Meals on wheels

DEVELOPMENTS in systems for transporting food from kitchens to wards within NHS hospitals are driven by three main influences. The Food Safety Act is the most important, and has led to increasingly sophisticated technology to ensure food is kept and served at correct temperatures.

The second is the role of the NHS Supplies Authority in relation to specifications for food trolleys, and the third is the switch over to trust status, which has brought budgetary disciplines and a competitive edge to the market.

Choosing the right equipment for food transportation is a very complex business. Primary considerations extend beyond matching the trolleys or the insulated boxes to the needs of varying food preparation systems: conventional hotline, cook-chill or cook-freeze and the implications of bulk delivery versus plated meals to the wards.

Buyers must also consider the distance from the kitchen or the meal assembly point and the condition of the ground to be covered. If the hospital is a flat site, distances must be taken into account when selecting trolleys or insulated boxes because heat loss can be rapid.

To withstand the ill effects of rough ground and manhandling by porters, the equipment must be robust and above all safe, as the system will be catering for some of the most vulnerable customers.

Faced with such complexity, catering managers cannot afford to make mistakes with capital expenditure, and evaluating the performance of equipment such as trolleys becomes vital.

According to a support services manager at a large hospital in Yorkshire: “We invited manufacturers to take part in trials because we had found with experience that performance claims made in sales brochures were often only a guide; the actual performance often fell far short of requirements in key areas such as temperature control. As it happens, after evaluating the data, we chose Corsair equipment.

“It is worth remembering that equipment designed for operations such as cook-chill and cook-freeze have a life of six to seven years, and heavy-duty equipment a life of between 12 and 15 years. The other factor to take account of is that legislation changes so fast. You have got to get it right,” he said.

Quite apart from the initiatives of individual hospitals, tests are being run on behalf of the NHS Supplies Authority.

According to Alan Oliver, district catering adviser at the Mid-Surrey Health Authority and national catering representative of the south-east divisional supplies area: “The NHS Supplies Authority commissioned the University of Huddersfield to undertake trials of food delivery trolleys against a set of specifications aimed at achieving quality standards that in some instances asked for more than the legal minimum.”

The aim of the NHS Supplies Authority is to put in place a mechanism that gives individual budget-holders clear guidance on the suitability of equipment for specific purposes.

“It is vital that we are absolutely confident in our choice of equipment; it is part of due diligence. While people will have the option to disregard the recommendations they will have to be 100% sure that the choice of equipment will comply with the Food Safety Act,” Oliver says.

In trust-status hospitals patients are now called customers, and catering managers claim that the meals on offer are a lot better than the food served in non-trust hospitals. Although no exact figures are available from the Department of Health, the educated guess is that by April next year, between 80-90% of all hospitals in the NHS will have trust status.

At the Northampton General hospital, the catering department is gearing up for the change over to trust status next April. Patients are offered a 14-choice menu at lunch and dinner (the menu changes every week) rather than the standard three-course options.

According to Michaela McKie, catering manager, “Our optional analysis found that, with an extended menu, buying in cook-chill or frozen meals would prove more expensive. A bought-in meal service offering three courses on a three-week cycle was also unsatisfactory.”

Food is produced in the Freeze Production Unit on site, and then dispatched in 9in x 9in foil containers to finishing kitchens, where it is regenerated in convection ovens before being plated up and sent to the ward on heated bases with lids.

In the last 12 months McKie’s team has tried different meal delivery systems with the aim of regeneration at ward level, although there has been no change in production methods other than the food being rapidly thawed before assembly and plated in a controlled environment.

The previous system was judged to be unsatisfactory because of the transportation of food over a large site in ambient trolleys, the acceptable temperature only being held for 15 minutes. It is also labour-intensive, operating two kitchens.

Patient trays are assembled using chilled food and complete meals. Entrée, soup or hot sweet and cold food items such as salads are placed in a Temp-rite TR 300 regeneration cart, which in turn is placed in refrigeration cabinets sited on the wards. The food is safely chilled between 0ºC and 3ºC until served.

Bulk regeneration was rejected: “Patient turnover is very high and we operate a same-day ordering system: presentation is important and we have semi-skilled staff, with an eye for presentation, plating up the meals on individual trays,” explains McKie.

“With bulk delivery to the ward we would have to rely on domestics or nursing staff for serving the meals and we would also lose the benefits of portion control. Neither would we be able to offer such a wide selection which is an additional feature of our quality service,” she added.

The new system is operating on three wards and McKie claims: “It has enabled us to close down one finishing kitchen and make substantial savings in labour costs.

“We have also included a new breakfast service. Four Square Klix in conjunction with the Catering Quality Action Group at Northampton General Hospital have designed and produced a breakfast trolley complete with beverage system which also provides freshly brewed tea together with a continental breakfast served from the trolley; again, a system which has made considerable savings in labour costs.” o