A presentation by Jill Venables at the Department of Health Improving Hospital Food event. It outlines government buying standards for food and explains its implementation.

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Jill Venables, Head of Facilities
Achieving GBSF with
Patient Delivered Systems

2. J.Ven/NC/HEFMA 1:091012
Achieving GBSF with Patient Delivered Systems - Summary
What does GBS for food and catering services include? (DEFRA)
GBSF standards - additional considerations with Patient Meal Delivered Systems
Getting started, obtaining relevant information
GBSF menu engineering
Questions and concerns relating to GBSF
Cost effective menu engineering - Examples

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The GBS for food and catering services includes a suite of criteria covering three
areas of sustainable procurement:
Foods produced to higher sustainability standards - covering
issues such as a food produced to higher environmental standards, fish
from sustainable sources, seasonal fresh food, animal welfare and
ethical trading considerations.
Foods procured and served to higher nutritional standards -
to reduce salt, saturated fat and sugar and increase consumption of fibre,
fish and fruit and vegetables.
Procurement of catering operations to higher sustainability
standards - including equipment, waste and energy management.
What does Sustainability mean for food and catering services?
DEFRA, (2012)

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Impact
Area
Standard
Animal welfare All eggs, including fresh in-shell, liquid and powdered eggs, are
sourced from systems that do not use conventional cages. If from
a caged system, enriched cages must be used.
Seasonal
produce
Where fresh produce is used, menus are designed to reflect in-
season produce and in-season produce is highlighted on menus.
Fish All fish are demonstrably sustainable with all wild-caught fish
meeting the FAO Code of Conduct for Responsible Fisheries
(includes Marine Stewardship Council certification and Marine
Conservation Society ‘fish to eat'). If caterers serve lunch and an
evening meal, fish is provided twice a week, one of which is oily. If
caterers only serve lunch or an evening meal, an oily fish is
available at least once every 3 weeks.
Environmental
production
standards
At least 10% by value of primary commodity (i.e. raw ingredient)
food and drink is produced to certified or assured higher level
environmental standards (e.g. organic, LEAF).

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Impact
Area
Standard
Ethical trading At least 50% of tea and coffee is fairly traded.
Water Tap water is visible and freely available and such provision is
promoted. Pre-bottled water (mineral or spring) is not included in
the hospitality menu.
Reducing Salt Vegetables and boiled starchy foods such as rice, pasta and
potatoes, are cooked without salt. Salt is not available on tables.
At least 50% of meat and meat products, breads, breakfast
cereals, soups and cooking sauces, ready meals and pre-packed
sandwiches (procured by volume) meet Responsibility Deal salt
targets and all stock preparations are lower salt varieties (i.e.
below 0.6g/100mls).

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Impact
Area
Standard
Increasing Fruit
and Vegetable
Consumption
At least 50% of the volume of desserts available is based on fruit –
which can be fresh, canned in fruit juice, dried or frozen.
A portion of fruit is cheaper than a portion of hot or cold dessert.
Meal deals include a starchy carbohydrate, vegetables and one
portion of fruit.
Reducing
Saturated Fat
Meat and meat products, biscuits, cakes and pastries (procured by
volume) are lower in saturated fat where available.
At least 50% of hard yellow cheese has a maximum total fat
content of 25g/100g; at least 75% of ready meals contain less than
6g saturated fat per portion.
At least 75% of milk is reduced fat; and at least 75% of oils and
spreads are based on unsaturated fats.
Cereals At least 50% of breakfast cereals (procured by volume) are higher
in fibre (i.e. more than 6g/100g) and do not exceed 12.5g/100g
added sugars.

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Impact
Area
Standard
SMEs (Small
Medium
Enterprise)
Provide opportunity for separate contracts for supply and
distribution; and advertise all food-related tenders to SMEs.
Reducing
Landfill -
Recycling
There are facilities available to staff and customers for recycling
cans, bottles, cardboard and plastics.
Food Waste Any contractor must take steps to minimise food waste in its on-
site operation using the guidance provided to help decide what
action they will take.
Contractors should set out what they will do, and feed back to
clients on progress and results. The procuring authority must
check whether a separate food waste collection service can be
provided (see guidance on how to do so). If the service can be
provided, while achieving value for money, then it should meet the
best practice standard.

