Food safety policy

1 Introduction

The trust has a responsibility to ensure that all food that it provides to its patients, staff and visitors is safe to eat. Good hygiene, food safety practices and trained staff are vital in the preparation, storage, distribution and service of food. These matters may have a particular importance in a healthcare environment where food is served to vulnerable groups, and them being at a greater risk of acquiring food poisoning.

This policy outlines the trusts responsibilities and procedures that are required to demonstrate compliance with relevant food safety legislation and good practice, including:

The Food Safety Act (1990)
Regulation (EC) No 852/2004 on the hygiene of foodstuffs
The Food Safety and Hygiene (England) Regulations 2013
The EU Food Information for Consumers Regulation (number 1169/2011) The Food Information Regulations 2014
Managing food waste in the NHS
Care quality commission outcome 5 meeting nutritional needs
Hospital Caterers Association, good practice guide healthcare food and beverage service standards-guide to ward level services
Rotherham, Doncaster and South Humber NHS Trust Hazard Analysis of Critical Control Points (HACCP)

2 Purpose

The purpose of this policy is to provide clear definitions of responsibilities in relation to food safety and to ensure that the trust has considered the risks related to the provision of food and beverages on its premises. The trust has procedures to demonstrate compliance with relevant food safety legislation and good practice. The purpose of these is to ensure that:

all staff including catering staff, ward or department staff and managers understands the scope of their responsibilities in relation to food hygiene and food safety
all patients and consumers including those in vulnerable risk groups (babies, young children, the elderly, patient who are ill, expectant mothers and unborn babies, and those who are immunocompromised, for example, drug users) are provided with food that is safe
to minimise the risk of complaints or other action against the trust

It is the intention of the trust to ensure effective implementation of the following statements and to keep them under consideration in all aspects of resource management and decision-making.

The trust attaches the greatest importance to the health, safety and welfare of its patients, staff and other persons to whom the trust owes a duty of care.

The trust attaches a high priority to the safe provision of food.

The trust considers it essential that all staff should work together positively to deliver the safe and effective provision of food services to its patients, staff and others and where risks to health of all persons who it owes a duty of care are reduced to a reasonably practicable minimum.

The trust will provide training, information, procedures and safety equipment where appropriate.

3 Scope

This policy is applicable to all staff and volunteers involved in food ordering, food preparation, food production and food service, including facilities, nursing and multidisciplinary staff, for example, occupational therapists, rehabilitation staff.

Some of the activities associated with the management of food safety overlap with those of other trust policies and procedures. This policy does not specifically address issues of food nutrition and special dietary needs and general infection prevention and control issues.

This policy applies to any individual, group, company or other body which supplies food to be consumed on trust premises or where an area is managed by the trust.

4 Responsibilities, accountabilities and duties

4.1 The chief executive

The chief executive has overall accountability for ensuring that the trust complies with food hygiene and food safety regulations and that a policy is in place to reduce food safety related risks. The responsibility for implementation of procedures to mitigate against food safety risks is devolved to directors, heads of service, modern matrons and service managers.

4.2 Board of directors

The board of directors is responsible for having policies and procedures in place to support best practice, effective management, service delivery, management of associated risks and meet national and local legislation and or requirements in relation to food safety issues.

4.3 Care group directors, deputy care group directors, modern matrons and service managers

Care group directors, deputy care group directors, modern matrons and service managers have a key responsibility for ensuring that there is a proactive approach to organising, planning, controlling and reviewing health and safety. They have a responsibility to ensure that staff under their control is provided with suitable information, instruction, training and equipment in relation to all relevant health and safety matters which includes food hygiene and food safety.

Care group directors, deputy care group directors, modern matrons and service managers are responsible for ensuring that where food is handled in areas within their control that these areas have appropriate arrangements in place to reduce the risks related to food safety. Appropriate procedures described in section 5 of this policy should be introduced and maintained to reduce risks.

4.4 Head of estates and facilities

The head of estates and facilities has the delegated responsibility for ensuring that all food safety standards are developed, implemented and maintained for all areas under the control of the estates and facilities function.

This responsibility is further delegated to the head of facilities and the catering manager.

4.5 Head of facilities

The head of facilities has the delegated responsibility for ensuring that all food safety standards under the control of the estates and facilities function are developed, implemented and maintained.

The head of facilities will act as a source of knowledge and act as trust lead on catering issues for the trust. These responsibilities are further delegated to the catering manager.

