The power of a catering organisation like the Hospital Caterers Association (HCA) comes from the ability of its individual members to learn from each other, share good ideas and develop their skills as a result.
That’s what drives HCA chair Stewart McKenzie, who is now six months into his term of office, as he looks ahead to the challenges facing the association.
That, and an absolutely cast-iron commitment to put the patient at the heart of all the work hospital caterers do.
He spoke recently about how these two core beliefs colour his view of healthcare catering issues.
David Foad: What are the challenges for the HCA as a UK-wide association when its members operate under slightly different versions of the NHS?
Stewart McKenzie: It’s simple really: we’ve all got the same objective, which is good food for patients. We might operate to slightly different frameworks – for example, each of the four home nations has its own benchmarking for measuring in terms of reporting – but in reality there’s no great difference. In Scotland we work to the HealthyLiving Award, while in England we have CQUINs. For me, as chair, the important point is to get that level of consistency we need and always to look to good practice wherever our members happen to work. That means reinforcing the importance of the Power of Three [caterers, clinicians and dietitians collaborating] and the Last Nine Yards [ensuring the best-quality meal is actually delivered to the patient]. And that’s the same whether you are in England, Scotland, Wales or Northern Ireland. I want to see us sharing best practice, because if you can find that golden nugget it could come from any hospital and might work well in any other. That’s one of the real benefits of attending the annual training and development forum: the opportunity to share the good work that’s being done.
DF: What are you looking forward to at the 2018 Leadership and Development Forum?
SM: The concept of the Power of Three – caterers, clinicians and dietitians working closely together – is absolutely crucial to patient-centred care, and we are completely focused on that and the Last Nine Yards, the service delivery. They will be key issues at the forum, along with protecting food budgets. Food, as we all know, is one of the best forms of medicine and we must make sure we have that available to us. Other topics will include advice on giving our managers the tools to do their jobs properly, and training and developing your staff.
DF: How important is working together with others?
SM: The partnerships and collaborations the HCA has already formed make us collectively stronger and it’s important we strengthen these to take a more joined-up approach in order to have more influence on the political platform. Over the last few years we have sought greater collaboration between caterers, nurses and dietitians as part of our Power of Three campaign, in addition to working more closely with other public sector catering organisations and industry trade bodies. A multi-disciplinary approach is pivotal in ensuring a patient is at the heart of hospital services. It provides training to members to deliver a more inclusive patient-centred and safe catering service within the NHS, at the best possible price.
As chair I will continue to promote such collaboration because I believe it should overarch much of what we are aiming to promote as an association.
DF: What’s your focus during your time as chair of the HCA?
SM: Everything we do is about the patients in our care. I am passionate about patient services and doing the best we can for them. I believe in the ethos of the NHS, and the social values it has instilled in us. People who work in the NHS tend to do so because they care. I also want to see us building closer links with the other bodies, including those like the Institute of Hospitality (IoH), which we’ve not necessarily worked that closely with before. I also want to increase the bursary schemes available within the HCA to get more funding into those to help people train and get the qualifications they need to develop their careers.
DF: Tell us about the HCA’s role in the launch of the Level 2 Award in Professional Cookery in Health and Social Care?
SM: It’s a fantastic idea and it's been sadly missing for as long as I can remember. It will allow our chefs to get the acknowledgement and recognition for the work they do in healthcare. I’ll be talking to the IoH, who are nationally based and have connections with the training and accreditation bodies across all four nations. And I’ll be delivering an update on the progress we’ve made at the conference about developments across the four nations. The IoH is the recognised training and accreditation body for hospitality and catering, so it makes absolute sense to be associated with them. We need something like this because healthcare is not seen as the sexy side of catering, but it’s got some great opportunities. It’s rewarding in many ways – you know you’re there to aid people in their recovery, there’s a recognised career path, and it’s perfectly possible to move up to management level if you want to.
DF: The latest Estates Returns Information Collection (ERIC) data is due soon – what are you expecting?
