The NHS encourages hospitals to improve aspects of their work by offering financial incentives under a scheme known as “Commissioning for Quality and Innovation” (CQUIN). One of the aspects covered in the “improving staff health and wellbeing” section in the CQUIN for 2017-2019 is the provision of healthy food for staff and visitors. The requirements for this will apply to all sites providing food in hospitals, including cafes, shops, kiosks and vending machines.
This document will help operators in the supply of food and drink to hospitals and will recommend the types of product that will be suitable.
The health and wellbeing CQUIN for 2016/2017 banned the advertising and promotion of products high in salt, fat and sugar from all points of sale in hospitals. It also required that healthy options be available at all times including for those working nights. The health and wellbeing CQUIN for 2017/2018 builds on this by requiring that:
- 70% of drink products must be sugar free (less than 5 grams of sugar per 100ml)
- 60% of confectionery does not exceed 250 calories
- At least 60% of sandwiches and other savoury products contain 400 kcal or less and less than 5g saturated fat per 100g
In the health and wellbeing CQUIN for 2018/2019 these figures are increased to 80%, 80% and 75%.
However, the NHS has consulted on further restrictions on the sale of sugary drinks and decided to require suppliers to sign up to a voluntary commitment by the 30th July 2017. This commitment is to reduce the sale of sugary drinks to a maximum of 10% per sales outlet by March 2018 with the intention of banning the sale of such drinks entirely by 1 July 2018. While the initial commitment is voluntary, the ban would be implemented by changing the terms of the NHS standard contract. The voluntary commitment also requires vendors to report quarterly sales figures to demonstrate that sales are achieving the required target.
It is important to discuss the range of products to be placed in machines with each hospital as some trusts may choose to go further than the standards set. For example, some hospitals have already chosen to ban the sale of soft drinks containing sugar entirely and have also banned the sale of chocolate bars near children’s wards.
Guidance on Compliance
The definition of drinks includes water, fruit drinks and milk drinks. Each product must not contain more than 5g per 100ml of added sugar, but the sugar that is naturally present in fruit drinks is not included. Milk drinks, containing more than 50% milk, are allowed to contain up to 10g per 100ml added sugar, while those containing less than 50% milk are included with sugary drinks and limited to 5g per 100ml added sugar. Many manufacturers have already responded to the demand for lower sugar products and a wide range of products are available that comply with this requirement. Water, both still and carbonated, is permitted, and actively encouraged in all hospitals.
Fruit juice and fruit juice-based drinks are permitted as long as they do not contain more than 5 g per 100ml added sugar. There are a number of brands available of both juice and juice drinks with around 50% juice. Smoothies are also permitted as long as they contain less than 5 g per 100ml added sugar.
Manufacturers of milk drinks have also taken steps to provide products that comply with the requirements and a number of suitable products are available.
The quantity of sugar per 100ml is given in the nutritional declaration on the pack.
All of the wholesalers to the industry will stock a range of suitable products.
Many manufacturers have changed the size of their products to fall under the 250kcal limit. The calorie content of the product is given in the nutritional declaration on the pack. Having a nutrition panel became a legal requirement, even for small manufacturers, in December 2016 so the information should be readily available.
If you operate fresh food machines you will need to talk to your supplier to ensure your offering complies with the requirements. Major sandwich providers, such as Marks and Spencer, are already providing sandwiches that contain fewer than 400 kcals per serving but smaller manufacturers may find this a challenge as they may not have the resources available to be able to calculate the nutrient content of their products. However, software is readily available to allow them to do this. If you are selling food in a hospital, it will expect you to be able to prove that your sandwich offering complies. There is no allowance in this requirement for purchasers from small manufacturers so if your supplier is unwilling to provide the information, you may need to change supplier.
While the health and wellbeing CQUIN does not include savoury products, many hospitals will look to the Government Buying Standards, which do include savoury snacks, for guidance. These standards require savoury snacks to be available in packs of 30 grams or less. An increasing number of suppliers now offer products in packs of less than 30 grams. The range available includes:
- baked crisps
- lentil curls
- oat crackers and biscuits
- lower fat fried crisps
- rice cakes
- bread sticks
Individual hospitals may have additional requirements than the CQUIN, for example some specify that no sugar sweetened soft drinks at all should be stocked or that semi-skimmed milk should be available.
If the specification requires the vending operator to provide chilled food, a suitable range might include:
- Filled rolls, wraps, baguettes & sandwiches
- Pasta, noodle or rice pots
- Couscous and quinoa pots (add water)
- Salad Pots
- Bread Sticks & crudities
- Crackers & Cheese
- Fresh Fruit
- Fruit Pots
- Fromage frais
Most of the drink products and many of the confectionery products will be readily available retail brands with which customers will be familiar. However, if you are introducing new products it may be good to arrange a sampling so that customers can try the products. This will also allow the hospital to gauge customer reaction and likely sales. It may also help to talk to a hospital dietitian about the selection of products. It is known that people tend to buy products in the middle of the machine so it may be beneficial to put the healthier products in the centre of the machine with other products in the outer spirals.