Helen Ream 3 The Review Began Event to launch the review in November 2016 Members worked in groups to review chapters Comments included document too long content is repetitive in places ID: 1048216
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2. WelcomeDebbie Sutton2
3. Session 1Helen Ream3
4. The Review Began……… Event to launch the review in November 2016 Members worked in groups to review chapters Comments included: document too long content is repetitive in places reference updates to capture new information required 4
5. The Digest Review Group….A group was formed including:Chapter leads with support personContent reviewersCritical readersStakeholders Home Countries Designers 5
6. The ProcessChapter leads led the review of their chapter Chapters reviewed at meetings to identify changes and discuss pertinent points Full copy put together in August and sent to stakeholdersFormatting and amendments process Launch event planned 6
7. Discussion Points Included…The structure and format of the documentHow much information to include Provision of new chapter on staff and visitor cateringFormat and content of therapeutic diet chapterEnergy targetsHealthier eating coding criteria 7
8. The New FormatLonger in page numbers but not content!Easier to read Easier to navigateFollows BDA branding Use as online document but can be printed and held locally if required 8
9. What Next...?Launched on BDA Website,Working with our stakeholders to promote and share the 2nd editionUpdate the checklist to demonstrate compliance with Hospital Food Standards9
10. Thank You10
11. Session 2 – Chapters 1 to 4Angela TellaKatherine CrossfieldLisa BakerRebecca Deeley11
12. Chapter OverviewInternational, national and local influences impact on food and beverage services.Summary of relevant documents providing guidance and legislation for catering in care settings. Key messages: Application of these policies needs to be relevant.Focus is on appropriate food and beverage provision for the end user. A multi-disciplinary approach is important.
13. National
14. England14
15. Wales
16. Scotland
17. Overview of Chapter 2- Nutrition, Hydration, Eating and DrinkingThis chapter discusses the importance of ensuring adequate nutrition and hydration for our patients. It focuses on;The importance of screening for malnutritionFactors that increase the risk of malnutritionThe effects of malnutritionFood fortificationThe importance of adequate hydration17
18. What’s new in Chapter 2- Nutrition, Hydration, Eating and Drinking?Movement of some information to other chaptersConsideration of overweight/ obese patientsAddition of the ‘Malnutrition Carousel’ from BAPENMore emphasis on the importance of all fluidsUpdate of appropriate references18
19. Catering for Staff and Visitors in the NHS Health & Wellbeing has become an increasing priority within the NHS since 2012New chapter dedicated to this topic within the 2nd edition 19
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21. Key topic areas: Health & Wellbeing within the NHSHospital Food StandardsForms part of every NHS Standard Contract Standards 4 and 5 relate specifically to staff and visitorsStandard 4 – Healthier and More Sustainable Catering for Staff and Visitors: Nutrition Principles (Public Health England, 2017)Standard 5 - Government Buying Standards for Food and Catering Services (DEFRA, 2014)21
22. Key topic areas: Health & Wellbeing within the NHSCommissioning for Quality and Innovation (CQUIN)2016/2017 CQUIN Healthier alternatives are available 24 hours a dayHFSS foods are not sold near till points, are not price promoted and are not advertised 2017/2018 & 2018/2019 CQUINRetain the requirements of the 16/17 CQUIN Plus ensure that (by year two): 90% of drinks lines stocked are not sugar sweetened80% of confectionary contains <250kcal75% of sandwiches and salads are ≤400kcal and ≤5g saturated fat 22
23. Key topic areas: Health & Wellbeing within the NHS3. Reduction of Sugar Sweetened Beverages (SSB)Voluntary targets brought in by NHS England to reduce the amount of SSB sold within NHS premises April 2017 saw the announcement of a scheme where by sales of SSB would be expected to reduce to 10% of total drink sales by March 2018Non-compliance may result in an out-right ban on NHS premises being considered23
24. Other Areas Covered Health & Wellbeing in Scotland, Wales and Northern Ireland Health & Wellbeing for PatientsThe Role of the Registered Dietitian 24
25. Dietitian’s role within catering To identify strengths and weaknesses in a food provision chainDevelopment of policies and proceduresMenu and service planning To act as a dietetic – catering link, improving communication and insight. To improve the understanding of food and beverage service by the rest of the dietetic team. HCPC standards of proficiency and conduct (2013), performance and ethics (2016) also help to support and clarify the role of dietitians working within the provision of food and beverage services. RecommendationA dedicated catering liaison dietitian for every department to lead developments and act as the main interface between catering and clinical services.25