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Impact
Area
Standard
Energy
Management
The on-site catering operation is run in accordance with the host
building’s overall energy management policy.
Catering
Equipment
Domestic refrigerators and freezers - it meets Energy Efficiency
standard A and meets standards on greenhouse gases.
Commercial refrigerators and freezers - it meets the latest
Enhanced Capital Allowance criteria and meets standards on
GHGs.
Covers for refrigerated units – it meets the latest Enhanced Capital
Allowance criteria Domestic electric ovens – it meets Energy
Efficiency standard A, at varying energy efficiency indices
depending on cavity size.
Domestic dishwashers – it meets Energy Efficiency standard A, at
varying energy efficiency indices for overall energy efficiency,
drying and cleaning performance.

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Impact
Area
Standard
Catering
Equipment
Cont/d …
Kitchen taps – have flow rates of not less than 5l/min delivered
through either automatic shut off, screw down/lever, or spray taps;
and non-flow rate elements shall meet the Enhanced Capital.
Allowance Scheme (ECA) Water Technology List criteria.
Paper Products The minimum mandatory Government Buying Standards for paper
products apply where relevant:
Tissue paper (for example kitchen and toilet tissue and hand
towels) must have 100% recycled content, to include only genuine
recovered fibre (i.e. no ‘mill broke’), in accordance with NAPM
definition.

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PDMS is predominantly either cook-chill/freeze; it is estimated that approximately
50% of hospital operate either a cook chill or cook freeze system Commons, (2005).
All the GBSF standards are applicable to your catering operation; however,
there are several additional considerations for a PDMS.
Reducing Salt - 50% of ‘Ready Meals’, soups and pre-packed sandwiches must meet
Responsibility Deal Salt Targets.
● At least 75% of ready made meals must contain 6g or less of saturated fat per portion.
‘Ready Made Meals’ are your main course items.
● A minimum of 10% of raw ingredients procured is either certified organic or LEAF. This means
10% of raw foods and beverages only. ‘Ready Meals’ (all products) are not raw ingredients!
GBSF Standards + Additional Considerations for a Patient
Delivered Meal System (PDMS)

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● 50% of meats and meat products purchased for patients salads etc must meet
Responsibility Deal Salt Targets.
● 50% of the volume of desserts must be fruit based.
● 50% of hard yellow cheese must have a maximum total fat content of 25g per 100g.
75% of milk procured for patients and retail must be reduced fat (semi-skimmed). This does
not apply to patients who are nutritionally ‘at risk’.
75% of oils and spreads are based on unsaturated fats. This does not apply to patients
who are nutritionally ‘at risk’.
50% of breakfast cereals must be higher in fibre (more than 6g per 100g) and must
not exceed 12.5g of sugar per 100g.
GBSF Standards + Additional Considerations for a Patient
Delivered Meal System (PDMS)

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Cereals More than
6g/100g Fibre
Less than
12.5g/100g Sugar
GBSF MET
Bran Flakes 13 22.8 X
Shreddies 9.5 15.49 X
Porridge (Made with milk & water) 0.8 2.4 X
Corn Flakes 0.9 8.2 X
Rice Krispies 0.7 10.4 X
Special K 2 17.8 X
Shredded Wheat 9.8 0.6 
Weetabix 9.7 4.9 
Ready Break 8 1.9 
GBSF Compliant - 50% Breakfast Cereals are higher than
6g/100g of fibre and do not exceed 12.5g/100g of sugar

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GBSF Compliance - Tips to Get Started
Collect key information from relevant sources
Websites:
Department of Health Website
Improving Hospital Food
Healthier and more sustainable catering: A toolkit for serving
foods to adults.
● Responsibility Deal Salt Targets
DEFRA Website (direct link from the DH’s Website)
list of the GBS standards
Reports - Schools & Hospitals & checklists from the reports
NHS Supply Chain - Supplier catalogues for ‘ready made meals’ for
the three main suppliers; TVF, Apetito & Anglia Crown. NHS Supply
Chain have ‘product flagged’ the catalogues and highlighted the products
that comply to GBSF.

