Food and nutrition

Where you can make a positive impact towards net zero

AHPs and their teams should reduce the carbon impact from food waste by:

  • Considering how your actions and services are impacting on meal-times and patient appetite. If a patient is scheduled for medical imaging and is required to be nil by mouth, has this been communicated to the catering team? Are you undertaking a procedure or providing drugs that are likely to suppress appetite?
  • Considering moving to “assisted mealtimes”, rather than simply “protected mealtimes”, to ensure adequate support and encouragement for patients to eat well.
  • Supporting other health and care professions, including housekeeping, carers, ward hosts and healthcare assistants to contribute to this agenda. They will have significant contact time with patients, and many will already be at the heart of attempts to improve nutrition uptake and reduce waste.
  • Using menu planning, which can play an important role in reducing food waste. Dietitians in particular should play a key role in ensuring that menus provide appropriate portion sizes, are not overly complex and minimise packaging waste. The BDA Food Services Specialist Group Nutrition and Hydration Digest has detailed guidance on menu planning and design.
  • Seeking to identify causes of food waste or consider conducting a ward-level food waste audit. Feed back any potential causes to management, which could range from the food itself, to provision, process or communication e.g. large portion sizes for a particular meal, dissatisfaction with meal choice, difficulty using cutlery, misunderstanding of menu etc.
  • Promoting good practice among staff to avoid patient and staff food waste.

AHPs in leadership or management roles should:

  • Use technology tools to reduce food waste. Implementing and supporting electronic ordering systems has been shown to improve intake and patients’ satisfaction while reducing wasted food. Technology can also be used to more effectively measure and monitor waste and food consumption.
  • Encourage consistent practice of measuring food waste at ward level, either through a separate food waste bin, or via a specific food waste processing technology. Understanding the amount of food wasted can incentivise collective action from staff and management, for health, ethical, environmental and financial reasons.

Cartoon image of a group of healthcare professionals sitting at a table and eatingThe impact of our food systems

Globally, nine of the top fifteen risk factors for morbidity, including high body mass index (BMI), high blood pressure, cardiac disease, diabetes and malnutrition, are associated with poor diet.

Two-thirds of the British adult population are overweight, and 27% are living with obesity. The effects of poor diet are unevenly distributed, with individuals from the lowest socioeconomic areas having double the prevalence of obesity, compared to the least deprived (36% compared to 20%). Fruit and vegetable consumption also follow a social gradient, with adults and children in the lowest income decile eating, on average, 42% less fruit and vegetables than recommended.

The NHS in England provides 140 million inpatient meals per year, spending £633 million on inpatient food provision. The retail revenue in hospitals, most of which is from food and drink sales, is estimated at £2-3 billion a year. The NHS in England prescribes over 300,000 Oral Nutritional Supplements(ONS).

The link between food, health, and climate change is clear. Food is responsible for around one quarter of the UK’s carbon footprint, predominately from fertiliser use, livestock food production and food waste. It is estimated that food and catering services in the NHS produces 1,543 ktCO2e – each year, which make up around 6% of the NHS’s total emissions.

Reducing food waste and promoting healthy and low carbon diets, high in seasonal fruit and vegetables, beans, pulses and other lower carbon sources of protein, will help bring health benefits as well as carbon emissions reduction.

AHPs, including dietitians, occupational therapists and speech and language therapists, will interact with the food system in various ways and have a unique opportunity to be agents for change.

Food is an important part of an individual’s recovery and health. Many AHPs will work with vulnerable patients and a range of communities, and not every approach to sustainability will be appropriate or applicable. This section explains how we believe AHPs can contribute to the green agenda in relation to food within the NHS and wider health and care settings.

Food waste

9.5 million tonnes of all food produced is spoiled or wasted in the UK every year. Some of this is an avoidable waste of resources and produces ‘unnecessary’ emissions. WRAP estimates that up to 18% of food in hospitals may be wasted (equivalent to 1 in every 6 meals wasted). All the carbon emissions generated through growing, transporting and preparing a meal is wasted when it is thrown away. Food that is not eaten also has no nutritional value and is not supporting a patient’s recovery. Research has shown that reducing food waste is a key means of addressing the environmental impact of food in health and care settings.

Examples – Occupational therapists and speech and language therapists

Occupational therapists should consider the physical and psychosocial reasons for food waste, making recommendations where appropriate such as adaptive cutlery or routine eating behaviours. Meal planning and assessment should be incorporated in assessing for discharge.

Speech and language therapists can provide recommendations to ensure safe swallowing and to optimise nutrition and hydration.

In a hospital setting, AHPs, where possible, should also consider how they can directly support patients to eat as part of their practice in order to improve nutritional status and reduce food waste. Protected mealtimes are widely used within the NHS and care homes, but for many AHPs this is a point at which they leave so as to minimise disruption. Instead consider how you could use your skills to support patients to eat better and waste less. Many AHPs can (and already do) play a role here.

Examples – Dietitians and physiotherapists

Dietitians could lead and encourage good mealtime practices by remaining on their wards at lunchtime. This also provides an opportunity to review first-hand how their patients are managing at mealtimes so they can tailor the nutrition support provided.

Physiotherapists can identify and support patients to sit out at mealtimes. Good positioning aids digestion and likely reduces aspiration risk. Mealtimes provide an opportunity to get a patient moving.

Packaging waste

Recycling has become a common part of life for many of us, and the “5 Rs” (Reduce, Reuse, Reprocess, Renewable, Recyclable) also apply to food packaging (see link to 5Rs explanation in equipment section). However, it can seem that we leave this approach at the door when we go to work. Although patient needs and safety must always be a top priority, AHPs like all health and care staff can do more to reduce packaging waste whether it is recycled or goes to landfill.

Prescribed food or nutrition products (such as ONS) are a significant source of waste both in terms of packaging and money for health services when they are prescribed inappropriately. These products are used widely in hospitals, often as a cheap and easy alternative to meeting a patient’s nutritional requirements when malnourished. Dietitians in particular can play a key role in ensuring more appropriate ONS prescribing practice, in both hospitals and community/primary care settings. This may include reducing or changing the form of ONS provided, adopting a “food first” approach or making simple changes like trialling ONS with a patient for palatability.

All AHPs should be encouraging good hydration and may need to provide fluids as part of treatment. Reusable containers are a key means of reducing plastic waste.

Example – Bladder filling protocols

The bladder filling protocols for certain pelvic radiotherapy regimes and diagnostic imaging examinations have the potential to greatly impact the carbon footprint of a department. A bladder filling regime of 500ml for a 20-fraction prostate radiotherapy course could result in over sixty plastic cups being deposited in landfill per patient. Encouraging patients to bring a reusable bottle to each appointment could have a positive impact.