Catering for Patients a Follow-Up Report
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Catering for patients A follow-up report Prepared for the Auditor General for Scotland November 2006 Auditor General for Scotland The Auditor General for Scotland is the Parliament’s watchdog for ensuring propriety and value for money in the spending of public funds. He is responsible for investigating whether public spending bodies achieve the best possible value for money and adhere to the highest standards of financial management. He is independent and not subject to the control of any member of the Scottish Executive or the Parliament. The Auditor General is responsible for securing the audit of the Scottish Executive and most other public sector bodies except local authorities and fire and police boards. The following bodies fall within the remit of the Auditor General: • departments of the Scottish Executive eg, the Health Department • executive agencies eg, the Prison Service, Historic Scotland • NHS boards • further education colleges • Scottish Water • NDPBs and others eg, Scottish Enterprise. Acknowledgements Audit Scotland gratefully acknowledges the time and effort given by the NHS boards and special health boards participating in this review. We are particularly grateful to the catering managers and finance managers who provided most of the information used in this report. We would also like to thank members of the study advisory group (listed in Appendix 2) who provided valuable advice and feedback throughout the study. Roddy Ferguson managed the project with support from Kenny Reilly and Geoff Lees, under the general direction of Tricia Meldrum. Audit Scotland is a statutory body set up in April 2000 under the Public Finance and Accountability (Scotland) Act 2000. It provides services to the Auditor General for Scotland and the Accounts Commission. Together they ensure that the Scottish Executive and public sector bodies in Scotland are held to account for the proper, efficient and effective use of public funds. 1 Contents Part 1. Summary Part 3. Financial management Part 5. Summary of recommendations Setting the scene Key findings Page 26 Why hospital catering is important Hospital catering costs have risen Appendix 1. Boards and hospitals more slowly than other followed up from baseline Key findings operating costs Page 27 About the study There remains wide variation in the Appendix 2. Study advisory group Page 3 amount spent on catering services Page 28 Page 13 Part 2. Meeting patients’ needs and preferences Catering staff costs have risen more quickly than the costs of food Key findings and beverages Patients are not routinely screened Catering services for NHS staff and for risk of undernutrition on visitors are not breaking even admission to hospital Page 15 Page 5 Boards have reduced wastage due Not all boards have fully developed to unserved meals systems for ensuring the nutritional balance of patient meals Recommendations Page 17 Progress is being made but patients’ nutritional care is not yet consistently Part 4. Strategic management prioritised at ward level Page 6 Key findings All boards have systems in place to Catering services are becoming offer patients choice and to cater for more of a strategic priority at patients with special dietary needs board level Page 20 Catering services are offering an improved level of choice to patients Catering staff vacancy rates and Page 9 sickness absence rates remain high Boards have some processes in Implementation of Agenda for place to seek patients’ views on Change varies among boards catering services Page 21 Recommendations A fully functioning national Page 11 eProcurement system for catering is not yet in place across the NHS in Scotland Boards have the required food safety and hygiene control systems in place Page 24 Recommendations Page 25 2 Part 1. Summary Catering services are offering patients an improved level of choice but boards still need to do more to ensure patients’ nutritional care. Part 1. Setting the scene 3 Setting the scene Key findings About the study 1. This review of hospital catering • Catering services are offering 5. The overall aim of this study was follows up the issues from our an improved level of choice to assess progress against the baseline report which was published to patients, including giving recommendations reported in the in November 2003.1 The baseline patients the opportunity to 2003 baseline report. In particular, report provided detailed findings order meals less far in advance, the study examined whether: and recommendations on nutrition, offering a range of portion sizes processes are in place to provide quality, patient satisfaction, costs and ensuring that snacks are quality nutritional care to patients; and the management of the available to patients outside patients are receiving a good quality catering service. This follow-up normal mealtimes. catering service; catering services study assesses the progress have improved their control of costs made in implementing those • Boards