4.6 Catering manager

The catering manager has the delegated responsibility for ensuring that:

food safety standards are developed, implemented and maintained for all areas under the control of the estates and facilities function
all staff under their control complies with the procedures outlined in this policy and the locally developed hazard analysis of critical control points (HACCP) document

4.7 All staff involved in food handling

The definition of a food handler is anyone involved in the handling or preparation of food products and beverages. This includes such groups as catering staff, domestic or support services assistants, nursing staff, care staff, therapy staff, volunteers etc. It is imperative that the food safety policy is brought to the attention of all these groups of people within the trust.

5 Procedure or implementation

Food safety requires suitable conditions and managed activities in order to maintain a hygienic environment which keeps food safety risks under control.

The trust’s catering services department is committed to identify potential food hazards in areas within its control and to implement effective control and monitoring procedures at those points critical to food safety.

All staff involved in food handling, preparation and or serving shall be appropriately trained and shall follow all agreed local procedures.

5.1 Reputable suppliers

All food products and catering equipment are to be purchased in line with the trusts standing financial instructions. All suppliers must be on the NHS purchasing framework. Details of all approved suppliers are to be documented in the catering HACCP document.

All approved suppliers are aware of the trusts catering service critical control points relating to temperatures, delivery schedules, quality and standards. The catering manager has the autonomy to reject deliveries should the supplier fail to maintain the critical control points upon delivery.

All purchases of food products are recorded on the trusts purchase ledger systems. Delivery notes are confirmed against invoicing to allow for product traceability.

Any food items brought into the organisation for patient consumption by the patient or by family or friends must be recorded in the patient’s notes so that traceability of items eaten can be carried out in the event of suspected food poisoning.

5.2 Food deliveries

All food deliveries from approved suppliers must be checked off against the consignment note before signing for receipt of goods. Food items which breach the critical control point (CCP) (refer to 5.3) or where the packaging is damaged, the items are contaminated, spoilt, date-expired, or unlabelled, must be rejected.

5.3 Food storage and temperature control

The storage of ambient, chilled and frozen food all have ‘critical control points’ (CCP) which must be adhered to.

The Food Safety and Hygiene (England) Regulations 2013 stipulates that it is a legal requirement that temperature checks are completed throughout the entire food chain from delivery to consumption. Handheld thermometers are typically used to verify temperatures at critical points in the process. A record of the temperature must be recorded in the appropriate log book which is located in individual ward or department kitchens.

The storage of food items must be as such to negate the risk of contamination from microbiological, physical, chemical and allergenic hazards. Regardless of the type of storage being used, it is essential that daily stock rotation is performed to ensure old stock which has reached its ‘use by’ date is disposed of appropriately. Where a food item displays a ‘best before date’, judgement is to be used to determine the quality and taste of the item whether it should be served.

5.3.1 Ambient food

Dry goods should be stored at temperatures ranging from 10C and 15C and in cool, dry conditions. Shelving should be easy to clean and non-absorbent. Spillages should be cleared up straight away to reduce the risk of cross contamination and the risks associated with attracting vermin and pests.

Non-food items, including cleaning equipment and chemicals, must not be stored in a dry food or goods store.

Dry goods require protection from:

low temperatures
damp
excessive heat
direct sunlight
pests

5.3.2 Refrigerated food

Refrigeration is a method of storage by which spoilage is delayed but not prevented. High risk foods should be given priority if space is limited and should be stored at the rear of the refrigerator and always above raw foods.

The use of refrigerators in ward kitchens is for the use of patient food items only. Food items brought in by the patient or family member can be stored in the refrigerator providing the food item is labelled with the patient name, the food is within date, and the items are suitably packaged. Once opened, all food items must be labelled with the date opened and used within the timescales indicated on the packaging. Under no circumstances must food be stored in a plastic carrier bag within the refrigerator due to the risk of cross contamination from the outer packaging.

The operating temperature of refrigeration units must be between 1C and 4C. Temperatures must be recorded daily in the catering log book which is located in every ward kitchen. Any variation on the safe temperature must be observed for a few minutes as it may have been that the door has been left open. If the temperature drops to the required limit, no further action is required. If the temperature remains outside the critical limits, then action should be taken. If the food temperature is less than 8C or cannot have been above 8C for more than 4 hours, it should be moved to another refrigerator and maintenance called to repair the refrigerator. If the food has been above 8C for more than 4 hours it should be discarded.

