Globally, around 1/3 of the waste produced for human consumption is wasted or lost. Across the EU, food waste is a key target in the Circular Economy package. However, a recent report from the European Court of Auditors states that progress to date in tackling the issue is “fragmented and intermittent”. In the UK, the Waste and Resources Action Programme (WRAP), which leads the steering group tasked with implementing the Food Waste Recycling Action Plan, notes that the estimated household food waste in the UK was around 7.3 million tonnes.
Drivers for change to improve food quality in the National Health Service
The National Health Service (NHS) has a challenge to deliver £22 billion in savings by the end of the financial year 2020/21 including £700m from improving procurement. For example, NHS Suppy Chain, the central organisation that manages procurement of goods and services for the NHS has been tasked with increasing its price transparency to lower costs and to reduce the number of products and suppliers used to deliver economies of scale. NHS Supply Chain has reportedly reduced its catalogue from 600,000 product lines to 315,000 to help NHS organisations purchase products more efficiently. It manages more than four million orders per year from over 120,000 order points, at 10,000 different locations.
Hospitals nationally serve 300 million meals to patients each year, spending £500 million on food annually across approximately 1,200 hospitals. Diet-related ill-health costs the NHS some £5.8 billion a year and the cost to the wider economy is expected to rise to £50 billion a year by 2050. With respect to staff, estimates from Public Health England put the cost to the NHS of staff absence due to poor health at £2.4 billion per year – accounting for around £1 in every £40 of the total budget. This figure is before the cost of agency staff to fill in gaps, as well as the cost of treatment, is taken into account.
The NHS provides a range of catering services from on-site cooking to bought-in/delivered meals, and from NHS-employed staff to contract caterers. There are a number of statutory catering standards in existence, including: CQC registration standards, NICE Quality standards, NICE Clinical Guidelines, ‘10 key characteristics of good nutrition care and hydration’ (NHS England), ‘Nutrition and Hydration Digest’ (The British Dietetic Association), ‘Malnutrition Universal Screening Tool or equivalent’ (BAPEN), Healthier and More Sustainable Catering – Nutrition Principles (Public Health England), the Government Buying Standard for Food & Catering, and the Balanced Scorecard developed by Defra. In addition, there is also WRAP’s Hospitality and Foodservice Agreement (HaFSA), which is a voluntary agreement to support the hospitality and food service sector in reducing waste and increasing recycling.
In April 2013, the Patient-led assessments of the care environment (PLACE) was introduced to assess the quality of the patient environment in healthcare facilities providing NHS care. PLACE replaced the old Patient Environment Action Team (PEAT) inspections, and works in conjunction with the Estates Return Information Collection (ERIC) to report on service performance and environmental quality. Amongst other factors, the Care and Quality Commission (CQC) rates NHS organisations on the basis of food quality.
In 2014, the Hospitals Food Standards Panel report recommended a set of food standards that should become routine practice across NHS Hospitals. In 2015, Simon Stevens, the CEO of the NHS announced a £5 million drive to improve and support the health and wellbeing of the organisation’s 1.3million health service staff. A key plank was serving healthier food, in addition to promoting physical activity, reducing stress, and providing health checks covering mental health and musculoskeletal problems – the two biggest causes of sickness absence across the NHS. With respect to food, the initiative aimed to facilitate national action by NHS England working with Public Health England and other agencies to challenge and support catering contractors and private finance initiative (PFI) providers to raise the standards of food and nutrition. There was also a push for NHS organisations to ensure that they were providing easily understandable nutritional information and appropriate portion sizes. This was meant to build on the Government Buying Standards to ensure a healthy and sustainable food and drink offer. Food and drink offered in vending machines were also supposed to meet existing nutritional standards, so that staff could have a choice of healthy options, including when working at evenings and weekends.
Hospitals receive a financial incentive for taking steps to improve the food served to patients, visitors and staff through the Commissioning for Quality and Innovation (CQUIN) payment framework.
According to ERIC returns for 2015/6, hospitals spent around £547,972,579 on some 138,456,482 inpatient meals, at an average of £10.75 for each inpatient per day. Therefore, the cost of food is ‘low’ (0.004% of the overall £116 billion budget for the NHS). However, there is significant variation across regions. Based on various reports, food wastage is on average around 10 – 20%. An article in the Observer newspaper, four years ago noted that hospitals waste around 82,000 meals each day. Interestingly, the Hospital Food Standards Panel’s report argues that over half of all the food provided in NHS hospitals is served to staff and visitors, and their needs are very different from those of patients.
Overcoming food wastage
The majority of the food waste in the health and social care sector is reported to be due to food that is either of a poor quality or unsuitable for those in a hospital environment. These issues exist despite the fact that over the years, as noted above there have been a number of initiatives and various celebrities have also been brought in to reduce food wastage in the NHS (e.g. journalist and broadcaster Loyd Grossman and celebrity chefs – Albert Roux, John Benson-Smith, Mark Hix, Anton Edelmann and Heston Blumenthal).
Quality and suitability therefore should be key areas of focus in reducing food waste, as recommended by a number of agencies, including the Hospital Food Standards report of 2014. Hospitals often operate what is called a “protected” mealtime system. This ensures nursing and catering staff are available to serve food and assist patients if necessary. Some wards have the facilities to provide snacks or lighter meals, or allow patients to bring in food and store it in the ward’s fridge.
Menus should be varied (in both types and portion sizes), healthy, nutritious, and locally sourced. There should also be good planning for meal times, including communication between procurement, catering, dietetics and waste management teams. Staff (particularly given the shift patterns and sometimes unsociable hours worked), should have access to a healthy range of options. In these ways, not only are the health and wellbeing needs of the patients, staff and visitors met, but also transport miles of moving food are reduced, and local economies supported.
Driven in part by patient feedback, hospitals are increasingly seeking to move away from the use of frozen food, to producing fresh dishes on a daily basis. For example, at Northampton General Hospital in the UK, over 90% of its meals are freshly prepared, compared with only 50%, some two years ago. Meats are also sourced from Farm Assured Farms, with Red Tractor accreditation. At the same time, the NHS organisation has also worked with its dietetics department to ensure that patients have a range of meals and that they are nutritionally balanced. The Royal Brompton Hospital hosts the UK’s largest heart and lung centre. Some 30% of the Royal Brompton Hospital’s food is locally or organically sourced. It has received national media coverage and royal recognition for its focus on nutrition and procurement approach.
Of course, despite all efforts, there will still be waste produced. Effectively managing this waste has to entail a partnership approach involving the health and social care sector, industry, regulators, and policy makers. Healthcare facilities should also look to put in place options for recovering value either through the use of onsite anaerobic digestion or through external contractors.
These issues will form the core of an upcoming discussion on October 5, at a one day conference on food waste management that is being organised by the Healthcare Waste and Resources Research Group, at the Northampton Town Football ground. The speakers are drawn from a range of sectors including the healthcare, retail, waste water treatment, hospitality and local authority. For more details click here
