HSC Nutritional Standards: introduction

The National Diet and Nutrition Survey data for Northern Ireland reveals that overall the population consumes too much saturated fat and added sugar and not enough fruit, vegetables, oily fish or fibre, compared with current government recommendations. Concern about dietary salt intake remains and levels of obesity continue to rise: 65 per cent of adults and 25 per cent of children in Northern Ireland were overweight or obese in 2019, Department of Health, Health Survey Northern Ireland First Results 2019 to 2020.

The significant role of the workplace and employers in promoting healthier lifestyles and supporting staff to adopt and maintain better nutritional and other choices is increasingly recognised. As a major employer throughout the United Kingdom (UK), the Health Service should promote and protect health and lead by setting an example to employers in both public and private sectors.

In NI there is much valuable work being done locally within Health and Social Care (HSC) Trusts to promote healthier eating in the workplace and encourage appropriate lifestyle choices. Designing healthier menus, displaying calories on menus and implementing vending policies are some examples of this.

To further support this work, and in line with key objectives of the regional obesity prevention strategy, “A Fitter Future for All”, the Public Health Agency, the Food Standards Agency and safefood, in partnership with HSC colleagues, developed Nutritional Standards for catering in HSC settings in Northern Ireland. These Standards aim to support the provision of healthy, affordable and sustainable food choices for staff and visitors in HSC settings. These Standards can also be adopted for use by the wider public sector

 

A graphic showing rates of obesity and overweight in NI

Development of the Standards

This included the “Government Buying Standards for Food and Catering Services” (to note the Government Buying Standards published by the Department for Environment and Rural Affairs were republished in 2021) and the supporting resource Public Health England's “Healthier and More Sustainable Catering Toolkit” in England, the Scottish Government and National Health Service (NHS) Health Scotland’s Healthy Living Award, and the voluntary guidance on healthy food and drink choices for staff and visitors (Welsh Government, Supporting Healthy Food and Drink Choices for Staff and Visitors in Hospital 2011) and the Corporate Health Standard award in Wales, A Quality Framework and Award for Health and Well-being in the Workplace, 2016.

These initiatives were considered by the Working Group and, in conjunction with public health, nutrition and dietetics, catering and procurement specialists from across the region, were adapted for use in Northern Ireland.

The Nutritional Standards for catering in HSC have been modelled on the Eatwell Guide and based on the Public Health England (now Office for Health Improvement and Disparities) publication “Healthier and More Sustainable Catering: A Toolkit for Serving Food to Adults”. The authors wish to thank colleagues in the Office for Health Improvement and Disparities for permission to use and adapt the toolkit used in England, and for support and advice, particularly Dr Louis Levy, and many thanks also to Jane Crossley, Department of Health.

The authors also wish to acknowledge colleagues in the Scottish Government and Food Standards Scotland for sharing their knowledge and experiences acquired through implementing the Healthy Living Award and Healthcare Retail Standard, particularly Anne Lee, NHS Health Scotland.

Acknowledgement is also extended to our colleagues in Wales, in particular Judith John, Consultant Dietitian in Public Health for the Welsh Government, for insight and information relating to the Corporate Health Standards for Wales, and to Jessica Bearman, Lead Dietitian for Procurement, NHS Wales.

The Working Group that progressed the review also wishes to acknowledge the support provided by Margaret O’Neill and the Health Service Executive in the Republic of Ireland Healthier Food Environment Advisory Group.

Implementation and application of the Standards

The PHA, FSA and safefood, in partnership with HSC colleagues, have developed and are supporting implementation of the Nutritional Standards in catering for staff and visitors in HSC settings. (The Standards do not apply to patient food and beverage provision because there are already standards in place for food and beverages served to patients).

These Standards will be of interest to staff involved in catering and menu planning, along with those involved in food contract specifications, procurement and dietetics.

These Standards apply to all facilities serving food or beverages within HSC settings. This includes catering facilities, privately owned retail units and vending machines.

The Standards should be adhered to when food contracts are being specified in procurement processes (the sourcing, buying and provision or tendering process) and should also be applied when planning menus and serving food.

The Food Standards Agency are working in partnership with District Councils to develop nutritional standards for use in council catering establishments. This will include nutritional standards, vending standards and procurement guidance. The outcomes of this work will help to inform implementation beyond HSC settings, with the aim of rolling out Nutritional Standards across the wider public sector in Northern Ireland.

Food-based standards

The Nutritional Standards for catering in HSC settings are food-based standards that have been developed around the Eatwell Guide. Government recommendations for a healthy, balanced diet are reflected in the Guide. The FSA in Northern Ireland launched the refreshed Eatwell Guide locally on 17th March 2016. It replaces the Eatwell Plate, which has been providing guidance since 2007. The Eatwell Guide reflects updated dietary recommendations on consumption of sugar, fibre and starchy carbohydrates from the Scientific Advisory Committee on Nutrition’s report “Carbohydrates and Health”, published in 2015.

The Eatwell Guide

The Guide focuses on the following:

• eat at least five portions of a variety of fruit and vegetables every day
• base meals on potatoes, bread, rice, pasta or other starchy carbohydrates, choosing wholegrain versions where possible
• have some dairy or dairy alternatives (such as soya, rice or nut drinks), choosing lower fat and lower sugar options (and calcium-fortified dairy alternative options)
• eat some beans, pulses, fish, eggs, meat and other proteins (including two portions of fish every week, one of which should be oily)
• choose unsaturated oils and spreads and eat these in small amounts
• drink six to eight cups or glasses of fluid a day
• if consuming foods and drinks high in fat, salt or sugar, have these less often and in small amounts
• In addition to these messages, consumers are reminded to eat less salt (no more than 6 grams a day for adults), to become more active and achieve a healthy weight; it is also very important not to skip breakfast

The Eatwell Guide also provides information on calorie guidelines for adults and on front-of-pack nutrition labelling. 

Additional information on the Eatwell Guide can be found on the FSA website.

Industry Guidance

Where industry guidance exists (for example, UK-wide salt targets and sugar reduction guidance for industry (11) it should be applied when procuring products across all categories. Any updates to these and any guidance that is published in the future should also be applied.

The following table helps support caterers by listing specific requirements that must be met before a nutrition or health claim can be applied to a product, for example “high fibre”, “low fat” or “sugar-free”.

Nutrition claims are only permitted if they are listed in the Annex of Regulation (EC) No 1924/2006, lastly amended by Regulation (EU) No 1047/2012.

Table 1: Nutrition and health claims*

*European Commission Nutrition Claims

Table 2: Definitions

Table 2 provides definitions of some of the terms used within the Nutritional Standards.