5.3.3 Frozen food

Freezer units located in ward kitchens are for patient meals only and the same principle of stock rotation must apply as for dry and chilled goods. Food stored in ward freezers should be date coded and disposed of if not used within a 3-month period. If the freezer does not defrost automatically, defrosting should take place at least once a week to ensure that there is no build-up of ice.

Freezers must operate at below -18C. Deliveries of frozen food items must be no higher than -15C if the items are to go back into freezer storage.

5.4 Product date codes

To ensure good stock rotation and compliance with the Food Labelling Regulations, all foods except unprepared and uncut fruit and vegetables, sugar, wine, salt, must be date coded.

Produce delivered by nominated suppliers will be date coded as part of the purchase specification.

Date codes are classified under two headings:

“use by” applied to highly perishable, “high risk” products such as cooked meats, dairy products
“best before” applied to perishable and non-perishable foods, for example, cereals and packed products, cans, bottles, usually with a shelf life of over three months

All products must be used before the expiry date and care must be taken when using products to check labelling instructions, which may indicate for example:

refrigerate after opening
use within three days of opening

It is an offence to have food in possession beyond its use by date

The rule first in, first out should always be applied.

Opened packs of food should be decanted into clean containers with close fitting lids, labelled and date coded. Any food items belonging to a patient must be date coded with their name and date the food was open.

A common fault found in most food premises is that food is poorly wrapped thus allowing contamination, oxidation and dehydration. All food should be stored in airtight packaging which is date coded.

5.5 Food preparation

5.5.1 Cross contamination and thawing of frozen food

It is important that frozen foods are allowed to defrost under controlled conditions, for example, in a refrigerator. This is to ensure that the bacterial loading is kept to a minimum whilst defrosting is thorough. If frozen foods, particularly poultry, are not thawed properly prior to cooking, then cooking may be inadequate, and bacteria could survive.

To ensure the safe defrosting of food and avoid cross contamination the steps outlined below should be taken:

remove external packaging and place in container
defrost food away from other high risk foods ideally in a thawing cabinet (12 to 15C)
clean and disinfect contaminated work surfaces, for example, chopping boards
leave for sufficient time until the product core is fully defrosted.
dispose of any raw juice carefully
cover defrosted food and put in refrigerator

5.5.2 Preparation surfaces and equipment

After each use, food preparation surfaces must be cleaned and disinfected to remove all loose food debris, washed down with an appropriate hot water and detergent solution, rinsed off prior to disinfecting and let to air dry. Food preparation equipment should also be cleaned and disinfected after each use.

5.5.3 Avoidance of cross contamination

To avoid cross contamination, it is important that the same equipment is not used for handling raw and high-risk products without being cleaned and disinfected. To prevent this from occurring it is recommended that different colours are used. Colour coding may be extended to include washing facilities, trolleys, protective clothing and packaging material.

5.6 Cooking of food

Cooking is a form of preservation but is generally used to make food more palatable. Internal temperatures of 75C or above should be achieved to ensure bacteriological safety; however, some bacteria do survive these temperatures.

The centre of cooked meat must be checked regularly with an accurate temperature probe which is always cleaned and disinfected before and after use. The external surface of a joint of meat, for example, may give the appearance of being thoroughly cooked, but the centre temperature may be quite low.

5.7 Serving of hot and cold foods

5.7.1 Regeneration (patient meals)

Patient meals are delivered to the wards by members of the catering team. The orders are picked from a freezer store in the main central production unit (CPU) and transported to the wards in insulated boxes approximately 2 hours prior to commencing the meal service. Hot dishes are cooked at ward level in the regeneration ovens, and cold dishes are stored in the adjoining chiller unit or ward refrigerator. The cooking cycle for hot dishes is 90 minutes and the ovens are programmed to cook the meals from frozen, to temperatures of 75C or above in time for the planned meal sitting.

The temperature of the cooked food must reach 75C before being served. If the temperature is not achieved, then the oven must be ‘boosted’ and food left in the ovens to continue cooking until the correct temperature is achieved.

It is the responsibility of the nominated food handler to ensure that food temperatures are checked using a calibrated temperature probe and recorded in the catering logbook.

All food intended for service on the day should be discarded if not served. It should not be saved for re-heating or served cold later on in the day.

5.7.2 Hot foods (retail outlets)

All hot hold food served from the ‘hot hold’ cabinets should be served at or above 63C. Where food is displayed, this must be for no longer than a period of 120 minutes. If food does not maintain the required temperature it should be discarded, under no circumstances should it be re-heated.

All food intended for service on the day should be discarded if not served. It should not be re-served the following day.

