National Catering Production Strategy Strategy_15… · National Catering Production Strategy...

Shared Services

National CateringProduction Strategy

November 2016

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National Catering Production Strategy

CONTENTS

Executive summary

Why do we need a national catering production strategy?

What is going to change?

What is required to realise the strategy?

Conclusion

References

Appendices

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6

11

16

19

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EXECUTIVE SUMMARY

NHSScotland spent in the region of £86m delivering food services in Scotland in 2013/14 (figures specifically commissioned for this programme of work). We delivered 48,000 meals per day, employing the equivalent of around 2,181 full time staff from 99 locations (Ref 1).

National Catering Production Strategy for NHSScotland has been developed around the key points highlighted below.

1. National Catering Production Strategy sets out a framework for the development of catering production services across Scotland for the next decade. It is designed to give an evidence-based, perspective of why change is needed and what direction that change should take.

2. The NHS in Scotland has successfully made progress against many of the challenges to our nation’s health and healthcare. National Catering Production Strategy aims to support these key improvements in Healthcare provision in Scotland.

3. “The health of the population of Scotland is poorer than in many other European countries, but will continue to improve with national initiatives to support healthier lifestyle choices”. Better nutritional standards within the NHS should contribute to this improvement.

4. Despite the success of the National Health Service in Scotland, there are challenges that need to be addressed if we are to meet our aim of providing a first-class health service for the future.

We know that we, on average, tend to live longer will result in an increasing number of older people. While many older people will enjoy better health and nutrition than their predecessors did at an equivalent age, they will still have significant health needs.

5. We also know that the NHS in Scotland is at present challenged by a number of factors. We know that many of the current experienced catering staff in the service may retire in the next 10 years and that the skill set required to deliver the proposed service will alter.

6. As a result of the financial challenges being faced around the world, there will be constraints on what can be achieved with anticipated future resources. National Catering Production Strategy proposes that a continuous drive to deliver catering services of the highest quality and value is a more important and appropriate way of managing resources than an isolated focus on finance.

7. National Catering Production Strategy describes the rationale for a concentration of resources in centralised production facilities which will release resources to be utilised in front line patient care delivering a more person centered care.

8. The proposed service model aims to deliver safe, consistent, high quality food from (four) central production unit locations (CPUs) across Scotland operated by NHS Staff. The service model would be based around frozen meal to hospital locations

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for onsite finishing by NHS staff. This service will provide a range of meal options to meet the needs of all patients and staff across Scotland.

9. National Catering Production Strategy has shown from initial high level analysis, that over a 10 year period, cumulative operational running costs are estimated to reduce from £847.4m to £786m, an estimated cost reduction of £61.4m. This requires an estimated capital expenditure investment of £34m and could potentially release resources over a 10 year period of £27.4m to be reinvested in patient care.

10. National Catering Production Strategy suggests a phased approach to change. The initial phase involves the introduction of a number of regionally based catering production units which can deliver safe, nutritious food to wider geographical areas and potentially other public service user groups. The Strategy proposes a “proof of concept” based on NHS Lothian Our Food, Our Health, Our Care NHS Lothian Catering Strategy 2014 – 2024 which has identified an immediate need for change to its current catering production facilities. This “proof of concept” will provide an exemplar model for further regional production centers.

11. It is recognised that in some sections of the media and caterers, it is perceived that food produced with a cook serve model is a better product than either cook freeze or cook chill. Our research evidenced that (following a Literature Review and Blind Tasting) there is no one catering production system that is either better or safer than any other.

12. It is essential to take forward planning and delivery locally, regionally and nationally. Whilst recognising the benefits of a “Once for Scotland” approach. Planning and delivery within geographical and/or other boundaries may no longer deliver what is needed; planning and delivering services for and across populations, regardless of locality, is key. We must increase the collaborative working that is the hallmark of the NHS in Scotland. The potential future service configurations as a consequence of the integration of health and social care will be a part of this.

