How a hospital food plan can tackle more than nutrition

Communal dining and food waste reduction go hand in hand with the Food for Life programme

Communal dining and food waste reduction go hand in hand with the Food for Life programme

Patients are encouraged to get out of bed, get dressed and have their meals together.

It is lunchtime in the frailty ward at Warwick Hospital and a group of patients are sitting together at a dining table. They chat and laugh and reminisce as nursing staff obligingly top up their cups.

‘Sometimes the patients will drink six cups of tea without noticing,’ says Rebecca Moore, emergency division matron at South Warwickshire NHS Foundation Trust (SWFT). ‘If they were sitting beside or in their bed, chances are they might not even have finished one.’

These patients – older women, sometimes in hospital for several weeks at a time – are benefiting from the trust’s focus on nutrition and hydration, which includes, among other things, a policy of communal dining. Those patients who are able to do so are encouraged to sit together to have their meals, with tremendous benefits for their health and well-being.

‘People feel less isolated’

‘Hospitals used to have a lot of dining rooms, but the designs changed,’ explains Ms Moore.

Ms Moore: 'When ​​​​people sit together
they eat and drink more.’

‘We’ve put dining tables in the bays and we have found that when people sit there together they eat and drink more. It’s a social time, and people feel less isolated – it has great benefits for them, and we’ve had good feedback from patients and relatives.’

SWFT is one of around 60 trusts or hospital settings that have signed up to a programme called Food for Life Served Here, a framework and award scheme designed to help hospitals ensure that food for patients, staff and visitors is ethical, sustainable and fresh, and meets nutritional guidelines.

The programme was developed by the Soil Association, a charity that campaigns on issues such as intensive farming, buying local and public education on nutrition.

It is one of several schemes offered by the charity to support initiatives such as the latest NHS England briefing on healthy food for staff and visitors, and the development of a food and drink strategy.

‘Nurses have an important role to play in being champions of good food’

Susannah McWilliam, hospital programme manager, Food For Life 

According to Food for Life’s hospital programme manager Susannah McWilliam, the scheme makes a difference not just to patients, but to staff as well.

‘It’s often said that food is medicine, but it’s also true that food is care,’ she says. ‘Nurses have an important role to play in being champions of good food. Mealtimes shouldn’t only be the highlight of the day – they are an opportunity to get to know patients and their likes and dislikes. Nurses are on the front line of this.’

Nutrition at the heart of care

One of the most important aspects of the Food for Life Served Here programme is bringing together people from a variety of disciplines, including nursing, catering, dietetics, sustainability, patient experience, and sometimes public health and clinical commissioning groups.

‘NHS trusts are enormous organisations, but whose “business” is food?’ Ms McWilliam asks. ‘It should be at the very heart of care. Nutrition should be embedded. It should demonstrate the values of the NHS organisation to patients and to staff.’

Hospitals are at different starting points but all should be on a journey of improvement, she says. ‘There are some pockets of fantastic good practice, but there are also gaps that we feel the programme can help to support, for example as a focus to bring the multidisciplinary approach together, and to help join the dots between what different parts of an organisation are doing, such as nursing and catering staff.’

She accepts that not all trusts will be able to cook everything fresh, from scratch on-site, but says they can all support and celebrate local companies and suppliers. They can also take small steps where possible.

‘Even trusts with small kitchens are very successful at making their own soup on-site’

Susannah McWilliam

‘NHS trusts can be huge beasts, but they can also be anchor organisations – an important part of the local community. Often they are the biggest employers locally, and they want to keep skills in the community.

‘Even trusts with small kitchens are very successful at making their own soup on-site – fresh, tasty and nutritionally dense, and very popular with patients.’

Some trusts that have signed up to Food for Life Served Here have decided to bring catering back in-house, she adds. ‘The feedback we have is that it gives them more flexibility to meet patients’ needs.’

