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					Patient and Public Involvement North Cumbria Acute Hospitals PPI Forum Forum

PATIENT CATERING SATISFACTION SURVEY

at North Cumbria Acute Hospitals NHS Trust

February 2007 Jean Clarkson (Lead) Christine Johnstone Stan Lightfoot

Support for North Cumbria Acute Hospitals PPI Forum is provided by Inhouse Forum Support Team - Cumbria CPPIH, c/o VAC, The Old Stables, Redhills, Penrith, Cumbria, CA11 0DT. Tel: 01768 899608 Email: ForumSupport.Inhouse104@cppih.org Fax: 01768 242134 Web: www.ncumbriapatientforums.org.uk

Contents
Patient and Public Involvement in Health Forums ................................................... 3 The Role of the Trust PPI Forum is to ....................................................................... 3 Background to the Project ......................................................................................... 3 Methodology ............................................................................................................... 3 Summary of Findings at Cumberland Infirmary ....................................................... 4 Summary of Findings at West Cumberland Hospital ............................................... 5 Conclusion of Findings.............................................................................................. 6 Recommendations ..................................................................................................... 7 Appendix I - Results of Findings at Cumberland Infirmary ..................................... 8 Appendix II - Results of Findings at West Cumberland Hospital .......................... 10

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Patient and Public Involvement in Health Forums
The Forums (PPI Forums) are part of the Department of Health’s overall strategy to improve patients’ experiences of health services. The Forums are statutory bodies, which mean they are set up by law and have certain duties and powers. The Trust Forums are independent of the NHS but work closely with service users to represent the public’s and patients’ views.

The Role of the Trust PPI Forum is to
  


Monitor and review the services provided by the Trust. Get the views of patients, users and carers about those services. Make reports and recommendations to the Trust about those services, based on the views of the patients and the public. Work with other Forums on areas where they have a shared interest.

Background to the Project
The Forum had received several negative comments regarding the quality of food served at the Cumberland Infirmary, in contrast to the glowing reports of the quality of food being served to patients at the West Cumberland Hospital. Therefore the forum members elected a visiting team to undertake a patient satisfaction survey to compare the quality of food across both sites. The main objective of this project is to ensure, across both sites, the same quality standards of food are served to patients.

Methodology
The members devised a survey to aid the visiting team in their audit of both sites. The team conducted a pre-visit evaluation of the preparation of meals, both for the public canteen and wards. This was to compare the different methods used at both sites (e.g. meals made fresh from locally sourced ingredients in-house at West Cumberland Hospital, Whitehaven and also supplied by Anglia Crown at Cumberland Infirmary, Carlisle). A random sample of patients, of equal numbers, was surveyed on both sites by asking a variety of pre determined questions on the quality and service provided by the Catering Department, for patient meals.

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Summary of Findings at Cumberland Infirmary
We met with Charles Sydney, Interserve Catering Manager, who explained the process of food purchase and preparation prior to being served to patients. Interserve has a contract with Anglia Crown (one of the three major NHS approved suppliers) in Manchester who supplies all the food to the Cumberland Infirmary. This contract is 3 month concurrent and, although Interserve frequently looks elsewhere for suppliers, Anglia Crown has been supplying food to the hospital for 6 years. In addition to this main contract, several smaller contracts are held which supply specialist meals, e.g. Kosher, Halal and liquidised. Menus are given to patients, by the nursing staff, to indicate their choice of meal for the following day. This information is collated by the nursing staff and entered on a Menu Return Sheet which is then forwarded to the Catering Department for action. It should be noted that the Catering Department do not always get the menu requests for the following day from the wards and this, therefore, creates inconsistencies. The Catering Department complete a stock control on a Friday and submit a ‘top-up’ order to Anglia Crown to supply meals for the following week. The cook/chill meals delivered by Anglia Crown have a shelf life of 5 days. However, Interserve has a freezer room where 3 to 4 days supply of food for the hospital is held. Puréed meals are served to those patients who have difficulty swallowing. However, ‘Clinturen’ smooth food (this is a powdered food which is mixed with water) is served to these patients on Christmas Day, Boxing Day and New Year’s Day when puréed meals are not available. Patient feedback is taken into consideration when changes to menus are made. These changes to menus are made annually. At this hospital there are no snack boxes available on the wards but food can be requested from the Catering Department out of hours. On average, approximately 1620 meals for patients are provided each day. Meals arrive cooked and chilled and are plated and regenerated in trolleys connected to docking bays at the Cumberland Infirmary. The trolley temperature can be maintained for 45 minutes. These trolleys are taken off their docking station 15 minutes before the relevant meal time and taken to the ward. Therefore, when the trolley arrives on the ward, food should be kept at the correct temperature for 30 minutes thus allowing food to be served acceptable to the palate. Patient satisfaction of the meals offered and served and their comments can be found in Appendix I.

