Enter and view: The Royal Free Hospital mealtime observational visit

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Summary of report content

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.

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General details

Report title 
Enter and view: The Royal Free Hospital mealtime observational visit
Local Healthwatch 
Healthwatch Barnet
Date of publication 
Wednesday, 30 August, 2017
Date evidence capture began 
Wednesday, 22 February, 2017
Date evidence capture finished 
Sunday, 23 April, 2017
Type of report 
Enter and view
Key themes 
Cleanliness hygiene and infection control
Continuity of care
Food and nutrition
Health and safety
Health promotion
Information providing
Quality of catering
Quality of staffing
Service delivery organisation and staffing
Staff levels
Healthwatch reference number 

Methodology and approach

Was the work undertaken at the request of another organisation? 
Primary research method used 
Structured interview
How was the information collected? 
Visit to provider
If an Enter and View methodology was applied, was the visit announced or unannounced? 

Details of health and care services included in the report

Secondary care services 
Acute services with overnight beds

Details of people who shared their views

Number of people who shared their views 
Age group 
All people 18 and over
Specific ethnicity if known 
Sexual orientation 
Does the information include public's views? 
Does the information include carer's, friend's or relative's views? 
Does the information include staff's views? 
Types of health and care professionals engaged 
All care professionals
Care / support workers
Service manager
Does the information include other people's views? 
What was the main sentiment of the people who shared their views? 

Outcomes and impact

Were recommendations made by local Healthwatch in the report? 
Does the information contain a response from a provider? 
Yes action has been taken or promised
Is there evidence of impact in the report? 
Is there evidence of impact external to the report? 
What type of impact was determined? 
Tangible Impact (cost related)

Network Impact
Relationships that exist locally, regionally, nationally have benefited from the work undertaken in the report
Implied Impact
Where it is implied that change may occur in the future as a result of Healthwatch work. This can be implied in a provider  response, press release or other source. Implied impact can become tangible impact once change has occurred.
Tangible Impact
There is evidence of change that can be directly attributed to Healthwatch work undertaken in the report.