SM: ERIC operates in England, while in Scotland we have a national benchmarking scheme that’s similar but operates under another name. It churns out trust figures on things like the cost per patient, cost per square metre, and food wastage. The different systems all do a potentially useful job, but the problems arise when people don’t report accurately or measure uniformly. Estates managers in Scotland have to generate reports much more regularly, though, so you're ahead of the game and can react more quickly; the fresher the information you have, the better chance you have to react to it. As a caterer I would also like to see the estates data linked much more closely to the PLACE (Patient-Led Assessments of the Care Environment) assessments so we can see how spending and cost are related to patient satisfaction.
DF: The CQUIN for food sold in hospital shops and cafes in England is moving to ban branding, on-pack promotions, BOGOFFs, and discounting of goods going out of date. How will this impact catering in hospitals, and tell us about how Scotland has already taken action on these issues?
SM: It depends on what the commercial agreement, return or rent is in any particular trust. If the result of any action is that the NHS gets less income then that will have an impact on us, but I think we can and should switch to a healthier offering and it need not hit our income.
Take the issue of selling high-sugar drinks through vending machines. Not so long ago every caterer said that banning their sale would affect their income. I’m not convinced it will be that significant because staff and visitors will choose those alternatives you provide. I think it’s right and proper that in healthcare environments you sell healthier, low-sugar drinks and snacks. The effects of working to earn the HealthyLiving Award are not generating any negative feedback or loss of income for catering operators. Under these guidelines you put bottled water in vending machines at eye level, with low-sugar drinks below that. Where you place the drinks is important in persuading people to accept the healthier options.
DF: More generally, hospitals face continuing huge cost pressures. What do your members tell you about this and how they manage?
SM: Everyone's under pressure, commodities are increasing in price and the move to negotiate Brexit is having an impact. It’s extremely challenging. At the HCA we have been encouraging trusts in England to come together in their own areas to create regional purchasing agreements. In time these could eventually be bundled together into national-level deals. The NHS in Scotland already has a central purchasing agreement, which I think is the right and proper way to operate. NHS Supply Chain is a very fragmented system, and frankly doesn’t make much sense. I think regional collaborations need to start coming into play. Don’t forget, the NHS is for the greater good of everyone. In Glasgow, for instance, I could buy bread cheaper, but that’s not fair on catering buyers in hospitals much further away from the city-based bakeries who would have to pay a transport premium without a national agreement. Some NHS trusts in England have got a bit greedy and started working for themselves, but we can work much more efficiently with combined, greater buying power.
Every authority is under pressure to save money and I don’t want to see food budgets eroded, so you need to do your buying and catering efficiently. To me, then, it all comes back to a question of delivering quality º that’s the best-value and most efficient way to deliver a catering service.
DF: Is it difficult to recruit enough qualified staff to work in hospital catering?
SM: My own experience is that we’ve not had huge challenges because those that come in often stay a long time. It offers people a career structure all the way up to management and there are rewarding aspects of the work, too, in seeing people getting fed, enjoying the food you’ve prepared and hopefully getting better. There has been a certain de-skilling of catering teams with the use of systems such as cook-freeze that have decreased the number of chefs. But there is a place and need for all sorts of cooking models in different situations, as long as we retain our focus on quality.
DF: If the Government relaxes the freeze on public sector pay, what will be the repercussions on your members?
SM: The challenge, of course, is will any pay increase be funded or not? Boards and trusts will have to fund efficiencies – effectively pay cuts because of inflation. At the moment there is no information on whether or not pay rises will be funded, although I don't think they will be. That will put extra pressure on boards and trusts that are already having to make huge savings. The NHS has been starved, but there are also huge financial pressures on it to modernise that, unfortunately, are not being met by investment. And it’s the same story with the National Living Wage.
DF: The Carter Report identified £5 billion in potential savings through efficiencies to be achieved by 2021. What will this mean for caterers?
SM: Something’s got to give.
DF: Will it help the HCA now it has Lord Hunt onboard as president?
SM: He’s fully committed to the agenda of patient-centred care, the Power of Three. Obviously, with him having been closely involved in the health sector for a number of years and still being an active politician gives us a chance to lobby for change and protect hospital catering.