Eventlaunch and it's process

2. Welcome
Debbie Sutton
2

3. Session 1
Helen Ream
3

4. The Review Began………
Event to launch the review in November 2016
Members worked in groups to review chapters
Comments included:
• document too long
• content is repetitive in places
• reference updates to capture new information required
4

5. The Digest Review Group….
A group was formed including:
• Chapter leads with support person
• Content reviewers
• Critical readers
• Stakeholders
• Home Countries
• Designers
5

6. The Process
• Chapter leads led the review of their chapter
• Chapters reviewed at meetings to identify
changes and discuss pertinent points
• Full copy put together in August and sent to
stakeholders
• Formatting and amendments process
• Launch event planned
6

7. Discussion Points Included…
• The structure and format of the document
• How much information to include
• Provision of new chapter on staff and visitor
catering
• Format and content of therapeutic diet chapter
• Energy targets
• Healthier eating coding criteria
7

8. The New Format
• Longer in page numbers but not content!
• Easier to read
• Easier to navigate
• Follows BDA branding
• Use as online document but can be printed and
held locally if required
8

9. What Next...?
• Launched on BDA Website,
• Working with our stakeholders to promote
and share the 2nd edition
• Update the checklist to demonstrate
compliance with Hospital Food Standards
9

10. Thank You
10

11. Session 2 – Chapters 1 to 4
Angela Tella
Katherine Crossfield
Lisa Baker
Rebecca Deeley
11

12. Chapter Overview
 International, national and local influences impact on food and
beverage services.
 Summary of relevant documents providing guidance and
legislation for catering in care settings.
 Key messages:
• Application of these policies needs to be relevant.
• Focus is on appropriate food and beverage provision for
the end user.
• A multi-disciplinary approach is important.

13. National
• Brings together EU rules on general food labelling and nutrition labelling into one piece
of legislation.
• Most legal requirements of this directive (including allergen information) came into
force in December 2014.
• BDA Food Services Specialist Group & Hospital Caterers Association toolkit
addressing food allergies/intolerances within healthcare catering settings.
• Mandatory nutrition declarations for most pre-packed foods came into force in
December 2016
Labelling [Food Information to Consumers (FIR) (The European
Parliament and the Council of the European Union, 2011)].
Eatwell Plate replaced by the Eatwell Guide in March 2016.

14. England
• Highlights five standards included in NHS standard contract.
• > 50% of hospitals fully compliant with standards; > 90%
working towards compliance (DH, 2017).
• Monitored via PLACE, including comprehensive evaluation of
taste, flavour and presentation of hospital food.
Hospital Food
Standards Panel
Report (2014)
• Part of NHS Standard Contract from 2015.
• All NHS Hospitals should develop and maintain a food and
drink strategy.
Food & Drink
Strategy Toolkit
(2014)
• Implementing GBS is compatible with ‘eating for health’
approach mentioned in HFSP.
• Provides scope for dietitians to ensure specialist dietetic needs
of specific patient groups are met e.g. sugary drinks for
hypoglycaemia, cheese for nutritionally vulnerable.
Government Buying
Standards
(updated 2015)
• One of four CQUINs.
CQUIN for NHS Staff
Health and
Wellbeing (2016)
14

15. Nutrition and Catering Standards for Food and Fluid Provision for Hospital Inpatients
Made mandatory in 2012, its implementation is facilitated by:
USING NUTRITIONALLY
ANALYSED RECIPES
that meet standards to
devise menus
INTRODUCING NEW AND
REVISED RECIPES
at intervals following
piloting and evaluation
PATIENT SATISFACTION
SURVEYS + ACCREDITED
NUTRITION & FOOD SKILLS
MODULE
for ward-based food service
staff.
ALL WALES NUTRITION
COORDINATORS GROUP
(Nursing + Dietetic +
Catering) which
monitors implementation
of nutrition care pathway
and standards.
LEAD DIETITIAN ROLE
within the NHS Wales
food procurement
service
Wales

16. Scotland
• Mandatory.
• Provide focus for nutritional care in NHS
Scotland.
Food, Fluid and Nutritional
Care Standards
(2014).
• Enables compliance with standards.
• Food and nutrient-based standards,
guidance on menu planning and
therapeutic dietary provision.
Food in Hospitals –
National Catering and
Nutrition Specification for
Food and Fluid Provision
for Hospitals in Scotland
(Revised 2016).

