Why is food sold on NHS premises under the spotlight?
There is a critical mission to get the people in the UK healthier, mainly by eating better, exercising more and taking care of their physical and mental health. With the NHS being the largest employer in Europe, boasting over 1.3 million employees, and with 54% of their staff being either overweight or obese, the NHS seems a good place to set a precedent.
This, coupled with the fact that NHS premises have a large footfall not only from staff but also outpatients and visitors, means that many would benefit from healthy food availability. Data from The Hospital Food Standards Panel Report (2014) shows that over half of all the food provided in NHS hospitals is being served to staff and visitors.
Commitment to this idea is supported by Simon Stevens, Chief Executive of the NHS, and is seen in NHS England’s Five Year Forward View (2014). This NHS plan identifies improving the health of its workforce and the health of the nation as a priority.
As a result, over the last year, we have seen the introduction of new policies and initiatives which focus on increasing the provision of healthier food and drink sold within the NHS.
In this article, Anna-Maria Holt RD, Company Dietitian and Health & Wellbeing Lead at Pelican Procurement Services, takes us through the health and wellbeing initiatives currently impacting the NHS in England.
The current health and wellbeing initiatives include CQUIN, the new Food Standard with the NHS Standard Contract, and the Reduction of sugar-sweetened beverages Voluntary Scheme.
What are the key health and wellbeing initiatives within the NHS?
The current health and wellbeing initiatives include the new Hospital Food Standards in the NHS Standard Contract, CQUIN 1b (Healthy food for NHS staff, visitors, and patients) and the Reduction of sugar-sweetened beverages Voluntary Scheme.
1. Hospital Food Standards in the NHS Standard Contract
A further step to embed healthier food and drinks provision within the NHS is the addition of the new Hospital Food Standards that were recently added to the NHS Standard Contract. The Standard Contract not only requires NHS food providers to follow a food and drink strategy in accordance with the Hospital Food Standards Report, but it also stipulates provision of healthy eating options and compliance with the Government Buying Standard for Food and Catering Services and the Healthier and More Sustainable Catering for Staff and Visitors: Nutrition Principle.
This means that when contractual agreements for food and drink provision within the NHS are being made these requirements must be agreed and adhered to as part of the service delivery.
2. CQUIN 1b – Healthy food for NHS staff, visitors, and patients
Budgets are tighter than ever and any opportunity to secure additional funds is welcome in any sector. In the NHS, CQUIN (Commissioning for Quality and Innovation) was introduced in 2009 to offer NHS Trusts and other health care settings a way to secure an enhanced budget.
This payments framework is run by NHS England and allows Clinical Commissioning Groups (CCGs) to top up their funding by up to 2.5%. As with any bonus initiative, there are targets to be achieved, which is why the word CQUIN is the talking point amongst NHS staff, partners and suppliers.
Since 2016, Improving staff health and wellbeing has been included as one of CQUIN’s 13 key indicators. This indicator not only includes the general improvement of the health and wellbeing of NHS staff (Indicator 1a), but it specifically mentions food in Indicator 1b ‘Healthy food for NHS staff, visitors and patients’.
Under Indicator 1b sugary drinks and food items which are high in fat, sugar or salt (HFSS) is banned from price promotions, advertisements, and checkouts on NHS premises. In addition, healthy options must always be available 24 hours a day including for staff working night shifts.
To determine which items are high in HFSS, caterers will need to refer to the nutrient profiling model or traffic light criteria, and avoid any food items which are coded red.
Items which are coded green or amber are considered healthier products and can be offered at the checkout and be part of price promotions and advertisements.
The downside of this way of categorising food items is that some foods which are high in either fat or sugar may be deemed as unhealthy, even though they have other nutritional benefits making them a nutritious snack option.
Dried foods such as raisins, apricots, seeds, and nuts are examples of these. It is therefore important to take a pragmatic approach and work with a dietitian or registered nutritionist to identify which items are healthier.
The sale of sugary drinks, those which have 5g or more of sugar per 100ml, are restricted as are energy drinks, milk-based drinks (sugar >10g per 100ml) and fruit juices with added sugar.