5.7.3 Chilled foods (patient meals and retail outlets)

All cold food should be served from a refrigeration unit or chilled display unit at a temperature of 8C or below. All perishable food intended for service on the day should be discarded if not served, it should not be re-served the following day.

5.7.4 Ready to eat foods served at ambient temperature

Ambient foods, including chilled foods such as sandwiches and salads which have been removed from the chiller unit for presentation for service, must be consumed or disposed of after three hours.

Chilled display units without a temperature control display must be treated as being at an ambient temperature and all foods displayed as such should be destroyed after three hours. This rule applies for food served at functions regardless of whether they have been prepared by the catering department or by other parties.

5.8 Personal hygiene

All food handlers have a moral and legal obligation to observe high standards of personal cleanliness. It is vitally important that all food handlers maintain a high standard of personal and general hygiene, to avoid the possibility of spreading infections, or causing food poisoning.

Food handlers must wash their hands regularly in a designated wash hand basin with liquid soap, warm running water and dried using disposable towels. Handwashing should take place as follows:

after visiting the toilet facilities
before handling any food or equipment
before and after any cleaning procedure
between different tasks
after touching ears, nose, mouth or hair
after any contact with patients or their immediate surroundings
after handling waste food or refuse
after handling any wrapped or unwrapped food, especially raw items
after eating

Cuts and abrasions must be covered by coloured waterproof dressings. The loss of a dressing must be reported immediately to the supervisor or person in charge. Waterproof dressings are necessary to prevent blood and bacteria contaminating the food and to prevent bacteria from food, especially raw meat or fish, as well as preventing the wound from getting infected which may turn septic.

Food and drink must not be consumed in any food preparation or ancillary area, including ward kitchens. Staff are not permitted to eat or drink food and beverages which are provided by the trust for patient consumption. Staff must consume their own food in the designated staff room or on site dining facilities.

Food handlers must adhere to the bare below the elbows (BBE) principle that work wear sleeves or cuffs and jewellery should not impede effective hand hygiene. Therefore:

no false nails, nail varnish, nail art, nail jewellery is to be worn
nails are to be kept short and scrupulously clean
no watches including physical activity trackers, for example, Fitbit to be worn
dermal piercings and anchors are not permitted anywhere on the hands, wrists or lower arms as this will impede hand hygiene and also provides a portal of entry for microbes
one plain ring is permissible

5.9 Food handler’s illness exclusion policy

It is a legal requirement for food handlers to advise their supervisor if they are suffering from diarrhoea or vomiting and or suspected food poisoning.

Food handlers must not engage in food handling until they have been symptom free for at least 48 hours.

In addition to this, food handlers must report to their supervisor if they have a throat infection, skin rash, boils or other skin lesions.

Supervisors must also be informed if:

any member of the household is suffering from diarrhoea or vomiting
they are returning to work after an illness involving diarrhoea or vomiting
they return to work after a holiday during which an attack of diarrhoea or vomiting lasting for two or more days was experienced

5.10 Clothing for food handlers

Food handlers must always wear appropriate clean clothing which is changed daily. Catering staff will be issued with uniforms and protective clothing on starting their employment with the trust. Other trust staff must wear disposable green aprons when working with food.

Fabric tabards may be worn in some circumstances and these must only be worn once and washed after each food handling session.

Catering staff are required to wear protective headwear to ensure that hair or dandruff does not contaminate food or surfaces. All food handlers must ensure that hair is clean and long hair is tied back, and off the collar when handling food.

Food handlers who work in food production who have beards are required to wear a beard covering for any growth over 5 days when working in food preparation areas. These can be obtained by the service manager.

Outdoor and work wear clothing are to be kept separate. Protective clothing should not be worn travelling to and from work and must be removed prior to using the toilet.

Footwear must be of a sensible, sturdy, low heeled and enclosed type and must be kept clean.

Authorised visitors to ward kitchens must comply with the above points

5.11 Cleaning

Daily cleaning schedules must be adhered to at all times and cleaning check lists completed and signed off by the appropriate person.

The cleaning of refrigeration units and ovens must take place on at least a weekly basis using food safe chemicals.

Spillages on surfaces, floors, refrigerator and ovens should be cleaned as soon as possible after they occur.

After cleaning and disinfecting, the surfaces need to be completely dried.

5.12 Equipment maintenance

All equipment used in connection with the transportation, storage, production and service of food must be in good repair and condition. Maintenance of such equipment is an integral component of management obligations. The trust is therefore committed to a pro-active and systematic assessment of equipment needs.