13. National Catering Production Strategy describes the advances that can be made by harnessing technology – both in catering production and resource control, to support standardisation of processes where they should be standardised, and to enhance food safety. NHSScotland will increasingly become an organisation that is driven by enhanced interpretation of data, and better use should be made of this data to support service improvement and performance management. The original Initial Assessment (IA) was based on the assumption that a National Catering Information System and Bedside Electronic Patient Meal Ordering System (NCIS/BEPMO) would be implemented in all A1 and A2 hospital locations. This development still requires to be progressed to achieve maximum service efficiency. In addition, menu harmonisation would be an essential element of catering services across Scotland. As we become more able to draw conclusions from “big data”, we should be able to enhance the production of food which is nutritionally compliant and consistent across NHSScotland.

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14. Acknowledging that the quality of services is related to the quality of our workforce, National Catering Production Strategy describes the development of skilled staff, working effectively in multidisciplinary and multi-organisational settings to deliver catering excellence.

15. In summary, National Catering Production Strategy sets out the case for:

• delivering a safe, nutritious, compliant, high quality and consistent catering product across the whole of NHSScotland

• delivering national menu harmonisation structure across NHSScotland

• developing cook freeze, regionally based catering production units, operated by NHS staff

• enhancing and promoting the image of patient catering services both within the NHS and to the wider population in Scotland

• caterers having greater responsibility for catering services, moving the service closer to the patient

• providing high quality, proportionate, effective and affordable catering services

• transformational change supported by investment in catering facilities and IT systems.

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WHY DO WE NEED A NATIONAL CATERING PRODUCTION STRATEGY?

Compelling Case for Change

The case for change is based on the need to develop sustainable services that align to the NHSScotland quality ambitions of a person-centered, safe, and effective service.

Catering services in NHSScotland aspire to achieve high standards in catering. They are provided within an industry leading policy and guidance framework, meeting many of the challenges placed upon them in the past. However, there are a significant number of challenges and drivers which future healthcare catering services will need to address to maintain and enhance the reputation of the service.

The NHS in Scotland has successfully made progress against many of the challenges to our nation’s health and healthcare. National Catering Production Strategy aims to support these key improvements in Healthcare provision in Scotland.

“The health of the population of Scotland is poorer than in many other European countries, but will continue to improve with national initiatives to support healthier lifestyle choices”. Better nutritional standards within the NHS should contribute to this improvement. (REF1)

The compelling Case for Change for NHSScotlandcatering production service improvements is basedupon the points below relating to the current service:

• Multiple (five) Catering Service Models i.e. conventional cook freeze, cook chill, hybrid and delivered meals.

• 99 food production locations across NHSScotland.

• Inconsistent and variable levels of service including no national menu harmonisation delivery.

• Variable actual costs per patient day (from £8.39 to £20.12 with the average £10.95).

• Deteriorating state of catering estate facilities and equipment across NHSScotland.

• Consistency of compliance with market leading, catering and nutrition specification/ standards (Food and Hospitals 2016, Food, Fluid and Nutritional Care Standards 2014).

• Challenging fiscal pressures.• Need for a National Catering Production Strategy.• Increasing pressures in recruiting skilled

production staff.• New food legislation requirements.• Increasing media and public attention in hospital

food.• Increasing desire to localise Scottish food

procurement.• The need to provide appropriate financial

information on the catering service to allow informed, up to date and accurate decision making.

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Fig 1 Hospital Food in Context

Hospitalfood

FOOD IN HOSPITALSCONTEXT IN SCOTLAND

Health Economy

Social Environment

Hospital food as an

examplar for society.

Scotland’s National Food

and Drink Policy

Becoming a Good Food Nation.

Tackling Health, Education,

Environment, Industry, Communities and Behaviour

Change

Procurement that delivers economic, environmental and

Food as part of the clinical treatment of

hospital patients.

The Standard for nutrient and food provision for

hospital food.

Scotland’s 15 National

Outcomes.

Safe, effective and

person-centred nutritional care.

Managing risks of under-nutrition.

Reducing food waste and the environmental impact of food.

Improving the health of the Scottish

population.

Community Planning Partnerships

Procurement Reform

(Scotland) Act

Climate Change

(Scotland) Act

Community Empowerment (Scotland) Act

The Scottish Dietary Goals

Complex Nutritional Care

Standards

Food, Fluid & Nutritional Care

Standards

The “Food in Hospitals” Guidance

Catering skills and trianing.

Maximising opportunities for patients to eat and

drink.

Delivering appropriate food and nutrition.

