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NHS Improvement Food Standards and Strategy Workshop

December 12th, 2018

Diversey Ltd, Weston Favell Centre, Northampton, NN3 8PD

Summary

Comments from workshop on raising the profile.

Contracts & Procurement

Concern standardising products because each trust has their own guidelines and procurement models.

There was a request for standard contracts to be compulsory, the suppliers will probably spend more effort creating products if they knew the whole of the NHS will buy them. 

Standardised templates for contract tendering?

Each Trust decided what it buys and who from so there is no consistency. Each tender for food service/retail has its own standards and it means moving goalposts which is more difficult for the suppliers.

Additionally, supply chain mentioned that wards also buy their own stock sometimes which adds more complication.

Also, a tender is often (especially if run by consultants) decided on a 70/30% basis cost versus quality.

There are many factors e.g. Supply chain is always talking about sustainability but there is no discussion about sustainability when another part of the NHS is talking about it

There is a cost to better quality and one part of the NHS says one thing while the other is looking for another thing. All parts of the NHS have different pinch points to achieve.

Why not have templates for tendering in the same way with the same score and consistency also efficient (always paying consultants).

Somebody needs to lead from the top and we should impose from central. It happened in schools even though they are not controlled centrally.

They were clear they want legislation or mandatory rules not guidelines (which no one follows if they don’t want to).

Government Buying Standards

Are GBS fit for purpose/do they need updating?

Changing operating context
Modern slavery
Simplifying – to be able to answer
Not familiar
Compliance periodic update
Assumed compliant never told not compliant
Principles good not well communicated not applied not communicated
Big initial communication but not well executed
Vending perspective key set of measurables that can report against
Outdated
Organisations going above and beyond
Still lack of knowledge and understanding

What is working well?
more awareness raised
Becoming easier for SME's platform safer food, better business
CQUINNs better uptake because of monetary incentives
Tick box

What is not working well?
Simplicity
Resource intensive
No follow up one simple question are you complaint?
Limited supply chain mapping
Where is the ownership/responsibility for auditing?
Patchy how hospitals adhere and apply standards
Too much room for interpretation
One off questions asked
Not specific enough example sustainably sourced sea food
Where does certification sit?
Too much room for misinterpretation
Minimum and maximum size for adults and children?
Too much or too little choice?
Further specification Minimum 60% meat content?
No one policy
Contract catering model standardisation
Asked lots of daft questions with little or no visibility of what or why or how the data is used
Just a tick box
Cost is the most significant implication
Bids very wordy
Difficult to always stick to best practice Not well understood by the end user
Tick box exercise
Does not drive any further conversation or engagement
Disjointed approach to implementation making it difficult
Message is lost/Communication
Government buying standards have defined material issues for NHS supply chain.

What are the material issues identified and what material issues are suppliers focusing on?
Card
Plastic
Packaging as a whole
Energy efficiency Carbon
Modern Slavery
Delivery ordering efficiency just in time
Social impact
Waste
Food Waste
Packaging
Connecting SME Opportunities for SME's
Packaging
David Attenborough piece on impact of plant based diet
Cup recycling
Costa backhauling but barrier is volume how do you get them back.

How are government buying standards enforced?
What is the enforcement mechanism?
Need one
When is the end date for this to be mandatory.
Could there be a financial benefit?
No follow up, no audit. Not easily auditable/Not enforced 

Do suppliers see government buying standards enforced/adopted?
Initial conversations but no further
It is in all contracts pre-requisite for any tender response
Assumption of compliance
Basic compliance.

Why are the government buying standards not widely implemented/adopted?
Not simple/easy to implement
Sometimes asked for quarterly & annual updates
Dependent on individual
Not one set of simple clear guidance with WHY answered
Suppliers see government buying standards implemented inconsistently.

There is no method of reporting against performance against government buying standards.
How are suppliers reporting performance? Done on a local basis as part of regular meeting with trust independently set criteria for reporting
Landlords barrier
Larger businesses have reporting frameworks that fit with their strategy
Sustainability report see bidfood
Soil association accreditation.
Could we develop standards to ensure compliance? League table
More and more communications.