still need to do more and wastage; boards have strategies recommendations and improving to ensure the nutritional care for catering services and are hospital catering services. of patients. All patients are monitoring progress against not yet screened for risk of these strategies. Why hospital catering is important undernutrition and many hospitals do not have systems 6. Our baseline report investigated 2. Nutritional care is key in helping in place to ensure a nutritional the key areas of the catering the recovery of patients in hospital balance in the meals provided. service in 2003 and made 31 and hospital catering has an recommendations for improvement. important role to play in this.2 3 The • Not all boards are carrying out The key findings of that report are quality of hospital food is a very quarterly patient satisfaction summarised below: important part of ensuring that the surveys. However, many patient’s experience in hospital is boards are developing improved • Nutritional care needed to be positive. Regular mealtimes perform ways to get patients’ views given a higher priority by all a significant social role which can on catering and use these to staff through measures such promote the general well-being of improve the services provided. as nutritional screening, using patients and assist in their recovery. standardised recipes and • Catering costs have risen by nutritional analysis of menus. 3. Food safety and hygiene are a third since the baseline. essential and need to be rigorously Catering staff costs have • Patient satisfaction with monitored to minimise the risk of risen due in part to the low catering services was high but infection and ensure high-quality pay agreement, whereas the improvements were needed in patient care. costs of food and beverages the amount of choice available per patient day have remained to patients and in the ways that 4. The scale of the costs involved stable. patients’ views were gathered in catering for patients, staff and and used. hospital visitors is also significant. • Non-patient catering services are In 2004/05, hospital catering cost still being subsidised but boards • Food wastage at ward level the NHS in Scotland £73 million, are improving their management needed to reduce. We equivalent to just under one per information systems to allow recommended that regular cent of the total spend on the NHS.4 them to manage this. monitoring of wastage levels Catering is also a large employer should be introduced with the with 3,272 staff involved in producing • Boards have reduced the aim of reducing waste to a target and serving over 17 million meals amount of food wasted due to level of ten per cent. each year.5 6 unserved meals. 1 Catering for patients, Audit Scotland, November 2003. A copy of the baseline report is available to download at www.audit-scotland.gov.uk. 2 Malnutrition within an Ageing Population: A Call to Action, European Nutrition for Health Alliance, August 2005. 3 Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition, National Collaborating Centre for Acute Care, London, February 2006. 4 Scottish Health Services Costs, year ended 31 March 2005, Information Services Division (ISD). 5 Scottish Health Statistics workforce data, year ended 31 March 2005, ISD. 6 Audit Scotland survey, June-August 2006. 4 • Spending on catering services • reviewing supporting evidence 11. The rest of this report is organised varied significantly and services supplied by boards and hospitals into three parts. Part 2 reports on to staff and visitors were being progress in meeting the needs subsidised. We recommended • observing mealtime practice and preferences of patients. Part 3 that this could be better in a sample of ten wards to reviews how costs and wastage are controlled by introducing pricing understand the context in which being managed. And Part 4 looks policies, income generation catering is delivered at what improvements have been targets and policies on the level made in the strategic management and cost of subsidisation. • using existing documents and of catering services. findings from other sources 7. NHS Quality Improvement (including NHS QIS and the Scotland (NHS QIS) has produced Health Facilities Scotland standards for food, fluid and Catering Group).9 nutritional care in the NHS in Scotland and has recently reviewed 9. Fourteen NHS boards, the State and reported progress against three Hospital and the Golden Jubilee of the six standards.7 8 Audit Scotland National Hospital were included has worked closely with NHS in our study.10 We surveyed 149 QIS to provide a comprehensive hospitals that provide meals to picture of work in this area. The patients, visitors or staff and also complementary approach adopted carried out more detailed follow-up by both organisations has led to NHS work in a sample of 33 hospitals QIS focusing on the nutritional care which we had reviewed in the of patients, while our review has baseline study.11 These sample focused on the delivery of catering hospitals are listed in Appendix 1 services.