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Summary of Findings at West Cumberland Hospital
We met with Gordon Ashley, Catering Manager at West Cumberland Hospital, who explained the process of food purchase, preparation and storage. West Cumberland Hospital sources their produce locally. All meals are prepared in their own kitchens. We were taken around these kitchens where it was explained – and shown to us - the preparation, cooking, fast freezing and storage of meals. There is, at any one time, approximately 100,000 meals in freezer storage thus, in case of an emergency, food will be available. Two thirds of the meals are prepared three days in advance and are blast frozen. This avoids expensive shift working and is very cost effective. Menus are given to patients, by the nursing staff, to indicate their choice of meal for the following day. These menu requests are collected by the nursing staff and forwarded to the Catering Department for action. It should be noted that the Catering Department do not always get the menu requests for the following day from the wards and this, therefore, creates inconsistencies. Meals are served to patients from hot lock trolleys. A separate children’s menu is available. Puréed meals are served to those patients who have difficulty swallowing. The Catering Department have developed a range of puréed meals which look extremely appetizing. Various foods are puréed, to which a gelling agent (or similar) is added, this is then placed in a mould the shape of the original vegetable or meat and left to set. The food does not lose its shape, colour or taste on reheating. There is also a range of puréed fruit dishes available, again using the same method and setting it in a mould the same shape as the fruit. These meals have a ‘mousse like’ consistency. Patient feedback is taken into consideration when changes to menus are made and new meals are constantly being developed. Snack boxes are available for people who may have been admitted late in the day. A supply of these boxes is held on Patterdale ward (the admissions ward) from where other wards may request as necessary. Each box contains sandwiches, a piece of fruit, fruit juice, biscuits and yoghurt. On average, approximately 1500 meals for patients are provided each day. In addition, this Catering Department supplies Workington, Maryport, Cockermouth and Millom Community Hospitals. Frozen meals are transported weekly to each community hospital with vegetables being prepared fresh for each meal on the relevant site. Patient satisfaction of the meals offered and served and their comments can be found in Appendix II.

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Conclusion of Findings
Return of Menus More emphasis on the reason for returning the menu sheets to the Catering Department needs to be transmitted to the ward staff. Patient Feedback Ward staff need to be more aware of the significance of patient feedback questionnaires being completed and returned to the Catering Department, as this information reflects on patients and their satisfaction of catering services. It is appreciated that the ward staff are very busy and do not have the time to carry out these requests from the Catering Department. Therefore, to assist the Catering Department, would it be possible for help to be seconded from, say, the Patient Panel members? Temperature Control There is no way of monitoring the adherence of catering staff to the rules, e.g. closing the doors of the trolley when taking a meal to a patient; leaving a door open will reduce the temperature of the food inside the trolley. Patients are given a choice of the meals on the trolley. This sounds ideal, in that the patient is getting what he/she would like, but it is not following the menu request – if one has been completed. This procedure could result in a patient not getting what he/she would prefer.

General Comparing Both Sites
Overall, patients were very pleased with the food served at the West Cumberland Hospital, with no complaints at all recorded by the visiting team. At the Cumberland Infirmary it was generally felt that there was room for improvement. West Cumberland Hospital has the facilities to provide cook/chill meals for the CIC, ensuring produce is sourced locally, thereby helping the local economy. A viability study needs to be undertaken to assess West Cumberland Hospital providing the food to the Cumberland Infirmary as opposed to Anglia Crown. Should West Cumberland Hospital provide the food to Cumberland Infirmary, this would result in reducing environmental pollution created by cross country transportation of meals.