17. Overview of Chapter 2- Nutrition,
Hydration, Eating and Drinking
• This chapter discusses the importance of ensuring
adequate nutrition and hydration for our patients.
• It focuses on;
• The importance of screening for malnutrition
• Factors that increase the risk of malnutrition
• The effects of malnutrition
• Food fortification
• The importance of adequate hydration
17

18. What’s new in Chapter 2- Nutrition,
Hydration, Eating and Drinking?
• Movement of some information to other chapters
• Consideration of overweight/ obese patients
• Addition of the ‘Malnutrition Carousel’ from BAPEN
• More emphasis on the importance of all fluids
• Update of appropriate references
18

19. Catering for Staff and Visitors in the NHS
 Health & Wellbeing has become an increasing
priority within the NHS since 2012
 New chapter dedicated to this topic within the
2nd edition
19

20. 20

21. Key topic areas:
Health & Wellbeing within the NHS
1. Hospital Food Standards
 Forms part of every NHS Standard Contract
 Standards 4 and 5 relate specifically to staff and visitors
 Standard 4 – Healthier and More Sustainable Catering for Staff and
Visitors: Nutrition Principles (Public Health England, 2017)
 Standard 5 - Government Buying Standards for Food and Catering
Services (DEFRA, 2014)
21

22. Key topic areas:
Health & Wellbeing within the NHS
2. Commissioning for Quality and Innovation (CQUIN)
2016/2017 CQUIN
1. Healthier alternatives are available 24 hours a day
2. HFSS foods are not sold near till points, are not price promoted and
are not advertised
2017/2018 & 2018/2019 CQUIN
1. Retain the requirements of the 16/17 CQUIN
2. Plus ensure that (by year two):
 90% of drinks lines stocked are not sugar sweetened
 80% of confectionary contains <250kcal
 75% of sandwiches and salads are ≤400kcal and ≤5g saturated fat
22

23. Key topic areas:
Health & Wellbeing within the NHS
3. Reduction of Sugar Sweetened Beverages (SSB)
 Voluntary targets brought in by NHS England to reduce the amount
of SSB sold within NHS premises
 April 2017 saw the announcement of a scheme where by sales of
SSB would be expected to reduce to 10% of total drink sales by
March 2018
 Non-compliance may result in an out-right ban on NHS premises
being considered
23

24. Other Areas Covered
1.Health & Wellbeing in Scotland, Wales and
Northern Ireland
2.Health & Wellbeing for Patients
3.The Role of the Registered Dietitian
24

25. Dietitian’s role within catering
• To identify strengths and weaknesses in a food provision chain
• Development of policies and procedures
• Menu and service planning
• To act as a dietetic – catering link, improving communication and insight.
• To improve the understanding of food and beverage service by the rest of
the dietetic team.
HCPC standards of proficiency and conduct (2013), performance and ethics
(2016) also help to support and clarify the role of dietitians working within the
provision of food and beverage services.
Recommendation
A dedicated catering liaison dietitian for every department to lead developments
and act as the main interface between catering and clinical services.
25

26. Working in Partnership
The catering dietitian can help to bridge the gap between nursing, estates,
catering, suppliers and therapy departments.
Relationship with contractors/suppliers
Dietitians employed by commercial food suppliers and catering contractors
should work with the dietitians in health and care settings to ensure the needs
and preferences of all patient groups are met.
Health and well being
It is important that dedicated time is given to assist with the role of any health
and well being strategies within the NHS, these may relate to staff and visitor
dining or patients.
26

27. Training
Catering dietitians should help to ensure that all staff involved in the food chain
have access to relevant training to help provide a patient centred food service
that promotes nutritional care.
Topics may include:
• Basic nutrition
• Allergens
• Special diets
• Food hygiene and safety
• Portion control
• Food presentation
27

28. Dietitian’s role within service provision
Patient information
Dietitians should help to develop user friendly and patient centred information
using a variety of formats e.g. written and pictorial menus, guidance regarding
appropriate food choice.
Managing the eating environment
The multi disciplinary team involved within catering should work with ward
teams to achieve the best possible eating experience for the patients.
Promoting the importance of the physical environment, appropriate equipment
and staff behaviour.
28

29. Dietitian’s role within service provision
Managing the therapeutic diets
The dietitians should work with caterers to help ensure that therapeutic diets
meet the requirements of clinical treatment, nutritional standards, patient
preferences and are appetising for the patient.
Systems such as diet manuals should also be in place to help provide
recommendations on how to meet the needs for therapeutic diets when there is
no dietitian available to give advice.
Monitoring and audit
To support the development of appropriate performance indicators within food
and beverage services and nutritional care.
29

30. Thank You
30

31. Session 3 – Chapters 5 and 6
Andy Jones
Phil Shelley
31

32. 32

33. Food Service Delivery and Planning
• Working Together - The Power of 3
• Protected Mealtimes:
• Provision of a Patient-focused Meal Service
• Food Service Systems
• Control of Food Service Delivery
• Food Waste
• Food Hygiene and Safety
33

34. “It is essential that dietitians take a pro-active
role jointly with catering and clinical colleagues,
to ensure that acceptable standards for food and
beverage services are not put at risk and that
the budget is adequate to provide the nutritional
needs of the individual.”
34

