ON 21 SEPTEMBER, the Department of Health published the results of the first Patient-Led Assessments of the Care Environment (PLACE) for England 2013. This new system supersedes the former Patient Environment Action Team (PEAT) audits which took place annually between 2000- 2012 and were based on NHS Trusts conducting self-assessments. The new PLACE process, unlike PEAT, now includes patients in the teams that visit hospitals and hold regular public meetings at each site inspected.
The PLACE inspections aim to provide a snapshot of how an organisation is performing against a range of non-clinical activities which impact on the patient experience of care such as cleanliness, maintenance of premises, delivery of privacy and dignity and the quality and availability of food and drink. The assessment of food and hydration includes a range of questions relating to the organisational aspects of the catering service (e.g. choice, 24-hour availability, meal times, access to menus) as well as an assessment of the food service at ward level and the taste and temperature of the food.
A total of 1,358 assessments were undertaken across 274 organisations (233 NHS organisations/41 voluntary/independent/private sector organisations). Of the 274 assessed, none achieved a score lower than 60% whilst 76 were rated at 90% or higher for food and hydration services. The national average score for Food and Hydration services in PLACE 2013 was 84.98%.
Commenting on the inaugural PLACE findings in the publication Patient-Led Assessments of the Care Environment (PLACE): England 2013, Experimental Statistics, Andy Jones, Chair, Hospital Caterers Association (HCA) says:
“The HCA warmly welcomes the new PLACE inspection system which fully integrates, for the first time, patients in the assessment process. Although the inaugural results have been termed ‘experimental statistics’ by the Department of Health (DH) with the possibility of refinements being made to the process in its second year, the new system already appears to be providing a much more comprehensive insight into the patient’s view of key services. In terms of patient food and drink services, these first overall results are encouraging with high levels of patient satisfaction with hospital food across NHS Trusts and other health care centres in England”.
“However, whilst I believe that patient involvement is essential to providing a more accurate perspective of views on food, drink and general catering services and to identifying where improvements should be made, we must not allow ourselves to become distracted by overly focusing on scoring and league tables. It is key that our menus and beverage choice meet and are suitable for the patient groups we serve as well as being flexible in both their offering and adaptability. The advantage of the PLACE data is that it enables us to take a step back and explore in depth, patient feedback on specific aspects of the service and to work with the patients on those individual areas that have been identified as weaker. PLACE scores should also not be used as yet another stick but the carrot to catalyse continuous, quality improvements. However, in order to achieve that across the board, a view needs to be taken about how some of the catering service is managed in future, such as night time ward snacks and drinks, as these fall under ward budgets and are outside of the caterer’s area of responsibility. In order to improve the quality of all aspects of patient food and drink provision, the caterer should be allowed to take responsibility for the whole of the ward service”.
“What PLACE clearly shows is that because of the multi-disciplinary nature of a patient’s nutritional care, we must continue to work across all departments to ensure consistency and support for a patient’s total food and drink provision. For example, we need to encourage Trusts to seek CQUIN payments to help fund improvements to areas where we need to raise standards”.
“However, there is a need for greater understanding of the wider challenges of producing and delivering food to patients on our hospital wards. In order for nutritional care to be more ‘personalised’ to an individual patient, it is important for all members of the clinical care team as well as caterers to recognise the role that it can make to improving the patient’s clinical outcome and to imbed nutrition and hydration as part of the patient’s recovery plan”.
“This is why the HCA has pledged its support for the Campaign for Better Hospital Food which is calling for the introduction of mandatory standards for all patient meals in England, based on those outlined in the British Dietetic Association’s ‘Digest’. However, in order for all hospitals across the country to achieve a national standard, it will also be essential for a mandatory minimum expenditure on all patient meals to also be introduced. In addition, the HCA is calling for Protected Meal Times to be made mandatory by the Government in all hospitals and for more help to be provided for patients who need assistance to eat”.
“The deployment of ward hostesses on more wards, too, would ensure better monitoring and communication of individual patient food and drink requirements and intake. Improved screening of patients’ nutritional status on admission is called for so that special dietary conditions or needs can also be identified. With a better protocol in place for every single patient which can be followed by all members of the team – from ward to kitchen and throughout a patient’s stay, patients will then receive the optimum nutritional care they expect and deserve”.