The ‘good food’ schemes available

NHS organisations can access a number of Soil Association schemes to promote and celebrate good food and nutrition. These include:

  • The Food for Life Hospital Network, which gives member organisations the opportunity to receive policy briefings and share and hear good practice at seminars and conferences. Click here to find out more
  • Food for Life Served Here, an award scheme that ensures menus meet certain standards, for example, using free-range eggs, sustainable fish and food that can be traced back to suppliers. It encourages the use of locally sourced ethical ingredients and making healthy and sustainable eating easier for the consumer. For more on this and other support packages for hospitals, click here
  • A hospital good food award, which will promote a whole-hospital approach to supporting the health and well-being of patients, staff and visitors, is being developed by the Soil Association. It is looking for pioneer organisations who want to be part of re-imagining the role that hospitals can play in transforming food culture. To find out more email ffl@foodforlife.org.uk


Save by reducing food waste

Asked if the programme adds to costs, Ms McWilliam says: ‘All trusts have to account for every penny they spend, and have to be very careful with how they manage the budget. Some are making savings by using less but better quality meat, for example. Reducing food waste is also important – it’s an environmental and financial no-brainer, but it also makes sense from a nutritional perspective.’

She is working with East Lancashire Hospitals NHS Trust, something of a pioneer in using nutrition to tackle food waste, which she says is part of preventing malnutrition. In the pilot there is a focus on mealtimes and service, and understanding what people are eating and not eating.

‘Nurses are integral to this, and have a strong role and voice in ensuring patients get the best care,’ she says.

At Warwick Hospital the communal eating policy is one element in a much wider strategy to ensure that patients benefit from good nutrition and hydration.

Emergency division matron Ms Moore says the Malnutrition Universal Screening Tool (MUST) assessment is completed on all patients on admission to see what level of intervention is required, ranging from a watchful eye to food charts or a consultation with a dietitian.

Patients are weighed weekly and steps are put in place to ensure the good work continues when they return home, for example by alerting community staff, recommending high-calorie supplements or advising patients and their carers on ways to maintain weight – such as switching to full-fat milk and adding cream and cheese to recipes.

Blue plates and finger food are some of the adjustments made for people with dementia.

Using local suppliers

The trust has worked hard with its caterer to meet the requirements of the Food for Life programme, including using local suppliers where possible.

Although the food is not cooked from fresh on-site, it is seasonal and meets a variety of dietary and cultural requirements. It’s also imaginative – for example, during the Wimbledon tennis tournament patients are offered a scone with cream and strawberries.

Events planned for national nutrition and hydration week, 11-17 March, include tea parties. ‘The patients love the tea parties – there’s bunting, music and dancing, and of course there’s cake,’ she says. ‘This year there are plans for a Bake-Off style competition at our rehabilitation hospital in Leamington.’

‘‘We call it tea for two – it gives staff permission to take a break from task-oriented care and sit down with a patient’

Rebecca Moore, emergency division matron, South Warwickshire NHS Foundation Trust

Nutrition policies such as communal dining go hand in hand with an initiative to encourage patients to get up and get dressed rather than staying in bed. South Warwickshire was one of the trusts to take part in the England-wide End PJ Paralysis pilot, which started in April 2018.

‘We kept it going and now it’s business as usual for us,’ says Ms Moore. ‘Rather than sitting in a hospital nightie, the patients get up and dressed and move around. It prepares them for going home, and we’ve noticed a reduction in length of stay since we started it.’

Other moves at the trust include a volunteer programme to bring in specially trained individuals to support those who need help to eat and who can take an hour or more to finish a meal.

Nurses are encouraged to take time out to have a cup of tea and a chat with a patient who isn’t expecting visitors. ‘We call it tea for two – it gives staff permission to take a break from task-oriented care and sit down with a patient and have a cup of tea together.’

Needs and tastes are paramount

Families are also encouraged to bring their own lunch or supper and join their relative at the dining table. ‘We find that patients eat and drink more when this happens,’ says Ms Moore.

Patients are also offered snacks and drinks throughout the day, based around their needs and tastes. For example, people with dementia might be offered finger food on a blue plate, which this patient group find easier to cope with than the regulation white plates.

Happily, Ms Moore can personally vouch for the quality of the food served at the trust. ‘We’re involved in all the tasting when the menu changes seasonally,’ she says. ‘I go for the puddings. And fish and chips on Fridays are really popular.

‘I’ve never had a bad meal here, and if there is a problem with anything it’s removed from the menu. We see food as an important part of care – it’s part of what we do here.’

Jennifer Trueland is a health journalist

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