Delivering quality and choice for patients.

Improving local

outcome in the area.

Reducing waste and

CO2.

Catering Change -

buyring food sustainably.

The context of healthcare catering is illustrated in Fig 1.

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National drivers

There are a number of national drivers in terms of policies, strategies, reports and national context which the proposed plan supports. These in summary include:

• NHSScotland Shared Services: will be managed Once for Scotland and delivered in a consistent way where it is appropriate to do so.

• 2020 Vision “Achieving Sustainable Quality in Scotland’s Healthcare”: focus on achieving the highest standards of quality and safety, with the person at the centre of all decisions (Ref 2).

• The Healthcare Quality Strategy for NHSScotland: alignment with the three quality ambitions (person centered, safe, and effective) (Ref 3).

• NHSScotland Efficiency Framework for SR10: improving quality and efficiency through a developed workforce, adopting good practice, and reducing variation, waste, and harm (Ref 4).

• The Christie Commission On The Future Delivery Of Public Services Report: “we must prioritise expenditure on public services which prevent negative outcomes from arising” (Ref 5).

• Integration of Health and Social Care The Public Bodies (Joint Working) (Scotland) Act 2014 (Ref 6).

• CEL 46 (2008) Outsourcing of Soft Facilities Management in NHSScotland: NHSScotland are responsible for direct delivery of clinically related soft facilities management services, with any new arrangements exempt from contracting or outsourcing (Ref 7).

• NHSScotland National Catering and Nutritional Specification for Food and Fluid Provisions “Food in Hospitals”: National Catering and Nutrition Specification revised Mar 2016 (Ref 8).

• Healthcare Improvement Scotland, Standards for Food, Fluid and Nutritional Care 2014: “these standards can be used to reinforce national consistency and food, fluid and nutritional care across Scotland” (Ref 9).

• The Food Safety Act 1990: “provides a framework for all food legislation in Britain” (Ref 10).

• Compliance with Regulation (EU) 1169/2011:, identifying food labelling/allergens (Ref 11).

• Scotland’s National Food and Drink Policy 2009: “by 2025 people from every walk of life, will take pride and pleasure in the food served day by day in Scotland” (Ref 12).

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Local drivers

There are a number of local drivers specific to the catering production services in terms of policies, strategies, reports and local requirements which these proposals support.

These include:

• Strategic Review of Soft Facilities Management: acting on recommendations to produce a business case for the re-provision of Catering Production facilities across NHSScotland that moves to best practice and standardisation and makes best use of assets.

• Service model and site variations: minimising variances where appropriate in the move towards a national catering production Strategy.

• Varying levels of cost and service configuration efficiency: improving productivity and achieving efficiency savings by moving to an optimal model of service delivery.

• Varying condition of the catering production facilities: the catering production facilities are ageing and are in need of upgrade or replacement.

• Based on NHS Lothian’s Strategic Review “Our Food, Our Health, Our Care NHS Lothian Catering Strategy 2014 – 2024” (Ref 13)which has identified a need to change its current catering production facilities and recommending a cook freeze model It is suggested that a “proof of concept” be undertaken to provide an exemplar model for further regional production centers.

Case for change

Moving to delivery through an optimal model of service ensures an appropriate catering service is in place that contributes to the overall sustainability of wider NHSScotland services. The key service needs are outlined below:

• Best practice and standardisation which minimises variances where appropriate and aligns with the strategic direction of travel to ensure equity of service across NHSScotland.

• Delivering a consistently safe and nutritious choice for patients and non-patient catering across Scotland.

• Delivering services in modern fit for purpose facilities within capital allocation, addresses backlog maintenance issues, supports new ways of working, and improves health and safety of the workforce.

• Improving productivity and realising efficiencies that reduces the overall cost per unit generates costs savings that contribute to the sustainability of the service and wider NHSScotland.

• Developing and retaining a skilled and motivated workforce has positive impact on staff and ensures the productivity and sustainability of the service.

• Providing capacity with sufficient contingency arrangements to flexibly respond to frontline service demand ensures the service is effective and aligned with the delivery of person-centered care.

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Proposed service model

The proposed service model aims to deliver safe, consistent, high quality food from (four) central production unit locations (CPUs) across Scotland operated by NHS Staff. The service model would be based around frozen meal to hospital locations for onsite finishing by NHS staff. This service will provide a range of meal options to meet the needs of all patients and staff across Scotland.

