Significant steps have been taken to help change the food environment within staff and visitor food outlets in the NHS so that they can become beacons of good practice in supporting staff and visitors to make healthier choices. This chapter is specifically in relation to the food and drink served to staff and visitors within the NHS, not patients.
Having access to healthier food options in the workplace has many benefits for staff, including reducing the risk of developing multiple lifestyle related diseases and improving physical and mental wellbeing (1). A healthier, happier, more engaged workforce leads to better performance for both individuals and the organisation (2).
Helping staff to reach and maintain a healthier weight requires the consideration of several factors, including:
Additionally, visitors to hospitals may find it difficult to access food and drink due to travelling, looking after ill relatives and reduced time for food preparation.
Whilst it is important to promote healthier eating to help support people adopt healthier lifestyles, it needs to be recognised that people have different dietary requirements. Apart from physiological differences, some people may be more active than others with physically demanding jobs, therefore they need a higher energy intake than someone who has a desk-based role. It is also important to consider people’s overall relationship with food. A balanced approach to the promotion of healthier choices is required to avoid weight stigma, triggers for disordered eating and general unhealthy relationships with food.
Since 2017 there have been several important initiatives, standards and regulations introduced into the NHS to help improve the health and wellbeing of staff and visitors. These are listed below.
The National standards for healthcare food and drink released in 2022 (9) build on previous hospital food standards (10) and take into consideration the extensive recommendations from the ‘Report of the Independent Review of NHS Hospital Food’ (11) as well as key priorities for both the NHS and the Government.
The standards comprise of four sections, with section 3 outlining the mandatory requirements for retail, staff and visitor food and drink provided by healthcare organisations.
There are four mandatory standards that apply to staff and visitor food and drink which organisations must demonstrate compliance with (9).
The latest Government Buying Standards for Food and Catering Services (GBS) were published by the Department for Environment, Food and Rural Affairs (DEFRA) in 2021 (12).
The GBS includes a set of minimum mandatory standards with which NHS trusts must comply. It also incorporates recommended best practice guidance for health, sustainability and welfare for food and catering in the public sector.
The updated nutrition standards element of the GBS (13) aims to ensure consistent minimum standards for healthier food and drink options. This includes:
Organisations will need to assess their compliance with the nutrition standards both mandatory and best practice setting out a programme of implementation. Technical guidance has been published alongside the nutrition standards to support this (14).
The CQUINs form part of standard NHS Contract (15) and its framework is intended to reward excellence, encouraging a culture of continuous quality improvement, whilst delivering better outcomes for patients and staff (16).
The CQUIN indicator 1b Healthy food for staff, visitors and patients focuses on changing organisational behaviour and culture towards the food and drinks sold on NHS premises. The standard outlines mandatory requirements for retail outlets, including:
For specific targets for sugary drinks, confectionary and savoury pre-packaged meals, refer to the NHS staff health & wellbeing: CQUIN 2017-19 Indicator 1 Implementation Support document (17).
The Report of the Independent review of NHS Hospital Food is a first step towards improving food standards and focusses on the safety, nutrition, quality and production methods of food for patients, staff and visitors in NHS hospitals (11). It recognises the challenges to improving food culture in our hospitals and adopts a holistic approach to progress this. The report includes eight key recommendations for system-level change and a checklist for catering managers and chief executives.
This chapter includes some best practice examples pertinent to staff and visitor catering.
The calorie labelling regulations were introduced in April 2022 and aim to help consumers make healthier decisions, encourage businesses to provide lower calorie food options and food manufacturers to reformulate food and drink products (18).
The regulations only apply to staff and visitor restaurants or cafes in hospitals if they are run by an external contractor employing more than 250 people. Further information on the calorie labelling regulations can be found in Chapter 8: Food Composition, Labelling and Recipe Analysis.
The 2024 salt reduction targets (19) are for all sectors, including retailers, manufacturers and the out of home sector.
NHS restaurants and cafes for staff and visitors must ensure they are compliant by procuring products that are in line with the salt reductions targets. Any fresh food and drinks made on-site must also comply with the targets outlined in the out of home sector section.
Furthermore, there are also Calorie Reduction targets for 2024 (20) to be achieved by the food industry in specific product categories.
The Healthcare Retail Standard (HRS) (21) applies only to those retail outlets (i.e., where food is not prepared on-site but is ready for immediate purchase) within healthcare sites. The HRS is comparable to the National CQUIN scheme in England and consists of specific criteria that retail outlets must meet for compliance.
In line with a new three-year strategy and transformational programme, the Scottish Government have also considered changes in the out of home landscape by publishing ‘Diet and healthy weight: out of home action plan’ (22). Food Standards Scotland (FSS) will lead the overall monitoring and evaluation of this plan to inform future actions.
The Corporate Health Standard (23) is a free service which is funded as part of the Welsh Government’s ‘Healthy Working Wales’ programme.
It is the national quality framework and award for employers to improve health and well-being in the workplace. There is a standard for healthy eating within the workplace with specific criteria for workplaces with on-site catering facilities.
The Healthy Options Award Wales (24) is open to all types of catering premises that cater for the public.
This award rewards caterers who make it easier for their customers to make healthy choices when eating out. It aims to encourage food businesses to provide healthier options to customers through:
The use of healthier catering practices
Increasing fruit, vegetables and starchy carbohydrates
Decreasing fat, especially saturated fat, sugar and salt
Provision of healthy options for children
Rewards staff training
Promotion and marketing of healthier options.
The Nutritional Standards for Catering in Health and Social Care (25) were published in partnership with the Public Health Agency, the Food Standards Agency, safefood and Health and Social Care.
The standards apply to all facilities that serve food or beverages to staff or visitors operating within Health and Social Care settings. This includes catering facilities, privately owned retail units and vending machines.
The standards must be adhered to from the procurement of food contracts to menu planning and food service.
The food service dietitian can provide a vital contribution towards planning, implementation and monitoring of health and wellbeing strategies, programmes, policies and procedures in relation to staff and visitor catering in hospitals.
This role can be embedded within the clinical dietetic team or with contracted catering services where applicable.
Several initiatives can be taken on improving the accessibility and availability of healthier meal solutions for staff and visitors.
These can include but are not limited to:
Department of Health and Social Care. Policy paper on Health and Care Bill 2022 Hospital Food https://www.gov.uk/government/publications/health-and-care-bill-factsheets/health-and-care-bill-hospital-food#what-the-bill-will-do [Accessed 20th March 2023]
Department of Health. A Toolkit to Support the development of a hospital food and drink strategy. http://www.hospitalcaterers.org/media/1151/hospital-food-drink-strategy.pdf [Accessed 20th March 2023]
British Dietetic Association. Workplace Health Work Ready. https://www.bda.uk.com/food-health/workplace-health-work-ready.html [Accessed 20th March 2023]
Dimbleby etc al. National Food Strategy. https://www.nationalfoodstrategy.org/ [Accessed 20th March 2023]
Department for Environment, Food and Rural Affairs. Government food strategy. https://www.gov.uk/government/publications/government-food-strategy/government-food-strategy [Accessed 20th March 2023]
Royal College of Nursing. Rest, Rehydrate, Refuel. https://www.rcn.org.uk/healthy-workplace/healthy-workplaces/health-and-safety/rest-rehydrate-refuel [Accessed 20th March 2023]