Old equipment which has deteriorated with age becomes incapable of being cleaned thoroughly. Cracked, chipped, broken and badly pitted equipment allows the harbourage of dirt and bacteria and must be replaced. String or tape must not be used to repair defective handles of knives or other equipment.

Refrigerators with circulation fans should be serviced on a regular basis, at least twice a year.

Any refrigeration and freezer unit which do not maintain the correct running temperatures must be reported to the estates department for immediate attention. The catering manager must be contacted for advice on what to do with food stocks whilst the unit is awaiting repair.

5.13 Handling and storage of waste

Refuse must not be allowed to accumulate in kitchens and must not be left overnight. Waste generated may be stored in polythene bags which must be removed at the end of each day or regularly throughout the day if they become full. The bags must not be overfilled and must be tied to prevent problems from pests and insects. The containers for such bags must be maintained in a clean condition and must be foot operated and staff must be aware of the need to wash their hands after using the receptacles. Receptacles used for the storage of food must not be used for refuse.

5.14 Pest control

With all forms of pest control, prevention is better than cure. Good housekeeping is essential. All spillages must be removed as soon as possible. All properties serving food must have a pest control contract in place. If there is any evidence of infestation from any pests the pest control contractor must be contacted immediately by calling the estates helpdesk on 01302 796059 or by logging onto Backtraq.

5.15 Catering for functions

All catering for trust functions should be provided by either the trust catering department or from a caterer who has provided the satisfactory documentary evidence of compliance with statutory requirements.

Charity cake bakes should ensure that risk assessments are undertaken to ensure any food safety risks are managed. There is a legal requirement to ensure all food allergens are declared on any food items that are purchased or served free of charge. Refer to 5.17 on allergens. To minimise the risk, avoid homemade food and encourage those donating to the event to purchase shop bought pre-packed items which has the ingredient and allergen lists attached. If items are removed from the packaging, the labels must be retained for information during the event and the allergen information placed against each item. Separate serving utensils must be used for each item, in particular any ‘allergen free’ items.

5.16 Patient food not supplied by the trust

This part of the policy sets down the procedure for any foods that are consumed by patients which are either made by patients in self-catering facilities or brought to the site by patients and visitors (including takeaway meals).

There is a recognition that visitors have, over many years, grown used to the custom of bringing ‘treats’ for their relatives in hospital. In addition patients in some units are able to buy food for themselves on trips away from the hospital. Many of the foods concerned do not present a ‘food hygiene risk’; a good example is fresh fruit.

There are other items such as chilled foods and short ‘shelf life’ foods that need to be controlled.

5.16.1 Low risk foods

Fresh fruit, biscuits, sugar based sweets and chocolate can be stored in the patient’s lockers in suitable containers and monitored daily by nursing staff. Canned food should have a designated area in the ward kitchen.

5.16.2 High risk foods

High-risk foods are usually those which contain protein and are intended for consumption without treatment which would destroy such organisms, for example:

all cooked meat and poultry
cooked meat products including gravy and stock
milk, cream, artificial cream, custards and dairy produce
cooked eggs and products made with raw eggs, for example mayonnaise
shellfish and other seafood, for example, oysters VI. cooked rice

Nursing staff must monitor these items and they must be labelled with the patient’s name and stored in the ward fridge until consumed or until the ‘use by’ date, after which they must be disposed of. Any food that has been prepared at home by visitors or others, such as soups, casseroles, sandwiches, cakes etc. should be labelled with the patient’s name and date and placed in a refrigeration unit until ready for eating. Such items must be consumed on the date prepared. When reheating soups and casseroles etc. refer to section 5.16.4.

5.16.3 Take away or fast food

Patients may purchase take away meals for their own consumption. If orders are placed for delivery, it is advisable that only known reputable take away facilities are used. Before considering which take away facility to use, it is advisable to look at the food hygiene ratings at food ratings website (opens in new window) A score of 5 is the highest rating achievable and would be the preferred choice when ordering take away food.

A record of any meals brought into the trust from an external provider must be recorded on the patient’s records for traceability purposes.

5.16.4 The reheating (microwaving) of meals

Under no circumstances must food prepared by the trust catering department be re-heated in a microwave.