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WHAT IS GOING TO CHANGE?

NHSScotland need to change the way catering production works

National Catering Production Strategy identifies an ambitious and radical change over a period of 10 years to catering production services across NHSScotland. The key outcomes from adopting this Strategy will be:

• Standardisation of food quality and an improved more consistent service to patients, staff and visitors.

• The elimination of an ageing catering estate in a number of NHS Boards.

• A reduction in the wide variations in service modelling, quality and choice.

• The reduction in highly variable costs per patient (food and labour).

• The reduction in high volumes of food wastage in some NHS Boards.

• Compliance with increasingly onerous food safety and standards legislation e.g. Hazard Analysis Critical Control Point System (HACCP) and food labelling/allergen regulations.

• Managing potential future skill shortage resulting from changing demographics of catering production staff and recruitment pressures.

• Releasing resources for frontline patient care.• Eliminating catering subsides for non-patient

catering.

It is recognised that parts of the media and a number of caterers wish to retain a production model based on a traditional cook serve methodology and this vocal lobby finds resonance with certain groups within Scotland, that food produced by a cook serve process is a better than that by either cook freeze or cook chill. The reality is that (following a Literature Review and Blind Tasting) there is no one catering production system that is either better or safer than any other. In fact many of the cook serve operations utilise significant volumes of frozen products within their normal “conventional” food production.

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It is proposed that the optimum way forward is to develop a “proof of concept” for the production of cook freeze facilities. NHS Lothian, which has an immediate need to upgrade its predominantlyconventional catering facilities, has already conducted a review and produced a local NHS Lothian Catering Strategy (Ref 13). This Strategy, based on a move to cook freeze production, has already undergone public consultation. As this is in line with the NHSScotland Catering Strategy, early discussions have strongly indicated a desire to work in partnership to use NHS Lothian as this “proof of concept”.

National Catering Production Strategy for NHSScotland strongly recommends the need for the regional catering production units to service an area wider than those of any current individual NHS Boards. It is essential, for the Strategy to derive maximum benefits, that it has the capacity to meet current and potential future demands.

The proposals of National Catering Production Strategy apply essentially to those NHS Boards planning new builds, or requiring to redevelop their catering estate or equipment. Those Boards that already have existing catering production arrangements that are fully compliant with all guidelines and legislation, and/or where there are

substantive reasons for maintaining their existing arrangement, would not be expected to change their service model in the short to medium term. This may for example apply to the Island NHS Boards.

National Catering Production Strategy describes the rationale for a concentration of resources in centralised production facilities which will release resources to be utilised in frontline patient care delivering a more person centered care.

We also know that the NHS in Scotland is at present challenged by a number of factors. We know that many of the current experienced catering staff in the service may retire in the next 10 years and that the skill set required to deliver the proposed service will alter.

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We’re going to ensure a Once for Scotland approach

National Catering Production Strategy recognises that Shared Services will be managed Once for Scotland and delivered in a consistent way where it is appropriate to do so. It is based on these aims.

NHSScotland Shared Services will:

• Transform the way support services are delivered by integrating services and working across boundaries.

• Support Scotland’s health with a sustainable, consistent and effective service which meets service user’s requirements.

• Be fully accountable to their service user’s for the quality and effectiveness of their services.

• Exploit economies of scale to increase efficiency, reduce costs and maximise returns from continuous improvement.

• Embed governance to set strategic direction, prioritise service improvements and resolve day to day issue.

National Catering Production Strategy will:

• Improve quality of food and patient experience by providing a service closer to the patient, with food that is produced from nutritionally analyzed recipes. Moving the service as close to the patient as possible to enhance their requirements in terms of choice, timings and suitability.

• Introduce new opportunities for the Scottish supply chain to achieve enhanced social, economic and environmental outcomes through food. There is a desire for as much of the food utilised in any future NHS catering production system to be sourced as close to the method of production as possible. It is essential that any food producers (wherever based) need to be able to meet the current and future NHS procurement specifications.