35. Catering Specifications and Contracts
• Barriers to Good Practice
• Catering Specifications
• Catering Contracts
35

36. 36

37. Thank You
37

38. Session 4 – Chapters 7 and 8
Lauren Bowen
Maxine Cartz
38

39. Food Composition, Labelling and Recipe
Analysis - Overview
• Nutritional Content
• Food Labelling Legislation
• Allergen and Nutrition Information
• Nutritional Analysis
• Recipe Analysis and software
39

40. Nutritional Content – Key Highlights
• Emphasis on food costs – menus should
provide good nutritional ‘value for
money’
• Procurement – Mandatory particulars
(product specifications)
• Packaging – PLACE requirements
40

41. Food Labelling Legislation – Key Highlights
• EU FIC Updated
• Allergen Information
• Nutrition Information – Mandatory
Nutrients, Supplementary Nutrients
41

42. Nutritional Analysis – Key Highlights
• Chemical Analysis
• Tolerances and Rounding – Included
• Calculated Analysis – CoFIDS and
MW7
42

43. Recipe Analysis and Software – Key Highlights
• Recipe Analysis – Requirements and
considerations to complete recipe
analysis
• Recipe Types and example analysis
• Software - Updated
43

44. Menu Design and Content
• Amalgamated chapters 6 and 7 - menu design
structure and planning and menu content
• Emphasis on getting the right menu and service
• Updated to include the Eat Well Guide
• Menu assessment checklist included in
appendix
• Basic vitamin and mineral descriptions
44

45. Thank You
45

46. Lunch Break
46

47. Session 5 – Chapters 9 and 10
Saachi Patel
Sadaf Saied
47

48. Nutritional Standards: Day Parts Approach
• Nutritional Targets
• Nutritionally Well – energy targets based on EARs
for Energy from the DRVs for Energy (SACN, 2011)
• Nutritionally Vulnerable – protein targets based on
PENG recommendations – 1.1 g / kg body weight
• Menu Capacity
• Complete meal = starter + main + dessert
• Minimum energy = 500 kcals
48

49. Nutritional Standards: Day Parts Approach
• Day Parts Model
• Used to demonstrate the menus capacity in meeting targets
• Divides the day into meal parts
• Breakfast + Snacks + Beverages = 40% intake
• Midday & Evening Meal = 30% each (60% total)
49
Complete Meal Targets (Starter + Main + Dessert)
for midday and evening meals
Nutritionally
Well
Nutritionally
Vulnerable
Energy 500 800
Protein 15 25

50. Analysing Menu Capacity
• What does it contain? What's changed?
• Worked Examples – Cycle and A la Carte
• Table 10.1-10.6
• Standard / Lighter Choice and Vegetarian
• A worked example
• Practicalities and Pitfalls
50

51. Worked Example
À la Carte Menu
51

52. Where to start ?
Setup a template matching your menu cycle & structure
Insert Values
52
Well Vulnerable
Breakfast 400 kcal / 10g Protein 545 kcal / 15g Protein
Beverages 184 kcal / 14g Protein 264 kcal / 13g Protein
Snacks 150 kcal /2 Protein 300 kcal / 4g Protein
Minimum Maximum
Lunch Use your own based on the menu
Supper
Fixed
40%
Variable
60%

53. Scan the menu for min
and max choices
53

54. The calculations!
54
473 kcal
24.4 g protein
618 kcal
33.5 g protein
1198 kcal
32.5 g protein
1303 kcal
44 g protein
3610
1825 2718

55. Practicalities and Pitfalls
• Menus Analysis as Evidence – Balanced -
Diverse
• How many days to analyse?
• Therapeutic , Dysphagia & Ethnic Menus
• Plain choice Meals?
• What about Micronutrients?
55

56. Thank You
56

57. Session 6 – Chapter 11
Lorraine Holden
Ruth Smith
57

58. What is Included?
Diets
Patient Groups
Menu Coding
58

59. What has changed?
• Combined previous chapters 9 and 10
• Introduced a new table format
• Updated healthier eating coding criteria
• Enhanced religious diets and vegan info
• Updated all therapeutic diets info
• Updated renal coding criteria
59

60. Now Includes…
• Enhanced food allergy and finger food info
• Enhanced children's section
• New low FODMAP section
• New critical illness section
• New dementia/cognitive impairment section
60

61. Content
Chapter is split into five sections
61
Type of diet Description
1. Standard Diets Majority of the population
2. Religious, Cultural, Personal
and Lifestyle Considerations
Cultural or religious including vegan
3. Therapeutic Diets Specific dietetic requirements
4. Specific Patient Groups Populations with specific
requirements
5. Test or Investigation Diets Temporary Diets

