A lean and green future

The 2011 Annual National Conference of the Hospital Caterers Association, which this year was entitled ‘L£AN & green’, took place at the Harrogate International Centre & Barcelo Harrogate Majestic Hotel 7-9 March. The conference focused on the primary issues facing the NHS and hospital catering in 2011 as well as the provision of efficient and cost effective services that are both lean and green.
    
With the NHS facing the biggest cuts since its inception, many of the speakers explored the significant implications of the financial challenges that lie ahead. Presentations provided guidance and case studies for hospital caterers, which illustrated not only how to work smarter but to do more for less without compromising quality.

A different approach
There was, however, a fundamental message from all speakers on the subject of lean, which was that taking actions that had cost savings as their primary objective, was the wrong approach. The aim for managers should be to, firstly, focus on improving customer benefits. Secondly, the direction should not be top down but bottom up. In other words, by driving customer focused improvements and efficiencies through front line staff consultation and involvement, it would increase productive working practices and lead to cost savings.
    
The conference explored the ‘NHS Lean Improvement Programme’ and how it has been used to demonstrate efficiencies by considering case studies on the productive ward. It also examined the way in which this process can, as it releases time to care, improve the patient meal service. The process also addresses issues of asset utilisation, maximising income by marketing services and other measures to help reduce overall operating costs.

Keynote speaker        
The conference opened with keynote speaker, Roy Lilley, an independent NHS writer and broadcaster, outlining his views of a changing NHS. He commented that “the NHS was originally fit for purpose but life and lifestyles had changed”. He believed that it was time to re-design services and to fill the missing gap.
    
It was, he said, not about food but the whole supply chain, involving everybody – from nurses to patients and their relatives. He also said that “something happens (in hospitals) between the kitchen and the plate” commenting that with 31 per cent of patients having trouble with feeding, it is not possible to resolve the situation with the current levels of staffing. The challenge now, he said, was less about the food but more about how to feed patients.

Customer benefits
In his presentation entitled ‘Lean thinking – there’s no instant pudding’, Paul Walley, associate professor at Warwick University, said it was not just about money, costs or savings but it should be expressed in terms of customer benefits. Cost savings were an outcome of making changes, not the reason to do them in the first place. He cited the Toyota car production ethic as an example of how to approach an improvement capability programme within the NHS. This involves engaging the workforce at the front line and for managers to spend more time there too.
    
He said that taking a lean approach was not a quick fix solution but a long scale measure.

Productive wards
Amanda Boyd and Jane Rosebury, productive ward facilitators, Pennine Acute Hospitals NHS Trust, explained how their trust was conducting ‘Lean in action – Productive Ward’. The overall aim of the exercise was to release time for care, freeing up nurses to look after patients and to improve safety and efficiency.
    
The whole Productive Ward programme, which commenced in March 2009, will be rolled out to 80 wards at the trust. The objectives are to first monitor the whole meal production, delivery and service process to identify inefficiencies in the system and to change those that impede service delivery – such as trolleys being loaded in the kitchen, out of sync with the order of patient beds on the ward.
    
Simple steps are leading to greater efficiencies and improvement in the meal service on the wards. As less time is required to sort and serve meals, more time is created for nurses to provide greater assistance to those who need help with feeding. As well as improving the nutritional status of patients, communication between the ward team and the catering department had improved and food wastage has dropped to just 3 per cent.
    
The conference also highlighted to delegates how they can increase revenue through maximising sales in retail outlets. John Hughes, head of catering at Nottingham University Hospitals, explained how the introduction of two own-brand ‘Coffee City’ sites at his trust had resulted in £700k net profit. He went on to estimate that if the NHS got retailing right such as addressing its own brand of coffee outlets for example, it could be £200-300 million better off.

Green topics
Green issues and sustainability were key subjects at the conference. Eminent speakers such as professor Ian Crute CBE, chief scientist, Agriculture and Development Board, Dominic Pattinson, lead – Food Policy Unit, DEFRA, and Sarah Pettitt, chairman, National Farmers Union Board for Horticulture & Potatoes, all stressed the need for caterers in the public sector to engage with the sustainability agenda. With over 300 million meals served every year and the NHS being the UK catering industry’s largest provider of meals, caterers were urged to recognise, on a wider basis, the important environmental role they can play by procuring food from sustainable sources.
    
According to John Hughes of Nottingham University Hospital caterers can, by adapting their menus to maximise their use of local produce, increase their contribution to sustainability. It requires being more flexible with menus, thinking more about seasonality, increasing communication with producers and having control over budgets.

Looking ahead
Summarising the future now facing hospital caterers, the new incoming HCA chair, Janice Gillan said: “Tough challenges lie ahead for all of us within healthcare catering and the NHS. Whilst we must continually aim for higher levels of service for our patients, staff and visitors to meet their expectations, we are facing major challenges as significant savings and economies have to be made in all departments.

“We will all be considering how we can continue to maintain quality hospital food, sourced as sustainably as possible and to deliver efficient catering services within a National Health Service that is facing the biggest budget cuts since it began.
  
 “As the incoming chair of the HCA, I will be focused on providing our members with as much support and guidance as possible so that they can continue to achieve high standards and safeguard the nutritional care of patients.”

Janice Gillan, chair, HCA
Janice Gillan is the new chairman of the Hospital Caterers Association (HCA) from March 2011-13. She was elected to the position at the Association’s Annual General Meeting on 8 March and has taken over from Kevan Wallace, the former chair who has now completed his two year term of office.
    
Janice has been a member of the HCA for over 16 years. She was branch secretary from 1996-2008 and then chairman from 2008-2011 of the HCA West of Scotland Branch. She was appointed national vice-chair 2009-2011.
    
Janice has considerable experience of healthcare catering gained from nearly 30 years within the NHS. She started her career as a trainee cook and worked her way through various positions, gaining a range of qualifications on route. She qualified as a member of the HCIMA in 1988 and is currently a senior catering manager within NHS Ayrshire & Arran. She is studying for a Masters in Business Administration at the University of West of Scotland.
    
Her current job involves responsibility for catering services within the 700-bedded Crosshouse Hospital and managing a departmental budget of £4.5 million for salaries and supplies and an income of £1.5 million. She says that one the biggest daily challenges in her job is tracking the movement of patients in a 98 per cent occupancy site.
    
She has been involved with the Scottish Health Department including the writing of the Health Department Letter (HDL) Guidance on Trading Accounts, participating in Food in Hospitals Specification and Commodity Advisory Panels. She has represented the HCA at Health Facilities Scotland meetings and at Scottish Government level regarding that National Nutritional Catering Specification, Integrated Nutritional Care Steering Group, NHS Quality Improvement and Scotland Food, Fluid & Nutritional Care Standards. She has been nominated for numerous awards over the years, winning the Health Facilities Scotland Award in 2005 and the Cost Sector Catering Healthcare Award in 2006. She was also an HCA Caterer of the Year Finalist in 2007.