26. Working in Partnership The catering dietitian can help to bridge the gap between nursing, estates, catering, suppliers and therapy departments. Relationship with contractors/suppliers Dietitians employed by commercial food suppliers and catering contractors should work with the dietitians in health and care settings to ensure the needs and preferences of all patient groups are met. Health and well being It is important that dedicated time is given to assist with the role of any health and well being strategies within the NHS, these may relate to staff and visitor dining or patients. 26
27. Training Catering dietitians should help to ensure that all staff involved in the food chain have access to relevant training to help provide a patient centred food service that promotes nutritional care. Topics may include: Basic nutritionAllergensSpecial dietsFood hygiene and safety Portion controlFood presentation27
28. Dietitian’s role within service provisionPatient informationDietitians should help to develop user friendly and patient centred information using a variety of formats e.g. written and pictorial menus, guidance regarding appropriate food choice. Managing the eating environmentThe multi disciplinary team involved within catering should work with ward teams to achieve the best possible eating experience for the patients. Promoting the importance of the physical environment, appropriate equipment and staff behaviour. 28
29. Dietitian’s role within service provision Managing the therapeutic dietsThe dietitians should work with caterers to help ensure that therapeutic diets meet the requirements of clinical treatment, nutritional standards, patient preferences and are appetising for the patient. Systems such as diet manuals should also be in place to help provide recommendations on how to meet the needs for therapeutic diets when there is no dietitian available to give advice. Monitoring and auditTo support the development of appropriate performance indicators within food and beverage services and nutritional care. 29
30. Thank You30
31. Session 3 – Chapters 5 and 6Andy JonesPhil Shelley31
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33. Food Service Delivery and PlanningWorking Together - The Power of 3 Protected Mealtimes: Provision of a Patient-focused Meal ServiceFood Service Systems Control of Food Service Delivery Food Waste Food Hygiene and Safety33
34. “It is essential that dietitians take a pro-active role jointly with catering and clinical colleagues, to ensure that acceptable standards for food and beverage services are not put at risk and that the budget is adequate to provide the nutritional needs of the individual.”34
35. Catering Specifications and ContractsBarriers to Good Practice Catering Specifications Catering Contracts 35
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37. Thank You37
38. Session 4 – Chapters 7 and 8Lauren BowenMaxine Cartz38
39. Food Composition, Labelling and Recipe Analysis - OverviewNutritional ContentFood Labelling LegislationAllergen and Nutrition InformationNutritional AnalysisRecipe Analysis and software39
40. Nutritional Content – Key HighlightsEmphasis on food costs – menus should provide good nutritional ‘value for money’Procurement – Mandatory particulars (product specifications)Packaging – PLACE requirements40
41. Food Labelling Legislation – Key HighlightsEU FIC UpdatedAllergen Information Nutrition Information – Mandatory Nutrients, Supplementary Nutrients41
42. Nutritional Analysis – Key HighlightsChemical AnalysisTolerances and Rounding – IncludedCalculated Analysis – CoFIDS and MW742
43. Recipe Analysis and Software – Key HighlightsRecipe Analysis – Requirements and considerations to complete recipe analysisRecipe Types and example analysisSoftware - Updated43
44. Menu Design and ContentAmalgamated chapters 6 and 7 - menu design structure and planning and menu contentEmphasis on getting the right menu and service Updated to include the Eat Well GuideMenu assessment checklist included in appendixBasic vitamin and mineral descriptions44
45. Thank You45
46. Lunch Break46
47. Session 5 – Chapters 9 and 10Saachi PatelSadaf Saied47
48. Nutritional Standards: Day Parts Approach Nutritional TargetsNutritionally Well – energy targets based on EARs for Energy from the DRVs for Energy (SACN, 2011)Nutritionally Vulnerable – protein targets based on PENG recommendations – 1.1 g / kg body weight Menu CapacityComplete meal = starter + main + dessertMinimum energy = 500 kcals 48
49. Nutritional Standards: Day Parts Approach Day Parts ModelUsed to demonstrate the menus capacity in meeting targetsDivides the day into meal partsBreakfast + Snacks + Beverages = 40% intakeMidday & Evening Meal = 30% each (60% total)49Complete Meal Targets (Starter + Main + Dessert)for midday and evening mealsNutritionally WellNutritionally VulnerableEnergy500800Protein1525
50. Analysing Menu Capacity What does it contain? What's changed?Worked Examples – Cycle and A la Carte Table 10.1-10.6Standard / Lighter Choice and VegetarianA worked examplePracticalities and Pitfalls50
51. Worked Example À la Carte Menu51
