Item 3 is on the Auditor General's report entitled, "Catering for patients: A follow-up report". Barbara Hurst has a briefing for us.
Our recently published report on catering follows up the recommendations in a baseline report that we did in November 2003. Some committee members might remember the discussions at that time. We examined hospital food because it plays such an important part in helping patients to get better. The baseline report made a series of recommendations on nutrition, quality, patient satisfaction, cost and management of catering services. The follow-up study assessed progress in implementing those recommendations in 149 hospitals and 16 health boards—the 14 territorial boards plus two special boards.
The report states:
The Health Department appointed Helen Davidson as food and nutrition adviser. She has spent the past nine months trying to develop the standards. Before that, there was a set of draft standards and a specification had been produced that was never fully realised. Helen Davidson is consulting widely with catering managers and dieticians to try to publish the specification by next April.
A fully functioning national e-procurement system for catering is not yet in place in the NHS in Scotland. A number of limitations in the professional electronic commerce online system—PECOS—have delayed its progress. To me, they seem to be fundamental problems. When, how and by whom will the system be sorted out?
You are right that the system has significant limitations—they are mainly to do with its responsiveness at the front end. It can be slow, although that might be a network problem, which takes us back to our previous discussion about information management and technology. If the system can be made to work, it should have significant benefits, but it is not functioning as well as it should.
It would be fine if the program actually worked.
The program is working, albeit slowly, but in a fast-moving world, people might choose to order supplies in a different way.
How does the centralisation of procurement fit with the objective to increase nutritional standards? In schools, we are developing local purchasing to ensure that schoolchildren get the benefit of local high-quality produce, such as fruit and vegetables that were picked the previous day. How do we extend that approach to the health service? Does it consider nutrition in a silo, without examining what is being done elsewhere?
That is a really interesting question. I remember that we had the same discussion about sourcing food locally three years ago. When Roddy Ferguson was scoping the study, he had a number of discussions with the central purchasing bodies. At that time, the direction in which things were going was clearly towards national contracts, which cuts across the possibility of local sourcing, unless it is possible to link the two. National contracts have reduced the cost of some food, but we have not considered local sourcing further.
If the award of the contracts is based solely on reducing cost, that can impact on the quality and nutritional value of the produce. What interests me is how we square that circle, but I see nothing in the report on which we could hang that.
No. We did not follow that through because we did not consider it in the initial report and because, in scoping the study, we found that the drive was towards national procurement. You are right to say that, if we are going to buy nationally, we need real quality standards that we can apply to orders. To take it one step back, that is why we have in the report focused on some of NHS QIS's findings on the need to meet nutritional standards. That links with our finding that menus need also to be nutritionally analysed. Catering is complex. It looks quite straightforward, but it links in with the nutritional spec that the Health Department should produce by next April.
How do we screen the nutritional needs of the patients in an acute hospital—I mean one that has the whole gamut of patients, such as acute admissions, elderly patients, psychiatric patients, maternity patients and paediatric patients—and have the catering service fulfil those needs when, as far as I can determine, no qualifications are required of the staff who deliver that service?
We are clear that nutritional care for patients is not only the responsibility of the catering service. Of course it is not; screening patients and ensuring that they then get the right food are also clinical responsibilities. Hospitals need enough dieticians to fulfil those responsibilities and they need to ensure that they have time to assess patients' needs properly on admission. They will also pay more attention to people who are in for longer—particularly vulnerable older people, I expect—than to those who are in for two or three days for a quick operation and then out again. If resources are tight, it is necessary to target them on the more vulnerable patients.
NHS QIS went into a bit more detail in its report. It outlined what nutritional screening tools it would expect to be used and gave examples of tools that are in use and what it would expect them to cover. It provided guidance on what hospitals should do and stressed the point that nutritional screening is a multidisciplinary responsibility that is not the responsibility of one group of staff. It is aware that nutritional screening is quite a big undertaking and a different way of working for hospitals.
I asked a question about the qualifications of the catering staff: it was not answered. I am concerned about qualifications because we are asking people to provide patients with food that is nutritionally sound. I read nothing in the report about investment in staff through modern apprenticeships, for example. In the generality of catering staff, some are qualified and some are unqualified. In the future, how can we ensure that staff understand what they are trying to achieve? If they do not have the basis of that information in the form of a qualification, how can we move forward?
Agenda for change should help on that front. The idea is to link staff to the skills that are needed to do the job. It was too early for us to assess what was happening under agenda for change because it is still being implemented across all NHS boards. However, it would be the mechanism to ensure that what Margaret Jamieson described happens.
The QIS standards also relate to ensuring that staff have appropriate education and training about nutritional care, and about food and fluids. It was found that there is a lot more to be done on that.
Does not that indicate that we have been using unqualified people for too long? If they were qualified, they would understand the fundamental aspects of nutritional care, which is part of the qualification.
Yes. It is certainly an area that needs to be improved.
In the drive to reduce costs, offering of qualifications has suffered in the health service. Boards would employ people who had qualifications but would not help them to add to them. That should be addressed.
That links to recruitment and retention of staff. We are still finding high vacancy rates in some areas. We fully agree with Margaret Jamieson. If organisations invest in their staff and ensure that they know what they are doing and that they are valued, that can reduce vacancy rates.
The 1 per cent of the total budget that is spent on hospital catering seems to be an irreducible minimum. However, I want to pursue Margaret Jamieson's point about local procurement because a national strategy should not preclude local procurement. Are figures available on the percentage of food that hospitals procure locally and on how many hospitals, like Edinburgh royal infirmary, buy pre-prepared food in bulk from another country?
I am not sure of the answer to that question. Did it come up through the study?
We did not examine such figures. It might be helpful to take a step back to Margaret Jamieson's question, which was about what the Health Department is doing. Some work on local procurement and organic produce is being done in schools. I understand that Gillian Kynoch from the Executive intends to learn the lessons from the schools work rather than try to do the work in every area. The health sector is considering what is happening in schools, prisons and other public sector areas, and because of the emphasis in other areas, we did not consider it particularly in the report. The figures are not terribly clear.
You mention that 30 per cent of boards carry out quarterly patient-satisfaction surveys. Is there any correlation between carrying out that work and learning from it, for example by delivering good practice in nutritional standards or savings in unserved meals?
When we did the original baseline report, we carried out our own patient-satisfaction survey, which was quite a big enterprise. We found no correlation between levels of satisfaction and any of the other indicators that we examined.
My question relates to non-patient catering and subsidisation. Boards are required to produce trading accounts for catering departments in 2006-07, which will make those costs more transparent. Will the accounts include the private contractors that would not provide information in three hospitals?
No.
So there will not be a complete picture.
No—but we did not have a complete picture the first time around.
There are no further questions. The committee will discuss its reaction to the report in private under agenda item 7. I thank Barbara Hurst and her team—Tricia Meldrum and Roddy Ferguson—for providing us with that briefing.