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Recommendations
1. A regular food tasting panel should be initiated to monitor the quality of food on both sites. This could be undertaken by members of staff together with Patient Forum members and/or service users. 2. Snack boxes to be widely promoted at West Cumberland Hospital. Snack boxes to be introduced at the Cumberland Infirmary and, again, widely promoted. 3. A procedure needs to be developed, on both sites, to obtain the requirements of patients’ catering needs, e.g. menus explained and patient satisfaction surveys completed. This could be cost-effective in that the catering department would be aware of the exact requirements of the patients on the ward thus reducing waste. 4. West Cumberland Hospital and Cumberland Infirmary conduct a viability study into providing meals from West Cumberland Hospital to both sites, including detailed financial costings and comparison to the current contract with Anglia Crown. 5. Cumberland Infirmary to adopt the pureed food presently prepared and provided at West Cumberland Hospital.

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Appendix I - Results of Findings at Cumberland Infirmary
Days in hospital at the time of the survey ranged from 2 days to 5 weeks.

Menus and Choice: Was the menu easy to understand? Did you get a choice of meals in advance? Did staff offer to explain the menu and help? Were you offered the kind of meals you like? Was there enough choice for: Breakfast Midday Evening Was there enough choice to suit religious beliefs? Was there enough vegetarian/vegan choice? If you follow a special diet, was there enough choice? Was food brought in for you from family/friends? Meal Time Housekeeping: Were you made comfortable before a meal? Were you given a chance to freshen up before the meal? Were the meal times suitable? Did you have enough time to eat your meal? Were staff serving meals friendly and helpful? If you needed help with eating, was it available?

Yes% No% 88 94 94 82 6 0 0 6

N/A% 6 6 6 12

72 94 94 67 28 39 17

22 6 6 27 6 6 77

6 0 0 6 66 55 6

83 83 88 88 83 0

0 0 0 0 0 0

17 17 12 12 17 100

Meals and Drinks: Did the meals look appetising? Were the hot meals hot? Were the cold meals cold? Did you always get the meal you ordered? 78 83 55 78 0 0 0 0 22 17 45 22

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Could you get a snack when you wanted? Are hot/cold drinks available between meals? If you missed a meal was a replacement offered? Were you given enough to eat?

6 88 33 83

0 0 0 6

94 12 67 11

Have you not been able to eat a meal because of look, smell or taste? 12 72 General Comments:

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The menus were difficult for older people to understand with the food being too ‘fancy’ at times, e.g. pasta dishes. Many patients said they had never seen a menu. The staff are too busy to explain the menus. More choice at breakfast would be appreciated particularly when a long stay patient. Low Residue Diet – not getting enough protein and vitamins and not suitable for diabetics. Protein content for vegetarians is lacking.

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Appendix II - Results of Findings at West Cumberland Hospital
Days in hospital at the time of the survey ranged from 1 day to 6 weeks. Menus and Choice: Was the menu easy to understand? Did you get a choice of meals in advance? Did staff offer to explain the menu and help? Were you offered the kind of meals you like? Was there enough choice for: Breakfast Midday Evening Was there enough choice to suit religious beliefs? Was there enough vegetarian/vegan choice? If you follow a special diet, was there enough choice? Was food brought in for you from family/friends? Meal Time Housekeeping: Were you made comfortable before a meal? Were you given a chance to freshen up before the meal? Were the meal times suitable? Did you have enough time to eat your meal? Were staff serving meals friendly and helpful? If you needed help with eating, was it available? Meals and Drinks: Did the meals look appetising? Were the hot meals hot? Were the cold meals cold? Did you always get the meal you ordered? 100 94 65 71 0 6 0 0 0 0 35 29 88 100 100 100 94 0 0 0 0 0 0 0 12 0 0 0 6 100 Yes% No% 53 53 70 82 6 12 24 0 N/A% 41 35 6 18

100 94 94 41 41 53 29

0 0 0 0 0 0 59

0 6 6 59 59 47 12

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Could you get a snack when you wanted? Are hot/cold drinks available between meals? If you missed a meal was a replacement offered? Were you given enough to eat?

29 94 53 94

18 0 0 0

53 6 47 6

Have you not been able to eat a meal because of look, smell or taste? 12 88 General Comments:

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Many patients said they had never seen a menu. The staff are too busy to explain the menus. Patients are offered a choice from the trolley and the choice is very good. Occasionally fruit is brought in by family/friends. Patients are not aware of snack boxes and these needs to be promoted.

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