52. Where to start ?Setup a template matching your menu cycle & structureInsert Values 52WellVulnerableBreakfast400 kcal / 10g Protein545 kcal / 15g ProteinBeverages184 kcal / 14g Protein264 kcal / 13g ProteinSnacks150 kcal /2 Protein300 kcal / 4g Protein Minimum MaximumLunch Use your own based on the menuSupperFixed 40% Variable 60%
53. Scan the menu for min and max choices 53
54. The calculations!54473 kcal 24.4 g protein 618 kcal 33.5 g protein 1198 kcal 32.5 g protein1303 kcal 44 g protein 361018252718
55. Practicalities and PitfallsMenus Analysis as Evidence – Balanced - DiverseHow many days to analyse?Therapeutic , Dysphagia & Ethnic MenusPlain choice Meals?What about Micronutrients? 55
56. Thank You56
57. Session 6 – Chapter 11Lorraine HoldenRuth Smith57
58. What is Included?DietsPatient Groups Menu Coding58
59. What has changed?Combined previous chapters 9 and 10Introduced a new table formatUpdated healthier eating coding criteriaEnhanced religious diets and vegan infoUpdated all therapeutic diets infoUpdated renal coding criteria59
60. Now Includes…Enhanced food allergy and finger food infoEnhanced children's sectionNew low FODMAP sectionNew critical illness sectionNew dementia/cognitive impairment section60
61. ContentChapter is split into five sections61Type of dietDescription1.Standard DietsMajority of the population2.Religious, Cultural, Personal and Lifestyle ConsiderationsCultural or religious including vegan3.Therapeutic DietsSpecific dietetic requirements4. Specific Patient GroupsPopulations with specific requirements5. Test or Investigation DietsTemporary Diets
62. Standard DietsHealthier eatingHigher energySofter choicesVegetarian62
63. Healthier EatingUpdated criteria – targets for breakdown of a main meal and a main courseCompatible with both cycle or a la carte menusMore evidence based63
64. Table 11.2 Healthier Eating Main Meal BreakdownTable 11.3 Healthier Eating Main Course Breakdown64Fat (g)Sat Fat (g)Sugars (g)Salt (g)Starters5.31.7n/a0.3Main courses165n/a1.5Desserts5.31.718n/aTotal26.68.4181.8Fat (g)Sat Fat (g)Sugars (g)Salt (g)Entrée165n/a1.5Starchno addedn/an/ano addedVegno addedn/an/ano added
65. Religious and Cultural DietsHalalKosherAsian VegetarianVegan65
66. Therapeutic DietsModified textureFinger foodsRenal suitableLiver (decompensated)Food allergyGluten freeLow FODMAP (new)Neutropenic66
67. Renal SuitableUpdated criteria – more comprehensive nutritional targets for the breakdown of a main meal as well as a main courseCompatible with both cycle or a la carte menusMore evidence based67
68. Table 11.5 Recommended parameters for renal mealsTable 11.6 Potassium Main Meal Breakdown68Energy (kcals)Energy (kcals)Protein (g)Protein (g)Sodium (mmol)Potassium (mmol)Phosphate (mmol)MinAve (no max)MinAve (no max)MaxMaxMaxMain Meal3004001523282812Dessert10020024382Total4006001727313614Meal ElementMinimum Portion Size (g)Average Energy (kcals)Average Protein (g)Potassium (mmol)Entrée-20018<10Starch1151503<10Vegetables80502<8Dessert-2004<8Totaln/a6002736
69. Therapeutic DietsModified textureFinger foodsRenal suitableLiver (decompensated)Food allergyGluten freeLow FODMAP (new)Neutropenic69
70. Patient GroupsChildrenCritical illness (new)ObesityOlder peopleDementia/cognitive impairment (new)CancerMental Health70
71. Children‘nutritionally well’ and ‘nutritionally vulnerable’ menus must cater to bothMust ensure that all children and young people admitted to hospital:• have options available to allow them to eat a well-balanced diet of healthy food, as outlined by national guidelines• have available sufficient food of good quality to meet their nutritional requirements71
72. Table 11.9 Nutrient Provision Guidelines for ChildrenTable 11.10 Guidelines for Nutritionally Well Children (Main Meal)72BreakfastLunchSnacks & DrinksSupperEnergy % EAR20%30%20%30%Protein % RNI20%30%20%30%Salt % SACN20%30%20%30%GenderMixed (Ave)Mixed (Ave)Mixed (Ave)Mixed (Ave)Age4-6 years7-10 years11-14 years15-18 yearsEnergy (kcal)429528675675Fat (g)17212626Sat fat (g)5688Free sugars (g)5799Protein (g)691315Salt (g)0.91.51.81.8
73. Nutritionally Vulnerable ChildrenFor hospitalised children and young people, the relative proportions of the food groups in The Eatwell Guide may not be appropriate (as they may have a greater reliance on energy dense foods and snacks – high in fat and/or sugar)The focus of nutritional provision from hospital food should be on achievement of an adequate energy intake. An average day’s intake from breakfast, two main meals, two to three snacks and milk (or a suitable alternative), should meet the Estimated Average Requirement (EAR)73
74. Patient GroupsChildrenCritical illness (new)ObesityOlder peopleDementia/cognitive impairment (new)CancerMental Health74
75. AcknowledgementsThanks to all the specialist groups and organisations that provided information to update these key areas.Coeliac UK The Anaphylaxis CampaignAllergy UK Great Ormond Street HospitalRenal Nutrition Group Oncology GroupOlder Peoples Group Mental Health GroupVegan Society Obesity GroupGastro/Liver Group Food Services GroupCritical Care Group Hospital Kosher Meals Service75
76. Thank You76
77. Debbie SuttonQ&A77
78. AGM78