It is recognised that occasionally relatives may wish to bring in home cooked meals or shop bought ready meals into the hospital for their relatives. This practice should be discouraged, but in circumstances where this would benefit the patient’s care the following must be adhered to:

the food items must be stored in a refrigeration unit until the time it is ready for being consumed
the food items can be microwaved following the instructions given on the pre-packed food
for food items which have been homemade, the heating process should be such that the food is piping hot throughout before serving and to have reached a core temperature of 75C
a record of the food items must be recorded on the food temperature log sheets giving an item description, the source, and the temperature once re-heated

5.16.5 Staff food Items

These items must be labelled and stored in the staff fridge or cupboard and controlled by the staff. As far as possible these should be kept separately from patient foods.

It is good practice that fridge and storage cupboards are monitored to ensure all foods are stored safely.

Any breaches of procedure should be recorded and reported to the manager of the area concerned and all ‘high risk foods’ beyond the ‘use by’ date must be disposed of immediately.

Food brought in from outside the hospital must not be stored in cupboards or refrigerators in plastic carrier bags, as these pose a risk of further contamination.

5.17 Allergen awareness

The EU Food Information for Consumers Regulation came into force in 2014.

Allergenic ingredients must be identified in the list of ingredients. There are 14 specified allergens covered by the Regulations which are shown below:

cereals containing gluten such as wheat, barley, oats, spelt
milk including lactose
eggs
peanuts
nuts such as almonds, hazelnuts, walnuts, cashews, Brazil nuts
fish
crustaceans for example prawns, crabs, lobster, crayfish
molluscs for example mussels, whelks, oysters, squid
soya
celery
mustard
sesame seeds
sulphur Dioxide (greater than 10mg/kg or 10mg/l) sulphites (found in some pickles and preservatives)
lupin

All persons who handle or serve food in the organisation must fully understand the legal requirements and what is expected of them. This includes the following:

knowledge of the food items ingredients and whether they contain a known allergen

know how to find out what the ingredients are and whether the food items contain a known allergen

With effect from the 1 October 2021, Natasha’s Law stipulates that any pre-packed food must have clear labelling which states the full list of ingredients (by order of weight) with any allergenic ingredients clearly stated in bold.

For more information and advice on food allergies and labelling the following websites may be accessed:

5.17.1 What to do if someone has an allergic reaction to food?

A food allergy is the term used to refer to an immunological reaction to food or drink. When someone has an allergy they can have many different physical reactions when exposed to allergens. When someone has a severe reaction to an allergen, it could potentially lead to that person collapsing and going into anaphylactic shock, which could result in death, and this can occur within minutes. If this happens seek medical attention immediately

5.17.2 Providing consumers with allergen Information

Information on allergenic ingredients must be either:

provided up front (for example on a menu, menu board or food packaging) without the customer having to ask for information
sign-posted to where written information can be found or obtained from a staff member

If information on allergenic ingredients is provided orally, this must be consistent and verifiable (for example, a business must have processes in place to capture information from recipes or ingredients lists from products bought in, and make this available to staff).

The section below is relevant for businesses that have a direct interaction with their customers.

It is important that customers with food allergies or intolerances are able to make informed choices when choosing products. All staff serving customers should be made aware of the potential risks to customer’s health if incorrect advice is given. A process must be in place to ensure that allergen information can be easily obtained and is both accurate and consistent.

Patients are strongly advised to speak to staff regarding their allergy requirements. If a member of staff is unsure of the answer to a customer’s question, they must find the information.

The change in the law means food handlers can no longer say they don’t know what allergens are in the food they serve.

Ward staff should discourage family members from bringing in food and should discourage patients from sharing food, as they may not be aware of another patient’s allergies or intolerance.

6 Training implications

6.1 Training for food handlers

It is a legal requirement for food business operations to ensure that food handlers are supervised and instructed on or trained in food hygiene matters commensurate with their work activity.

All staff and volunteers who handle food shall be trained in food hygiene standards (level 2) on a three yearly basis and be made aware of the procedures outlined in this policy. Best practice is for all catering staff and food handlers to complete on-line yearly food hygiene refresher training.

In areas where staff are provided with the facilities to prepare meals and beverages for or with patients, all staff preparing food should be provided with appropriate training.

6.2 Food hygiene training level 2 to all food handlers

How often should this be undertaken: Every 3 years.
Length of training: 1 day.
Delivery method: Classroom based.
Training delivered by whom: Head of facilities.
Where are the records of attendance held: ESR plus personal file.

6.3 Food hygiene training refresher or update

How often should this be undertaken: Every 12 months.
Length of training: Variable.
Delivery method: Classroom based.
Training delivered by whom: Self-study online training.
Where are the records of attendance held: ESR plus personal file.