Government buying standards are an entry level requirement some are going above and beyond.
Nottingham city hospital
Liverpool balanced score card attempt but missing KPI's
Sheffield
Craig from ISS

Sustainability

What is the overarching vision for sustainable food in the NHS? Aspiration not a vision to be more sustainable. How quantifiable is it? What are the targets?

What are the challenges to supplying more sustainable products to the NHS?
Concern of over complication of standards
Facilities management barriers from FM companies because separate short term contracts for food and waste
Problems of lack of budget
Waste contracts are well managed within hospitals
Race to the bottom price wise
Struggle to make social impact business case triple bottom line tenders not run in transparent manner
Net price
What is the definition of waste
Contractors sometimes targeted
Drivers are not coming from the NHS
Access to market
Accreditations
Sustainability not high up on the agenda not important enough to NHS
Not high on contractors agendas either
Lack of join up approach to manage waste streams
Lack of education of people on sites.
Same sustainability standards can be applied to all food settings

Products/Product ranges

Range rationalisation is a problem must have suitable and best products in that framework. They need detail in the tenders.
NHS Supply chain said prior to tendering they are running a WebEx. Then after there will be further WebEx’s for SMEs. Also, there is a procurement calendar on the NHS Supply chain website.

Suppliers want structure and clarity around what is required as lead time is important and every time a large supplier must list a new product they may have to un list others.

Development of standard tools and guidance (including menus, recipes, case studies and best practice) There is no common understanding of what good looks like.
No standard KPI's
No standard reporting framework
Could we develop standard mandatory KPI's?
Could we develop a reporting framework?
How are suppliers reporting performance?
Are current standards reflective of different healthcare settings?
It was noted that some companies have many similar products in different sizes due to differing demands and asked if we can mandate standard sizes.
Supply chain person said that they carry 70 different types of butter because Trusts can order what they want, their whole.

Nutrition/Standards

Felt there were too many suppliers and many far removed from patients, production and understanding of standards to be involved in this.

Suppliers wanted chapter to highlight food safety and allergens risk as well as HACCP. We as a group do not feel this is the right standards or area for this as it is about patient safety and not legislation, but we will add a small paragraph about ensuring systems comply with the law. (nutrition group) 

Comments on SOP

Will they align with CQUINN?
Suppliers raised there were too many chapters with a lot of overlap.

The suppliers can change the products but do not have confidence the trusts will follow the guidelines.
Many suppliers were asking if Food Standards will be mandatory.

Change needs to come from the NHS, we have to make them follow the standards.
Should be simple if a product is approved all hospitals should be buying that one
E.g. Easier in Scotland, CMO in Scotland sends letter to each health board and says you must do this.

NB: Cannot be mandatory easily because there are contracts in place that may span several years, it’s not easy to renegotiate a contract. So, may have to wait until some contracts have come to an end. This is in the public interest, but it is not going to happen tomorrow.

If you are putting together a fresh cook meal how can you guarantee it meets the SOP. It’s easier with chilled and frozen meals.

General feedback on the structure and format of the standards extract was positive. Participants said that it made sense to list standards by item and to include original sources.

Participants also praised the simplicity of the document, highlighting that this will likely lead to more compliance.

There is a need for more explicit definitions of important terms within the document, possibly in the form of a glossary. For example:

  • ‘Procured by volume’ this can refer to volume of range (i.e. 50% of items available on the shelves) or 50% of items sold, either by weight or by unit.
  • ‘Out of home’ items – some may not understand what this means.
  • ‘Per year’ – this could refer to the calendar year, or a variety of different financial years (April – March or Sept – Aug).
  • ‘Breakfast cereals’ – does this include items such as porridge?

‘Healthy options’ should be specified further, i.e. low in salt, salt and sugar.

  • Ideally this would not just be within a category but also within product lines – i.e. healthy crisps.
  • Important that healthy and nutritious options which may also be high in fat, such as some nuts, are not penalised.

“All healthcare settings to develop and maintain a hospital food and drink strategy” – this should be expanded to include a template/framework.