• Assist in maintaining jobs security. There will need to be a re-training programme for production staff who will need to develop new skills. Any productivity gains will be from natural wastage, not compulsory redundancy. Any displaced staff at the individual hospitals/sites could be reallocated to ward based patient facing roles. NHS Boards would be required to review existing workforce plans to reflect these changes.

• Acknowledging that the quality of services is related to the quality of our workforce, National Catering Production Strategy describes the development of skilled staff, working effectively in multidisciplinary and multi-organisational settings to deliver catering excellence.

• Release resources to move the catering service closer to the patient and most importantly ensure the delivery of safe food on a consistent basis to all patients across Scotland.

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Key Operating Principles of the National Catering Production Strategy

Listed below in table 1 are the key operating principles that will be applied to National Catering Production Strategy. Operating Principle Assumption

NHS Only The Strategy initially only addresses the needs of the NHS client base, whilst recognising that the integration of health and social care along with the shared services agenda’s should be understood in terms of future proofing.

Menu Harmonisation Standard practice will be that all patients are offered a consistent menu choice across NHSScotland from an approved suite of menus.

Safe Food(allergens)

Information technology is an important tool in protecting both the patient and the caterers in terms of having nutritionally analysed standard recipes for all products detailing the 14 Allergens identified in current legislation.

Cook Freeze Food will be cooked by conventional means and rapidly frozen. Food produced will be held at -18C or lower so that it has an enhanced shelf life.

Phased Approach There will not be a definitive date by when all production in NHSScotland will come from a defined source of production. It will be a phased approach, following proof of concept in NHS Lothian.

Staff and visitor dining Hospitals will provide a “reworked” model of retail and visitor catering services that are commercially viable.

Staff and Employee considerations The proposed changes will comply with all NHSScotland guidance and policies including CEL 46 (2008), (Outsourcing of soft facilities management services in NHSScotland).

“Manage the catering service closer to the patient”

NHS Board Catering Leads and staff will have a greater role in the entire catering journey.

Food Procurement Endeavour where possible to engage and utilise Scottish Small/Medium Enterprises (SME’s) food producers in NHSScotlandcatering food procurement.

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We’re going to change the way the NHSScotland catering production works through introducing more new technology

The original IA was predicated on the implementation of proven IT systems which were to be implemented to reduce food wastage and enhance the patient meal experience. The implementation of NCIS/BEPMO still requires to be progressed to fully achieve these aims.

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WHAT IS REQUIRED TO REALISE THE STRATEGY?

The development of the IA involved a series of Workshops and consultation which identified that to deliver National Catering Production Strategy the following will be required. These are outlined below:

Availability of investment capital and revenue streams - to maximise the potential benefits from the proposed food production system for NHSScotland it will be dependent upon suitable and adequate capital investment and future reasonable revenue stream funding.

Adoption of IT systems - improves quality of data and reduces the risk of over production and waste. All identified IT requirements within the Strategy assume that there is a consistency and capacity to adopt across NHSScotland. This will link in with any future eHealth Facilities Strategy.

Reliance of supply chain - to maximise the quality and benefits imbedded in the future food production model it will be essential to ensure that all supply chain partners (both local and national) are fully engaged in the process.

Multidisciplinary approach with other NHSScotland staff involved in patient catering services - the success of National Catering Production Strategy will only be realised if the whole NHS “team” involved in feeding the patients are engaged and supportive of the whole process, caterers alone cannot deliver the Strategy.

Effective communication Strategy - at present there are some deeply held views by both NHS staff and the general public about hospital food. National Catering Production Strategy identifies that it is essential to have the public and NHSScotland staff perceive a valued, quality food service across NHSScotland. An effective, consistent and strong communication Strategy requires to be developed across Scotland.

Effective project planning and implementation - it is likely that some of the proposed changes to food production across Scotland will involve major build or refurbishment project and it’s essential that these schemes are effectively managed in a timely and competent manner.

Shared NHS Boards’ vision - it is essential that all NHSScotland NHS Boards sign up to and agree with the whole Strategy and do not “cherry pick” parts of it that suit themselves and their local agendas.

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Effective Staff side engagement - it is likely that there will be significant changes in the future delivery of food production for catering services across Scotland and it is imperative that all staff are engaged in these changes as it could provide some real opportunities for re-training, re-skilling and re-educating essential frontline catering staff. It is hoped that the improved working environments will be seen as a significant benefit to certain staff.