The trust will ensure that this policy is brought to the attention of all food handlers within the trust during training and refresher training. General awareness will be achieved by team brief, supervision and personal development reviews (PDRs).

This policy will also be regularly reviewed and updated in accordance with developments in legislation and with particular reference to identifying points that are critical to food safety.

7 Monitoring arrangements

Procedures shall be monitored as determined by Hazard Analysis Critical Control Points (HACCP) principles and reviewed on a six monthly basis or whenever a significant change occurs.

7.1 Compliance with policy

How: Audit.
Who: External consultant or EHO.
Reported to: Head of facilities.
Frequency: Yearly.

7.2 Compliance with HACCP

How: Internal monitoring and verification of temperature logs, cleaning records, production processes.
Who: Catering manager.
Reported to: Head of facilities.
Frequency: Ongoing.

7.3 Policy remains up-to-date

How: Monitoring of regulations and guidance.
Who: Head of facilities.
Reported to: Head of estates and facilities.
Frequency: Ongoing.

7.4 Patient owned food in ward fridges

How: Audit of fridges to check that open food items are labelled or date coded.
Who: Facilities monitoring officer.
Reported to: Trust compliance officer.
Frequency: Quarterly.

8 Equality impact assessment screening

To access the equality impact assessment for this policy, please email rdash.equalityanddiversity@nhs.net to request the document.

8.1 Privacy, dignity and respect

The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, ‘not just clinically but in terms of dignity and respect’.

As a consequence the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided).

8.1.1 How this will be met

No issues have been identified in relation to this policy.

8.2 Mental Capacity Act 2005

Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals’ capacity to participate in the decision-making process. Consequently, no intervention should be carried out without either the individual’s informed consent, or the powers included in a legal framework, or by order of the court.

Therefore, the trust is required to make sure that all staff working with individuals who use our service are familiar with the provisions within the Mental Capacity Act (2005). For this reason all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act (2005) to ensure that the rights of individual are protected and they are supported to make their own decisions where possible and that any decisions made on their behalf when they lack capacity are made in their best interests and least restrictive of their rights and freedoms.

8.2.1 How this will be met

All individuals involved in the implementation of this policy should do so in accordance with the guiding principles of the Mental Capacity Act 2005 (section 1).

9 Links to any other associated documents

Pest control policy
Infection prevention and control manual (IPC manual):
- hand hygiene procedure
- diarrhoea and or vomiting procedure
- outbreak of infection management procedure
- cleaning and decontamination of the environment and patient equipment procedures
Trust hazard analysis of critical control points (HACCP) procedural document

10 References

National Institute for Health and Clinical Excellence (2012) Prevention and control of healthcare associated infections in primary and community care. NICE clinical guideline 139.
Food Safety Act 1990.
Food Hygiene Regulations (England) 2013
Health and Safety at Work Act 1974.
HACCP manual, Hazard Analysis Critical Control Points Manual (Catering production areas internal document).
Guidance document on the implementation of certain provisions of Regulation (EC) 852/2004 on the hygiene of foodstuffs.
Guidance document on the implementation of procedures based on the HACCP principles, and facilitation of the implementation of the HACCP principles in certain food businesses.
Wilson, J. (2001) Infection control in clinical practice. London. Balliere Tindall.
Sprenger, R.A. (2017) Supervising Food Safety Level 3

11 Appendices

11.1 Appendix A Procedure for dealing with a suspected outbreak of food poisoning

Reference must be made to the trust’s diarrhoea or vomiting procedure and outbreak of infection management procedure (IPC manual). The information in this appendix is supplementary to these policies.

11.1.1 Background

Diarrhoea and vomiting can have many causes. Organisms causing diarrhoea and vomiting are spread by the faecal oral route. To become infected, one must ingest the organism. Most commonly this will result from unwashed hands being in contact with the mouth.

It is often assumed that when outbreaks of diarrhoea or vomiting occur that food poisoning is the cause. This is quite often not the case, but this policy refers to outbreaks of diarrhoea and vomiting where food has been implicated. Food poisoning may be defined as “an acute illness”, usually of sudden onset brought about by eating contaminates or poisonous food. The symptoms normally include one or more of the following: abdominal pain, with or without diarrhoea, vomiting and nausea. The incubation period is normally short (between one and 36 hours). The number of bacteria required to cause illness in the healthy adult is usually large and multiplication of bacteria normally occurs within the food. Sufferers usually recover in a few days but where body defences are low, more serious consequences may arise.