  • This should outline the specific aims and deliverables of this strategy.
  • It should also include a refresh period and a monitoring/reporting process.

There are still some discrepancies between certain elements of the extract and other consultations and standards.

  • For example, PHE has identified through its calorie reduction consultation a 550kcal guideline for pre-packed sandwiches. This is at odds with the ‘75% at 400kcal’ guideline set out in these standards.

There should be clarifications about which standards apply where. E.g. – does Costa have to abide by GBSF standards?

It can be extremely challenging to ensure that 50%/75% of an item supplied over a year meets calorie or nutritional standards. Easier for suppliers to meet 100%. (Tim could add to this?)

If possible, the long-term vision for standards should be shared. Suppliers would find it easier to start reformulating now rather than continuously for the next few years.

Creation of a live 'document' that can be assessed by trusts. Single live document for trust to review is the right output.
Is one live document the right solution?
How can we ensure this is maintained?
Who will manage this?
Is there an equivalent for suppliers?

Comms

Suppliers said they cannot reach whole of NHS with little effort as you must go to every trust.

Suppliers need to know when they need to be compliant as they need to go off and assess what this means for the product.

The Future Considerations section should explicitly outline the end date of consultations once these are known.

Communicating what we are doing does not reach the right people
No method of reporting to the trust contract caterers report to the trust but limited visibility

Auditing/CQUINN

There were many questions about how this would be enforced.

Will there be penalties associated with noncompliance?

Can the standards be linked to a CQUIN for financial gain for compliance?
Clear KPI’s should be created for organisations relating to the standards

Patient experience standards should be piloted
Have we considered involving the Private Sector as they may have some good practice to share?

Participants mostly repeated points they had raised earlier, with a focus around definitions, metrics and monitoring.

Some also mentioned and shared useful tools which could be used for monitoring and assurance purposes. These included:

  • A spreadsheet which pulls nutritional information from set products and compares them to GBSF targets, producing a rating system. Hayley (?) enquiring to see if this can be shared with us.
  • PPI-B – a system currently used to report the prices paid for items to NHSI (response to Carter review: identifying and tackling cost variance for same items)
    • Data is submitted to NHSI through excel documents connected to PowerBI
    • Could be adapted to include food to allow for monitoring of items purchased?
  • A simple guide for caterers to help them implement the standards (with practical tips) could be helpful.

What if any tools are suppliers using?
WRAP Packaging
Included in bid writing process and managed centrally

What tools would be useful?
Govt developed a tool to show their rating compliance against the standards
Single portal with policy information
Simplified compliance piece
Central way of getting trusts to realise what their impact could be?
Utilising data better
One stop shop Target, KPI, measurement and transparency.
Energy, water, waste calculator.

Could we develop Audit toolkit for trusts?
Need to develop a tool for trusts to ask the right questions and how they can be scored.

Do suppliers currently undergo social and environmental audits?
ISOQUA environmental and sustainability
Soil Association
BRC
Supplier

Training staff

They mentioned adding volunteers to the list of key people for training, accountability etc.
Need clear guidelines for ward Assurance programs

Incentives

It was noted that CQUINN did get trusts to follow recommendations.
In CQUIN targets are clear but we might not be able to do price promotion like meal deals (boots)
How do we deal with this stopping us from providing a meal deal?

Concerns were raised that having a mixture of mandatory and best practice standards would reduce effectiveness.

  • Suppliers are unlikely to meet best practice standards.
  • Listing all standards as nationally mandated gives Trusts more leverage to negotiate changes with suppliers while mid-contract.

Lead time

There was a concern over how long they would be expected to conform to the standards.
Companies have a longer lead time (up to 18 months) to change products/packaging/recipes etc
Small companies may have a shorter lead time, but they must get the product listed which can be difficult.

Patients

Patient feedback – are there any central sources of patient feedback relating to food? E.g. NHS Choices – overall, not by Trust, to allow for thematic analysis of comments
Should patient subsidise food as inpatients?

Brexit

Consensus was most companies are ready for it.

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