1. Hospital food and beverage services

2. Food service
Menu planning
The Food Chain
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3. Menu planning An inclusive process
Requires in depth knowledge of the needs of the patient
Menu requires structure
Menu requires content
Menu is complemented with non-meal food and beverage services
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4. An inclusive process Nutritional value of food not eaten is nil
Need to involve the consumer at the planning stage
Need to involve the producer and make sure that plans can be delivered
Need to include service staff to engender a pride in the product
Need to check nutritional content and menu capacity
Need to check cost and affordability
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5. In depth knowledge of the needs of the patient
Age and gender
Ethnicity
Food preferences
State of health
State of dentition
Mental health
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6. Menu requires structure
How many meals per day?
How much choice on offer?
Range of accompaniments etc etc
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7. Menu requires content Home Start of this section
What is the most suitable range of dishes?
What specification of dishes?
What is the most suitable portion size?
What is the nutritional specification?
What are the ingredients specifications?
What are the cost specifications?
How will specification be met?
Standard recipes
Standards of procurement
Menu testing
Feedback from patients
Feedback from staff
Nutritional capacity testing
Nutritional analysis of menu
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8. Menu is complemented with non-meal food and beverage services
Ward issues of:
Milk, breakfast cereals, bread, butter, sugar, preserves, tea, coffee etc
Suitable items for between meal snacks
Supplements
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9. The Food Chain Patient orders food Food order communicated to kitchen
Provisions procured
Provisions delivered and receipted
Provisions stored
Food produced
Food distributed
Food served
Food intake monitored and appropriate action taken
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10. Patient orders food Ordered at time of service Ordered using menu card
Ordered using hand held device
Ordered using bedside terminal
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11. Food order communicated to the kitchen
Ward order predicted by forecasting
Card collated at ward level
Card collated centrally
Hand held linked on ward or centrally
Bedside terminal linked by ward or centrally
Systems can be linked to nutritional databases
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12. Provisions procured
Ingredients and product specification need to be determined
PASA system provides data
PASA manages specification of NHS contracts
GM free
Compliance with salt model
Allergen information
Nutrition information available
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13. Provisions delivered and receipted
Availability is critical to success
Critical control point with regard to hygiene and cost control
Food bill in typical 1000 bed hospital c£1.5M per annum
C£4,100 per day of perishable goods delivered
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14. Provisions stored Responsibility for food safety begins with delivery
Food poisoning killed 19 people in Wakefield 1985
Poor storage adversely affects nutritional content
EHO enforces food hygiene regulations
EHO can shut kitchen down with immediate effect
Breach of regulations can lead to prosecution
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15. Food produced Standard recipes are vital: Home Start of this section
Nutritional quality control
Cost control
Quality assurance
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16. Food distributed
Any hospital with more than 300 beds will need to consider distribution technology
Cook chill
Cook freeze
Sous vide
All distribution technology requires regeneration at ward level
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17. Food served Home Start of this section Protected mealtimes
Essence of care – food and nutrition benchmark
HCA food service at ward level
Ward prepared for the meal
Patients prepared for the meal
Right meal to the right patient
Appropriate equipment available
Appropriate assistance available and planned for
Arrangements in place for last minute changes
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18. Food intake monitored and appropriate action taken
Responsible Registered nurse must be aware of patients intake
Systems in place to record food intake for vulnerable patients
Systems in place to record missed meals
Systems in place to trigger action when food intake deemed inadequate
Regular communications with dietitian and clinical team about food intake
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