, for example, recipes not being followed leading to inconsistencies in the meals served. In addition, there was no cohesion to the food service – the moment the food left the kitchen the caterers were no longer involved. The Last 9 Yards was out of their hands. The Neller Davies team identified that ward staff needed better training in food safety and customer service to improve the patient dining experience.
Following this research, Neller Davies presented three costed models to the Trust:
- remediating and remodelling the existing operation into a modern, fit-for-purpose service;
- moving to a different style of service, such as bought-in;
- doing nothing
The Trust Board endorsed the first option. They retained Neller Davies to work with its different teams, including estates and facilities, dietetic and clinical to deliver the project. This collaborative approach was very important to make sure the right decisions were made and processes put in place from the very beginning.
Delivering transformation and a new patient catering facility
Neller Davies established three work streams. Each workstream led by a professional from the Trust, to methodically break down and focus on aspects of the project. These included the development of menus, staff engagement across the Trust and design of the service and necessary facilities. Although the work streams each had their own remit, they also considered the wider brief and objectives of the project.
Food work stream
The food work stream focused on menus. Realising, however, that food should not be a blanket service, this project team also considered the varying needs and special requirements of different patient groups. The approach they developed ensures that wards receive a differentiated service depending on those requirements.
Neller Davies involved dietitians closely in the development of the majority of specialist menus. These vary and range from clinical, cultural and therapeutic meal options. Some special diet meals are brought in externally to meet IDDSI guidelines currently, but this is being reviewed.
The Trust catering team, dietitians and nursing colleagues (commonly known as the ‘Power of Three’) designed the new menu. The menu was then facilitated and tested by Neller Davies’ culinary team. It includes up to 50 main meal combinations available every day. These meals include: vegetarian, vegan, specialist options, finger foods and grazing menus which are popular with older patients and those with specialist requirements.
In addition, Neller Davies invited the hospital chefs to a “cook-off”. Neller Davies gave each chef a bag of ingredients and challenged them to make a dish they thought patients would want to eat. Some of the dishes that resulted from this process were ultimately incorporated into the new menu.
To ensure patients receive the best nutrition possible, the Trust launched a new protected mealtimes policy “Meal time Matters” at the same time as the new menu. The policy means that, during meal-times, all non-essential activities and distractions on the wards stop.
Engagement work stream
The engagement work stream ensured that patient food was not just the responsibility of a small group of staff in the kitchen. It made food the concern of all and involved HR and nursing teams working to re-train, mentor and guide staff around issues including food safety and customer service. They re-purposed more than 200 people as part of the patient catering team. There were no redundancies or external recruitment. All of these staff are now integral to all parts of the catering and food service process.
Design work stream
The design team examined different models of food production and service. It concluded that re-developing the CPU at St Richard’s to serve all three hospitals at the Trust was the best solution. It also recommended that the Worthing kitchen became a receipt and distribution unit for the site. The project team ensured there was provision for the hospitals to safely store and freeze food, leading to less wastage and more availability. At any one time, the hospitals can store up to 16,000 meals.
Exemplar patient catering facility
The catering team cook all patient food from fresh and portion it into containers at the CPU. Food is finished on the wards using a bulk food service system. Patients order from an a la carte menu. Catering staff take orders two hours before service using iPads linked to a Datasym system.
The cook-freeze process offers far greater choice for patients. This leads to better nutrition as patients are more likely to eat their chosen food. In addition, it does not need any artificial modification to recipe ingredients and enables food to be served at the correct temperature. Staff slowly heat food for 90 minutes on the ward. This process transformation has reduced food waste significantly. The Trust saw a reduction of 50% in the initial phases after the CPU went live.
The Trust made a significant investment of £3m into new state-of-the-art equipment. This allows for the implementation of lean processes and a ‘single flow’ design. The designers segregated the kitchen into distinct zones to ensure that there is no cross-contamination ensuring full compliance with Food Safety legislation requirements. The Trust rejected the option to refurbish equipment where possible and only buy new where necessary. Currently, no equipment is under condition B status, which is seen as a more sustainable investment. The project team specified the industrial-grade equipment to ensure they had the capacity to meet requirements. The facility now has the capacity to produce 6,000 meals per day. The specification also included trolleys with HACCP controls to monitor temperature and other elements.
Opportunity to share best practice
David McLaughlin, Director of Estates and Facilities, Western Sussex Hospitals NHS Foundation Trust, says: “We are really pleased with the outcome. For us, we want to continue to evolve the system, and use our offer here as an opportunity to share best practice with others. It’s really important that we all continue to work with each other to help improve patient catering services.”
Neller Davies is a leading FM Consultancy and advocate of the Vested, outcome-based model of FM. Vested is based on a shared vision. Elements of Vested came into play during this project, particularly the collaboration of different disciplines and the way the Trust worked with suppliers. A spokesperson for the Consultancy says “The Trust and its staff have delivered this project. Neller Davies gave them the motivation and the tools to do it, but they were the agents of change,”.