If a patient develops diarrhoea a stool specimen must be sent for microscopic culture and sensitivity.

If a member of staff reports that they are suffering from diarrhoea or vomiting please refer to the trust’s diarrhoea and vomiting procedure (IPC manual). They must inform the occupational health department who will advise the member of staff about obtaining a stool specimen.

The local environmental health office must be contacted in cases where food is implicated as the cause. The Infection Prevention and Control team will contact public health and the local environmental health department.

11.1.2 Declaring an outbreak

An outbreak of infection is defined as the occurrence of two or more related cases of the same infection, or where the number of infections is more than would normally be expected (Wilson, 2001).

The severity of an outbreak is graded according to several factors:

the number of patients affected
the type and virulence of the organism
the endemic status of the organism
the resources available and necessary to control an outbreak
the media interest

Some organisms, for example viral gastroenteritis, are usually managed without the need for the major outbreak control plan to be initiated. This decision is at the discretion of the infection control doctor or director of infection prevention and control (DIPC) or consultant in communicable disease control (CCDC) or chief executive (CE).

The Infection Prevention and Control team (IPCT) must be informed of any area that has two or more related cases of diarrhoea and vomiting. It is the responsibility of the IPCT, in conjunction with the senior management of the unit to investigate, and then institute the outbreak of infection procedure if necessary. They will manage the outbreak in the trust and related areas.

The head of facilities or catering manager must be informed of any persons purchasing food from, or eating at, the premises who complain that they have subsequently been ill.

The IPCT will contact the head of facilities or catering manager and state the location of the alleged incident and the name of the person reporting the incident.

11.1.3 Outbreak occurring during a weekend or bank holiday

If the suspected outbreak occurs during a weekend or bank holiday, the nurse in charge or unit manager must contact the director on call and in turn they should contact the on-call microbiologist or public health and the environmental health office immediately. It is also imperative that the head of estates and facilities is informed at this time and can be contacted via the switchboard. The IPCT will need to be informed of the incident as soon as normal working hours resume.

The head of facilities or catering manager should ensure that further meals or suspected food are not served from the premises concerned until the environmental health officer (EHO) has carried out a full investigation.

The IPCT will liaise with the local EHO who will carry out an immediate investigation of the premises where the suspected source of the food poisoning occurred. The manager or representative from that department should accompany the EHO during their inspection of the premises. The first priority of the EHO will be to establish whether the illness is foodborne and if so, prevent the spread.

In all cases of reported food poisoning the EHO has the responsibility to determine whether there has been a breach of hygiene regulations or the Food Safety Act. If the EHO believes there has been a breach of legislation they will lead the investigation, with the assistance of the head of facilities and catering manager and the IPCT. In some cases the officer may recommend that the premises be closed pending a thorough investigation. If the EHO is satisfied with the methods of food preparation and production, and believes there is no case for legal liability the IPCT will continue with an internal investigation. This will be performed in collaboration with the EHO.

The objectives of the investigation of an outbreak are:

to determine which pathogens, or chemical, was responsible
to trace all cases and carriers, especially those involved in food handling
to determine which stage of the food preparation allowed bacterial multiplication
to recommend how food should be prepared in the future to prevent recurrences and further spread

The ward managers will compile lists of all people (staff, patients and visitors) who have reported as suffering from the symptoms of food poisoning. Details of the symptoms and the names of the patients or visitors will then be presented to the IPCT. The list of staff must be presented to the occupational health department.

The IPCT will agree the mechanism of the collection of specimens and the nature of specimens to be collected. All staff involved in the preparation of the suspect food will also be required to produce faecal specimens. If any staff involved in the preparation of the suspect food has reported symptoms then the head of facilities or catering manager should ensure that they are suspended from duty pending advice from the occupational health department. It is the responsibility of the outbreak control or IPCT to analyse the results of the investigation, initiate necessary action and to declare the outbreak over.

A critical review of the cause, identification and management of any outbreak should be held as soon after the event to identify positive aspects and those areas which require improvement. Findings should be reported to the chief executive and senior management of the area involved.

Document control

Version: 4.1.
Unique reference number 184.
Approved by: Corporate policy assurance group.
Date approved: 28 December 2023.
Name of originator or author: Head of facilities.
Name of responsible committee or individual: Clinical quality and standards group.
Unique reference number: 5 January 2024.
Date issued: August 2024.
Target audience: All trust staff who handle food and their managers.

Page last reviewed: November 12, 2024
Next review due: November 12, 2025

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