In addition to the above, the sale of confectionery items or sweets that provide more than 250kcal per serving will be restricted, as will sales of pre-packed ready to eat meals such as sandwiches and salad boxes that provide more than 400kcal per serving and 5g saturated fat per 100g.
CQUIN reporting requires the sales figures of these products to be monitored year on year and reduction in the sales of restricted products will need to be reported. Generally, reporting should show a percentage reduction of high sugar and salt products displayed and an increase in the number of healthier food alternatives on offer.
3. Reducing the sales of sugar-sweetened beverages Voluntary Scheme
In June 2017 Public Health England launched a new voluntary initiative focusing on the sale of sugar sweetened beverages (SSBs) on NHS premises. Under the scheme SSBs, defined as sugar containing drinks with more than 5g of sugar per 100ml, will be limited to 10% of total drinks sold by March 2018. The scheme excludes fruit juice but includes coffee with added syrup and sugary soft drinks.
Sugary drinks are being targeted because they are a major source of unnecessary calories according to the World Health Organisation (WHO).
In the UK the spotlight is firmly on sugar because high sugar intake leads to excess calorie consumption, which results in weight gain and eventually obesity. In addition, soft drinks are the largest single source of sugar and cause of tooth decay amongst children and are linked to the risk of developing Type 2 diabetes in adults.
Treating obesity, tooth decay and diabetes continues to cost the NHS millions of pounds, so preventing these conditions from developing is critical.
If the proposed voluntary scheme fails then NHS England will consider a total ban of SSB on NHS premises.
What support is available?
The objectives driving these initiatives are valuable, but the extensive and sometimes ambiguous criteria require both a good understanding of these initiatives, product knowledge and nutrition expertise.
NHS teams will need to work closely with a number of stakeholders including their purchasing teams, food procurement experts, food and drink suppliers and dietitians or nutritionists to ensure successful implementation and compliance with these health and wellbeing initiatives.
Pelican Procurement Services has the knowledge, expertise and systems to support NHS clients:
1. Online tools
Our new automated reports enable you to view the nutritional information for products being purchased. It has been designed to help identify products high in sugar, salt, saturated fat and total fat, so you can swap them for healthier alternatives if you wish.
The report’s function allow you to filter by Date Range, Supplier, Nutrient Type, or “traffic light zone” – or search for particular products and export the results into Excel.
This report saves vast amounts of time, making it easier and quicker to provide evidence of compliance with these initiatives.
2. Procurement expertise
Our Procurement Managers are experts with detailed knowledge of the catering and hospitality industry. The team assists NHS Trust catering and purchasing teams in:
- Identifying healthier product options.
- Organising sampling and market research of replacement products.
- Ensuring that all replacement products meet other initiatives that the NHS trusts may be working towards (i.e. the Food for Life Served Here Award).
- Providing profit analysis on the recommended replacement products measured against the existing range.
- Negotiating manufacturer price support and point of sale material.
- Ensuring that amendments are made to NHS Tender Documents to incorporate the changes and encouraging suppliers to be more creative and extensive with their range of healthier products.
To find out more information how Pelican can support your team comply with health and wellbeing initiative please contact us at email@example.com
Why work with Pelican?
- Pelican Procurement Services is a market-leading food procurement and supply chain specialist, supporting individual and multi-site organisations with their catering provision in education, hospitality and health care.
- We have CIPS qualified procurement specialists with the in-depth food industry and EU procurement knowledge and we have developed a portfolio of comprehensive services and cloud-based management systems.
- These services and systems enable organisations to achieve significant savings, improve back-office processes, enjoy a smooth, effective supply chain, gain greater control and visibility over their purchasing and maintain full compliance with industry standards.
- Pelican currently supports Guy’s and St Thomas’ NHS Foundation Trust procurement team. Discover how we are helping them to save money and improve service. Find out more
- Pelican is a member of the Food for Life Served Here Supplier Scheme and our team will fully support you every step of the way in successfully gaining this award. Find out more