Professor David Foskett
Some of the significant challenges facing NHS catering teams throughout the UK – from staff welfare, recruitment, patient nutrition, sustainability and food safety – were explored at the HCA’s 2024 forum.
Professor David Foskett, former head of hospitality and tourism at the University of West London, challenged the sector to see itself differently.
“The term catering always sounds quite demeaning to me. You are specialist professionals working in the public sector and the word hospitality means looking after your guest, which I think properly describes what you do in hospital where you work with the medics as a team to deliver a good guest experience.
“Hospitality describes the profile of your profession. We tell students that working to feed people in hospitals is a specialist profession where you work with the medical team – and remember that food is medicine. Hospitality means making people feel comfortable, relaxed and secure. A patient is not a number and it’s absolutely imperative to build a humane culture of hospitality in a hospital.
“We don’t sell this well enough to our students. It’s very much about the human touch. The Last Nine Yards is the most important part of the hospitality experience. And the people who deliver this service need to be valued more. Hospitality is not what comes to mind for catering students when they think about hospitals, they think of doctors and nurses because they don’t understand the importance of hospitality.
“I would like to see people from your sector becoming Hospital Ambassadors, who promote careers in their local colleges. I think you should be bidding for money to create these ambassadors to promote the sector. The message has to be communicated and promoted.
“Let’s talk the sector up. We clapped for the NHS during pandemic lockdown, we need to continue to clap for all the teams working in the sector and not forget the vital role you continue to play. Youngsters today want a better work-life balance and they are very conscious of benefits like pensions, and the public sector has appeal in that regard.”
Four nations debate
Each of the four nations in the UK was represented in a panel discussion that was moderated by forum facilitator Rachel McTavish and focused on procurement.
The representatives were Lorraine Hartley from NHS Scotland, Phil Shelley from NHS England, Rodney Smyth, a senior procurement manager in Northern Ireland, and Romano Provini from NHS Wales.
They were asked if the Four Nations could benefit each other by working better together.
Phil said it was certainly worth trialling the idea with a couple of case studies from each nation to compare notes and see where ideas could be shared better.
Romano added: “We’ve all got contracts due for renewal in the future, if we can align them we could look to see if there’s an opportunity for collaboration.”
The panel was asked whether it was always the lowest price that won procurement contracts. Romano pointed out that the specifications for contracts are drawn up by catering colleagues. “We look at a whole range of the criteria, but price is looked at last of all.”
Another delegate asked how sustainability targets affected procurement. Lorraine responded: “It’s difficult to find products that meet all the criteria, but we have targets. Romano added: “We’re still learning and need to work with suppliers and use their expertise to help us.”
The panel was united in pointing out: “In procurement we’re enablers, not blockers. We’re there to support caterers and provide them with the products they need to deliver the service required by patients.”
Staff wellbeing
Dr Hans Hartung from NHS Ayrshire & Arran told delegates that wellbeing started with self-care.
“First pay attention to our own wellbeing or we can’t help others,” he said.
This meant giving ourselves time to nurture relationships with other people, spending time ‘in nature’, taking part in physical activity, sleeping well, and eating well with a diverse diet that avoided ultra-processed foods as much as possible.
“Staff wellbeing is a big problem, but it can be tackled with simple, small measures: a smile, sharing a coffee together. And don’t let the drive for efficiency get in the way because these little things actually enhance productivity.”
He said research showed that £99bn is lost every year in the UK as a result of poor staff wellbeing, poor morale, and lack of support for staff.
“Every £1 spent on staff wellbeing returns £5 in productivity suggests research, so there is a good business case for it. Every system is perfectly designed to achieve the results it gets,” he said, urging people to challenge how they saw things and look to change systems.
“Take organisational change such as the four-day working week. Research has shown that it can help people improve productivity, and that they feel happier.”
Delegates also heard from Gill Murphy, who runs the Food Safety Pause programme for the Northern Health and Social Care Trust in Northern Ireland.
“Mistakes are easily made under pressure, and in response to a number of incidents we decided to develop a pause when serving food to frail, elderly people at risk – as a result of either dysphagia or allergens.
Multi-disciplinary Food & Drink Safety Groups looked at near-miss incidents as well as incidents where harm was caused.
“As a result we developed the Pause. Using this teams stop before serving or feeding anyone to consider four key areas: is the person you’re serving ready for the food and drink; are there any people on the care list who have dysphagic needs; does the person have food allergens; is the person at risk of malnutrition and/or dehydration that mean a check on any food left after they have finished.
“It requires teamwork between the catering and clinical teams, accessible information that is easily available, and the Pause must be explicit.”
Mhairi Gougeon MSP
MSP and Cabinet Secretary for Rural Affairs, Land Reform & Islands, Mairi Gougeon attended the forum to address delegates about Scotland’s Good Food Nations Plan.
She said: “It’s a way of making national and local policy align – and it emphasises the importance of the work you do.”
There was a framework to deliver the plan, she said, with the first proposals out for consultation. Of the Plan’s six outcomes, she focused on three: providing safe food; a sustainable food system; encouragement to adopt a healthy diet.
Understanding better nutrition
“Everyone knows the importance of eating well. There is lots of information out there, and many people understand what healthy eating looks like, but despite this we’re still not choosing to eat healthily,” says Jenna Mosimann, a co-founder of Raising Nutrition.
“Diet-related ill health is increasing, millions are spent advertising food low in nutrients, and most people in the UK still don’t meet Eatwell Guide recommendations. The cost of such ill health put at about £100bn a year.”
So what drives dietary behaviour? She says it is a mix of experiences, social factors, environmental factors, biological factors, and psychological factors. Many decisions are not even made consciously.
“Eating is an emotional experience, but also a way to express social identity. However, the appeal to emotions and nudges used to sell unhealthy foods can also be used to promote healthier choices.”
She offered six ideas to help caterers use such nudges to promote healthier eating habits:
• Framing – describe food linked to healthy choices by using positive descriptors
• Salience – catch people’s attention by using brighter images, or boxing menu items to make them more prominent
• Default bias – give people an easy choice like meal of the day, but make it the healthy option
• Product placement – follow the retail maxim ‘eye level is buy level’ in food display
• Food Choice Architecture – use combinations of these ideas together
Her co-founder David Titman added: “An individual’s needs, especially in hospital, are paramount. We choose food based on rewards, whether it’s tasty, on risk, for example we know we like it, and on resources, whether it’s cheap or convenient. So we need to understand what rewards people get, and how to minimise risk and resources.”
He said adopting the five Aspects Meal Model offered a template to help caterers. It includes taking into account not only the food but the wider eating environment, interactions with other people such as servers and chefs, the colour and design of crockery and cutlery, as well as background noise, lighting, and how the food is served.
“Having models and frameworks creates consistency and you need the structure to deliver this,” he said.