Food for thought

The ‘Nourish’ campaign, which ran from September 2008 through to January 2009, aimed to increase awareness about healthy eating options and the importance of a good diet amongst more than 30,000 hospital staff across 10 participating NHS hospital trusts in the region, as well as many hospital visitors.
    
Following an extensive consultation period with more than 1,700 hospital staff across six of the Trusts, which revealed a poor understanding of the term ‘healthy eating’, a series of interventions were developed across each of the Trusts to help promote healthier eating options to staff.
    
As part of the project, each of the 10 hospitals were asked to monitor and evaluate the effectiveness of a wide range of new healthy eating promotions, canteen menu overhauls and health food discounts, as well as the impact of modifying existing recipes to reduce the amount of additives such as fat, salt and sugar in meals.
    
The project also offered practical training workshops around nutrition for catering staff and encouraged them to look at how they could influence staff to choose healthy options. Findings from the project’s final Evaluation Report reveal a significant increase in the uptake of healthier meals and snacks amongst the participating Trusts.

Project achievements
Some of the Hospital Food Project’s key achievements over the 12 week ‘Nourish’ awareness campaign included:

• A weighing-in club was started up amongst staff at the Liverpool Heart and Chest NHS Trust which successfully saw participants loose a total of 27lbs
• The Royal Liverpool & Broadgreen University Hospitals Trust (RLBUHT) was able to involve all the outlets in the campaign and saw an increase in the purchase of healthier options in each facility, between 16-50 per cent on some products
• Low salt beans were introduced at the Countess of Chester NHS Foundation Trust and at Broadgreen Hospital, resulting in an approximate reduction of 0.6 grams of salt, and a reduction of three grams of sugar per portion 
• Wirral University Teaching Hospital NHS Foundation Trust sold an extra 12,000 healthy sandwich options during the project period, and reported a 40 per cent increase in fresh fruit sales after introducing two large branded fruit stands into their staff restaurant 
• The introduction of an improved salad bar at Liverpool Women’s NHS Foundation Trust saw sales steadily rise throughout the project period, from 300 salads sold in August 2008, to 719 in January 2009
• Fruit sales at Mersey Care NHS Trust increased from 75 pieces per week to 90 a week over the three month campaign
• A Grab and Go healthy range – salads, fruit, sandwiches – was introduced at Whiston Hospital, part of St Helens & Knowsley Teaching Hospital NHS Trust, which accounted for up to 16 per cent of all food purchased during the campaign    
• Aintree University Hospitals NHS Foundation Trust reduced the saturated fat content of many of their daily meals by four grams per portion, simply by reformulating their cheese sauce recipe
• Southport and Ormskirk Hospital NHS Trust has seen an increase in its staff asking for healthier option snacks, and to date has sold 144 boxes of healthier variety snacks and crisps.

Sharing best practice
‘Nourish’ also introduced a new website: www.nourish-uk.com, which acted as a mechanism to inform hospital catering teams and to facilitate a sharing of best practice with each other during the pilot period, and beyond. Each participating hospital was provided with their own web page where they could supply information on current promotions, recipes and menu options.
    
The ‘Nourish’ campaign also served to highlight a number of challenges for the Hospital Trusts to continue to work on, including issues around the close proximity of external fast food outlets and problems with promoting healthy options in the current economic climate which meant that staff were more inclined to choose food based on price not health considerations.  
    
Some Trusts were also unable to make dramatic improvements to the range of healthy food options they could offer staff due to existing contractual obligations with external catering companies which prevented them amending their orders.
    
Robin Ireland, chief executive of Heart of Mersey, commented: “Hospitals haven’t always historically had the best reputation for good catering, and even after important improvements to canteen food have been made, there remains a real major challenge in actually encouraging staff to take up new healthier food options.
    
“The reality is that although most people do understand what a balanced diet looks like, getting people to change their lifestyle doesn’t just happen overnight. There are genuine barriers to healthy eating such as the accessibility and affordability of choosing healthy food options. For me, the success of this project has been in its introduction of lots of small changes and its focus on helping catering staff to understand how to remove some of these barriers, in order to make it easier for people to choose a healthier diet.”
    
Wider audience
Over the coming months, each Trust will continue to build upon learning from this project with further menu alterations and healthy food promotions, and will continue to monitor food sales on different healthy food product lines and meals, sharing this learning with a wider audience.