Management of risk - it is essential that the “risk” factors associated with any future food production across NHSScotland will be identified, recorded and managed at an early stage in any changes.

National reporting and monitoring - any future Strategy for food production across NHSScotland must be dependent on a rigorous, fair and robust monitoring and auditing system that measures the consistency of all catering services against the agreed National standards.

Improved Logistics and Sustainability Requirements - it is essential that any proposals around the future configuration of food production across Scotland takes full account of the transportation issues involving logistics, costs and sustainability responsibilities and targets.

Ability to provide conformity on a consistent manner to Food, Fluid and Nutritional Care (FFNC) Standards 2014 - any future food production model must be able to fully support the current requirements of the FFNC Standards including, special, cultural and therapeutic diets.

Business Continuity - it is essential that any future National Catering Production Strategy is able to provide robust business continuity arrangements to ensure a continuous supply of food to NHS patients and staff.

Finances - this all requires to be delivered within the context of the toughest public expenditure conditions faced in a generation. The Scottish Government’s discretionary budget will be around 12% lower in real terms in 2019-20 than it was in 2010-11. Despite this pressure, health spending continues to be protected, with health resource spending in Scotland set to rise to a record level of £12.4 billion in 2016-17.

National Catering Production Strategy is primarily about improving the value delivered by catering production services. Improving value by providing reliable services that are proportionate to need, safe, effective, person centered and sustainable will increase value for patients, and is likely to stabilise costs.

National Catering Production Strategy has shown from initial high level analysis, that over a 10 year period, cumulative operational running costs are estimated to reduce from £847.4m to £786m, an estimated cost reduction of £61.4m. This requires an estimated capital expenditure investment of £34m and could potentially release resources over a 10 year period of £27.4m to be reinvested in patient care.

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Implementation It is clear that the proposed strategic direction cannot be implemented across the whole of Scotland on the same date. Therefore a phased implementation would be the optimal approach.

A “proof of concept” approach would be used in NHS Boards with immediate requirements to invest in their catering infrastructure e.g. NHS Lothian.

Evidence of the adoption of this technology is seen already by for example NHS Greater Glasgow and Clyde which is already committed to the proposed cook freeze service model.

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CONCLUSION

National Catering Production Strategy sets out the need for significant change in order to adapt to changing circumstances.

These Initiatives are complex, and reflect changes to legislation, policy and guidance related to food production, patient and staff catering; workforce skills and resources; potential outcomes and finance. It will require careful, yet thorough conversations within NHSScotland, the public and their representatives. However, failure to transform NHSScotland will limit the potential to build on the industry leading standards of patient catering services in Scotland and the reduction of wastage costs.

The aim of National Catering Production Strategy is to provide patients, visitors and staff with quality meals and reduce current variances across NHS Scotland. The Strategy is intended to improve upon current standards and in some cases offer a wider choice than currently available. Our aim is to improve the catering services that are proportionate to need, safe, effective, person centered and sustainable production models which is designed to enhance services for patients, with the potential to achieve value for money across NHS Scotland providing the “Once for Scotland” approach.

REFERENCES

1: NHSS National Clinical Strategy for Scotland

2: Achieving Sustainable Quality in Scotland’s

Healthcare August 2012

3: The Healthcare Quality Strategy for

NHSScotland – May 2010

4: NHSScotland Efficiency Framework for SR10

5: The Christie Commission On The Future

Delivery Of Public Services Report

6: Integration of Health and Social Care The

Public Bodies (Joint Working) (Scotland) Act 2014

7: CEL 46 (2008) Outsourcing of Soft Facilities

Management in NHSScotland

8: NHSScotland National Catering and Nutritional

Specification for Food and Fluid Provisions “Food

in Hospitals”

9: Healthcare Improvement Scotland, Standards

for Food, Fluid and Nutritional Care 2014

10: The Food Safety Act 1990

11: Compliance with Regulation (EU) 1169/2011

12: Scotland’s National Food and Drink Policy

2009

13: Our Food, Our Health, Our Care NHS Lothian

Catering Strategy 2014 - 2024

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APPENDICES

10.1 NHSScotland Catering Shared Services Catering Production Initial Agreement and Appendices

November 2016

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