The NHS is the very cornerstone of our welfare state, so it will always benefit if it can find cost savings. But in light of Jeremy Hunt’s ambitious announcement of a 7 day NHS, operational and financial managers and directors are under increasing pressure to find savings from somewhere – and to save that money without sacrificing service. We can’t account for the medical side, but in terms of catering, we’ve seen countless instances where money could be saved, service improved and reputation built from one really simple, common sense change. And what’s that secret’ The introduction of standardised recipes.
What do standardised recipes mean?
Standardising recipes is really the only approach that allows you to accurately track what is going into the meals that are served. And keeping track of what goes in to the food is the only way you can accurately track some of the most important metrics about the food, such as:
- cost per plate
- nutritional content of each plate
- allergens of each plate
It not only works for the business side of hospital catering – because it helps you track costs and therefore drive them down – but it also helps the dietitians develop more nutritious food, prevents accidentally serving the wrong ingredients to the wrong patients (such as non-halal meat to a patient who only eats halal), helps you track allergens and makes it easier to create better, tastier food.
A compelling business case
Clearly, the most straight forward and, for some, most compelling reason to bring in standardisation is that it saves money – potentially a 5-10% cost saving.
Standardised recipes help you track cost per plate. Without them, you just can’t know with any precision how much each meal is costing to produce. Once you know how much each dish costs you have the information to figure out where savings can be made – could you be using cheaper ingredients, does the recipe need tweaking, or can a high cost menu be replaced with something which ticks all the same boxes but costs a lot less’ These are the kinds of questions you can start asking in earnest once you have accurate data about the cost of each plate.
Breaking down the numbers:
Take this situation:
Food cost per patient per day: £8.50 (we know that this is a hard estimate to come to and it can vary widely between different hospitals)
Patients fed each day: 500
Daily food cost: £4250
Total cost of food per annum: £1,551,250 (so just over £1.5 million)
1% saving = £15,000 per annum saved
5-10% saving (the average saving made when using standardised recipes) = £75,000 – £150,000
We’re working to estimates and averages here, and haven’t included the cost of labour or equipment, but you get the idea. Just a 1% saving is the equivalent of £15,000 saved. On average standardised recipes save 5-10%, so that would equal £75,000 – £150,000 saved per year. Convincing figures, aren’t they?
Better information means more efficient purchasing
Standardised recipes aren’t as simple as using a written-down recipe that sits in a folder on the shelf. Operating standardised recipes means using the numbers you have to feed to drive the food ordering process as much as driving the production in the kitchen. So, instead of always ordering your 80kg of minced beef because it’s ‘Monday Week 1’, you can accurately forecast meal number requirements that will drive provisions orders. This is linked to improving your patient ordering systems – more on that later.
Standardised recipes can also specify a particular product from a specific supplier which offers serious benefits as explained by Alex Briggs at Interserve.
Don’t hospitals already use standardised recipes?
It might come as a surprise, but a lot of hospitals are not using standardised recipes at the moment, so this is a subject worth discussing.
Plenty are, though it’s difficult to find any reports detailing which hospitals are and which aren’t. However, we know from experience that alongside those who are rationalising their recipes, a lot of hospital catering services are not working to formalised, recorded recipes. Incredibly, they are creating food from recipes that can change daily – different amounts of ingredients can go into a dish every time it is made, so that one hospital’s spaghetti bolognaise can be made in three or four different ways. This makes it impossible for a hospital to keep track of stock, cost per dish and nutritional content because there’s no way to know what has gone in it.
What do our governments recommend?
The Welsh and Scottish government both recommend using standardised recipes, though they’ve never been recommended by the British government (despite producing a report on Hospital Food Standards recently). A Scottish report on Hospital Catering discusses the ‘significant patient health and safety risk associated with not following standard recipes’:
The importance for the need to follow standard recipes for the food provided in the hospital setting cannot be overemphasised. – ‘Food in Hospitals: National Catering and Nutrition Specification for Food and Fluid Provision in Hospitals in Scotland‘, The Scottish Government, 2008, p.42
Though standardisation has never been formally recommended, it is considered best practice by organisations such as the Hospital Caterers Association and the Campaign for Better Hospital Food. And it’s not hard to see why.
Preventing mistakes: standardised recipes could save lives!
Catering for thousands of patients every day is no mean feat, not least because we all eat differently and hospital patients have varying health needs. If caterers aren’t working to a formalised recipe, then it’s easy to accidentally put gluten products in a meal going to someone who requires gluten-free food, or to put dairy products in a meal for a vegan. Working to a standardised recipe that already has the adjustments made means mistakes are less frequent, because the caterer doesn’t have to try to monitor the variables all on their own.
Allergens are also really important in hospital, but it can be easy to miss an ingredient which actually contains an allergen. Working to a pre-developed recipe which has taken this into account avoids mistakenly putting an ingredient in which actually contains nut traces – and serving it up to a patient with nut allergies. That could really be a fatal mistake.
On top of ensuring that food isn’t going to make patients more ill, this is also avoids nightmare PR situations where hospital reputations can be damaged. Informing food consumers about potential allergens is now a legal requirement.
Creating better, more consistent hospital food
Alongside cost, nutrition is probably the most important thing in hospital catering. By using standardised recipes dietitians can get a clearer insight into the current nutritional value of meals. This means they can start to monitor and develop recipes with the right kind of nutrition for particular patients whilst taking into account what is appropriate for different groups of patients.
Of course, this has to be considered in practical terms recognising that if food isn’t appetising or familiar to a patient then they’re not going to eat it. Obviously, eating no food = zero nutritional value. So creating the right kind of food for hospitals isn’t as simple as just creating healthy food, it takes thought and familiarity with different kinds of cuisine to make something both appealing and nutritious.
