Enter and view: The Royal Free Hospital mealtime observational visit

Healthwatch Barnet carried out several observational visits at the Royal Free Hospital between February and April 2017. This was part of Healthwatch Barnet’s Enter and View schedule to investigate the food and mealtime support that was offered to patients in 7 wards at the Hampstead site.

Observations by the Enter and View representatives reported that: most patients and relatives were positive about care; the wards were clean; and patients were helped during mealtimes.

Negative observations were also made. Patients were not always aware of what the hand-wipes were for. There were some inconsistencies in the provision of meal services (green tick and menu systems); some wards did not have protected mealtimes in place; some patients found the menu either confusing to read, did not see a menu, or complained that portions were either too large or not sufficient. Some patients wanted to see more fruits, found some vegetables to be hard, had very limited options of vegetarian food, and that ingredients were not always made available. Very few patients were aware that snacks were available between meals. Some food was not covered which could make warm food cold when served; some patients felt they needed more information and menu options to support special diets for their health conditions; Healthwatch team was refused a visit to one of the wards due to a misunderstanding within the hospital management and the ward staff had not been informed, for which the hospital apologised.

Healthwatch Barnet made the following recommendations:

1) Ensure that protected mealtimes are operated effectively and adhered to on all wards

2) Review if the green tick system is beneficial and if so ensure that it is used and operated consistently on all wards

3) Review the process of ordering/serving meals to ensure that all patients who wish to have sight of a menu and where possible preferred meals are available. This will ensure that all patients will be able to see details of ingredients in meals

4) Explore if it is possible for relatives/carers who are closely involved in their relative’s care, to support choices and portion sizes

5) Vary portion sizes individually according to personal needs and preferences

6) Ensure that hand wipes are available and opened for those who need that support

7) Ensure that all patients are aware of the snack menu and its availability

8) Ensure that the tea trolley is in operation after meals have been finished

9) Explore covering hot puddings when they are served to keep them hot until eaten

10) Consider the needs of patients requiring specialist diets

11) Review the quality of meals to try and improve their appeal, particularly considering provision of fresh fruit and vegetables

12) Ensure that staff are aware of Healthwatch and their statutory rights to undertake Enter and View visits to services

In response to the report, Healthwatch representatives met with the Director of Facilities, the Head of Patient Environment, a dietician and the catering manager, and agreed an action plan to improve mealtimes.