62. Standard Diets
• Healthier eating
• Higher energy
• Softer choices
• Vegetarian
62

63. Healthier Eating
• Updated criteria – targets for breakdown of
a main meal and a main course
• Compatible with both cycle or a la carte
menus
• More evidence based
63

64. Table 11.2 Healthier Eating Main Meal Breakdown
Table 11.3 Healthier Eating Main Course Breakdown
64
Fat (g) Sat Fat (g) Sugars (g) Salt (g)
Starters 5.3 1.7 n/a 0.3
Main courses 16 5 n/a 1.5
Desserts 5.3 1.7 18 n/a
Total 26.6 8.4 18 1.8
Fat (g) Sat Fat (g) Sugars (g) Salt (g)
Entrée 16 5 n/a 1.5
Starch no added n/a n/a no added
Veg no added n/a n/a no added

65. Religious and Cultural Diets
• Halal
• Kosher
• Asian Vegetarian
• Vegan
65

66. Therapeutic Diets
• Modified texture
• Finger foods
• Renal suitable
• Liver (decompensated)
• Food allergy
• Gluten free
• Low FODMAP (new)
• Neutropenic
66

67. Renal Suitable
• Updated criteria – more comprehensive
nutritional targets for the breakdown of a main
meal as well as a main course
• Compatible with both cycle or a la carte menus
• More evidence based
67

68. Table 11.5 Recommended parameters for renal meals
Table 11.6 Potassium Main Meal Breakdown
68
Energy
(kcals)
Energy
(kcals)
Protein
(g)
Protein
(g)
Sodium
(mmol)
Potassium
(mmol)
Phosphate
(mmol)
Min
Ave (no
max)
Min
Ave (no
max)
Max Max Max
Main
Meal
300 400 15 23 28 28 12
Dessert 100 200 2 4 3 8 2
Total 400 600 17 27 31 36 14
Meal
Element
Minimum Portion
Size (g)
Average Energy
(kcals)
Average
Protein (g)
Potassium
(mmol)
Entrée - 200 18 <10
Starch 115 150 3 <10
Vegetables 80 50 2 <8
Dessert - 200 4 <8
Total n/a 600 27 36

69. Therapeutic Diets
• Modified texture
• Finger foods
• Renal suitable
• Liver (decompensated)
• Food allergy
• Gluten free
• Low FODMAP (new)
• Neutropenic
69

70. Patient Groups
• Children
• Critical illness (new)
• Obesity
• Older people
• Dementia/cognitive impairment (new)
• Cancer
• Mental Health
70

71. Children
• ‘nutritionally well’ and ‘nutritionally vulnerable’
• menus must cater to both
Must ensure that all children and young people admitted to
hospital:
• have options available to allow them to eat a well-
balanced diet of healthy food, as outlined by national
guidelines
• have available sufficient food of good quality to meet their
nutritional requirements
71

72. Table 11.9 Nutrient Provision Guidelines for Children
Table 11.10 Guidelines for Nutritionally Well Children (Main Meal)
72
Breakfast Lunch Snacks & Drinks Supper
Energy % EAR 20% 30% 20% 30%
Protein % RNI 20% 30% 20% 30%
Salt % SACN 20% 30% 20% 30%
Gender Mixed (Ave) Mixed (Ave) Mixed (Ave) Mixed (Ave)
Age 4-6 years 7-10 years 11-14 years 15-18 years
Energy (kcal) 429 528 675 675
Fat (g) 17 21 26 26
Sat fat (g) 5 6 8 8
Free sugars (g) 5 7 9 9
Protein (g) 6 9 13 15
Salt (g) 0.9 1.5 1.8 1.8

73. Nutritionally Vulnerable Children
• For hospitalised children and young people, the relative
proportions of the food groups in The Eatwell Guide may
not be appropriate (as they may have a greater reliance
on energy dense foods and snacks – high in fat and/or
sugar)
• The focus of nutritional provision from hospital food
should be on achievement of an adequate energy intake.
An average day’s intake from breakfast, two main meals,
two to three snacks and milk (or a suitable alternative),
should meet the Estimated Average Requirement (EAR)
73

74. Patient Groups
• Children
• Critical illness (new)
• Obesity
• Older people
• Dementia/cognitive impairment (new)
• Cancer
• Mental Health
74

75. Acknowledgements
Thanks to all the specialist groups and organisations that
provided information to update these key areas.
Coeliac UK The Anaphylaxis Campaign
Allergy UK Great Ormond Street Hospital
Renal Nutrition Group Oncology Group
Older Peoples Group Mental Health Group
Vegan Society Obesity Group
Gastro/Liver Group Food Services Group
Critical Care Group Hospital Kosher Meals Service
75

76. Thank You
76

77. Debbie Sutton
Q&A
77

78. AGM
78