There’s no reason why hospitals couldn’t have a reputation for serving great food, but part of this is being able to consistently serve up quality food. There’s nothing more disappointing than choosing a dish because you loved it so much the first time you had it, only to find it’s completely changed the next time you have it.
Standardised recipes does not mean inflexibility:
Standardised recipes are able to account for the differing food requirements of different types of patients. By using menu cards that can sit on system, you can easily edit a recipe for renal patients, vegans, halal diets or gluten-free requirements, or whatever you need.
What do the experts say?
From our point of view, standardised recipes are a no-brainer, but we wanted to talk to people in the NHS and further afield in the catering industry to find out whether standardised recipes are really suitable to meet the challenges of hospital catering. What we found is that using standardised recipes is generally considered best practice.
Philip Shelley, National Chairman of the Hospital Caterers Association (HCA):
‘The most important thing to remember is that patients have a huge variety of needs – there is no one size fits all menu. So when it comes to standardised recipes this shouldn’t be translated into a case for restricting the variety on a menu (of course, this is restricted by a host of other factors too).
‘That being said, I would absolutely advocate a standardised menu. Where I work we use a combination of food from contracted suppliers and an in-house kitchen. In-house we make a variety of tasty soups, sandwiches and salads – lessons learnt from James Martin’s ‘Operation Hospital Food ‘campaign. We couldn’t do this efficiently without standardised recipes.
‘If you want to run a financially and nutritionally driven hospital you have to know what is in the recipes. Standardised recipes are part and parcel of running a business, and in the NHS’s current form, you must run a hospital as a business when it comes to catering.’
Iain Bowers, Guy’s and St Thomas’ NHS Foundation Trust:
‘We have used standardised recipes for many years: they are the corner stone of what we do here at Guy’s and St Thomas’ production kitchen.
‘We produce in the region of 3,000 meals each day and it’s unimaginable we would achieve this safely, to the required standards and as cost effectively as we do without them.
‘In addition, they allow us to plan the best use for our equipment and skills so we can continually produce to the high levels we know our patients and visitors expect.’
Alex Briggs, Food Operations Manager at Interserve:
Interserve provides catering to a wide variety of sectors including healthcare. For Alex Briggs, is the purchasing power that standardised recipes can provide which makes the most compelling case:
‘A big advantage of standardised recipes is better purchasing. If a recipe identifies a specific product from a specific supplier everyone will order the same thing and ultimately you get a better price’
‘Ingredients are likely to have more than one supplier. If orders are generated ad hoc rather than to support standardised recipes people will order from different places, often the most convenient supplier is the most expensive so the purchasing advantage is totally diluted’
‘For me this is one of the strongest commercial reasons for standardised recipes that include specific supplier ingredients.’
What can we learn from restaurant brands?
The unique challenges of the NHS mean that you can’t simply overlay private sector practices and expect success, but there are some instances where looking to the commercial world can shed light on how things could be improved in the public sector.
It’s not wholly inappropriate to compare a restaurant chain to the behemoth of NHS catering, not in the least because the two are trying to keep costs down, provide a quality service and serve a lot of customers.
For this reason we got in touch with one of our customers, YO!Sushi to find out what standardised recipes mean to them. This is what they had to say:
Mike Lewis, YO!Sushi:
‘Standardised recipes are the foundation of restaurant chains. There is no way we could make a profit without knowing what was going into our food and without providing our customer with a consistent experience. If you want to stay at the front of the catering industry you also need to be giving your customers nutritional information. How can you do this if you don’t know what’s going into your food from one day to the next?’
‘Running our business without standardised recipes is unthinkable.’
What’s stopping the NHS from implementing standardised recipes’ Fretwell-Downing’s case for using software
So far we’ve been talking about standardised recipes without touching much on software. Since we sell software, it won’t come as a surprise that we advocate using standardised recipes in the context of a software system. But that’s also because there’s a really strong argument for using it in this case, and it’s great to be able to say with confidence that our product can help to do some good in hospitals. It’s an exciting thing for us.
The reason we want to talk about software here is that it can take all the benefits of standardised recipes a little bit further. In theory, you could use standardisation with computers – manually writing formalised recipes, figuring out cost and nutritional content from packaging and a bit of maths, and trusting labelling for allergen content. Excel spreadsheets galore!
But this route is never going to save you time. In fact, we suspect (though this is anecdotal) that a primary motivator for not moving to standardisation, and not monitoring costs and nutrition properly is that – without software – it’s a huge amount of work, and some hospitals and trusts simply don’t have the time and resources to do this. The great thing about Saffron is that it produces all the metrics for you automatically.
This is what a recipe card looks like:
And here’s how the nutritional and allergen information is presented:
Do you have an idea for a new recipe but need to assess these metrics before it’s rolled out’ Simple – then you can simply add the card to the system and the metrics will be there immediately. It’s also incredibly easy to tweak a recipe, for example to take out a dairy product and replace it with something else. Then you can save your recipe – lasagne (vegan); lasagne (vegetarian); lasagne (gluten-free) and so on, to make it really easy for your caterers to access the recipes for particular diets.
We’ve mentioned linking up your stock to the actual meals being ordered as integral to really harnessing the potential of standardised recipes. This is where savings and consistent quality can really be made. When you’re ordering food according to meal number requirements, then you won’t waste stock or have to make recipes from awkward remnant produce amounts, instead of what the patients and staff really need and want. Want to learn more about a patient ordering system’ Then take a look at our product page.
So to conclude, if you work in a hospital that isn’t using standardised recipes at the moment, it could be time to consider introducing them (the easy way: with software!). The benefits really are substantial, so can you afford not to?