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Product Description
OriginofMeat
&Dairy
Animal
Welfare
Fish
SaltReduction
SaturatedFat
Reduction
Fruit&Veg
consumption
FoodWaste
Calorie&
Allergen
Labelling
Packaging
Waste
Type of Meal
Standard or
Specialist
Responsibility Salt
target
Fish In Batter
yes yes
MSC Alaskan
Pollock
Yes Yes n/a yes yes yes Standard
Salt responsibility less than 1.13
(meal centre)
Fish Fingers
yes yes
Atlantic Cod,
Loinless Block -
MCS Rating 3 Yes Yes n/a yes yes yes Standard
Salt responsibility less than 1.13
(meal centre)
Braised Liver & Onions
yes yes n/a Yes Yes n/a yes yes yes Standard
Salt responsibility less
than 1.13 (meal centre)
Braised Liver & Bacon Hotpot
yes yes n/a Yes Yes n/a yes yes yes Standard
Salt responsibility less
than 1.13 (meal centre)
Meatballs In Tomato Sauce
yes yes n/a No No n/a yes yes yes Standard
Salt responsibility less
than 1.13 (meal centre)
Faggots In Onion Gravy
yes yes n/a Yes No n/a yes yes yes Standard
Salt responsibility less
than 1.13 (meal centre)
Vienna Steaks In Gravy
yes yes n/a No No n/a yes yes yes Standard
Salt responsibility less
than 1.13 (meal centre)
Cornish Pasties
yes yes n/a No Yes n/a yes yes yes Standard
Salt responsibility less
than 1.00 (Cornish Pasty)
Chicken In Mustard & Coriander
Sauce yes yes n/a Yes No n/a yes yes yes Standard
Salt responsibility less
than 1.13 (meal centre)
Chicken A La King
yes yes n/a Yes Yes n/a yes yes yes Standard
Salt responsibility less
than 1.13 (meal centre)
Chicken Pie (With Bacon)
yes yes n/a Yes No n/a yes yes yes Standard
Salt responsibility less
than 0.75 (meat based
pastry)
Curried Chicken
yes yes n/a Yes Yes n/a yes yes yes Standard
Salt responsibility less
than 1.13 (meal centre)
Chicken Korma
yes yes n/a Yes Yes n/a yes yes yes Standard
Salt responsibility less
than 1.13 (meal centre)
Sweet & Sour Chicken
yes yes n/a Yes Yes n/a yes yes yes Standard
Salt responsibility less
than 1.13 (meal centre)
Chicken Casserole
yes yes n/a Yes Yes n/a yes yes yes Standard
Salt responsibility less
than 1.13 (meal centre)
Chicken Escalopes
yes yes n/a No Yes n/a yes yes yes Standard
Salt responsibility less
than 1.13 (meal centre)
Chicken & Pasta With Tomato & Salt responsibility less

15. J.Ven/NC/HEFMA 1:091012
GBSF Compliance - Getting Started
Collect suppliers lists - NHS Supply Chain are ‘product flagging’ other suppliers
highlighting compliance. 3663 can also identify products that meet GBSF.
Prepare a spreadsheet for your retail areas and patient feeding.
Input current products/menu items to highlight compliance/non-compliance.
For Patient Delivered Meal Systems - select your supplier from the NHS Supply
Chain and engineer a new menu.
Don’t forget to include Responsibility Deal Salt Targets for pre-packed sandwiches
and cooked meats etc (Protein salad options), ensure 50% of desserts are fruit
based.
When ‘menu engineering’ it is functional to input salad, sandwich and fruit based
dessert options first and then build in the main course items to ensure balance.

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LUNCH MONDAY WK 1 Saturated Fat (g) Reducing Salt LUNCH TUESDAY WK 1 Saturated Fat (g) Reducing Salt LUNCH WEDNESDAY WK 1 Saturated Fat (g) Reducing Salt LUNCH THURSDAY WK 1 Saturated Fat (g) Reducing Salt LUNCH FRIDAY WK 1 Saturated Fat (g) Reducing Salt LUNCH SATURDAY WK 1 Saturated Fat (g) Reducing Salt LUNCH SUNDAY WK 1 Saturated Fat (g) Reducing Salt
TOTAL READY MEALS 0% 0% TOTAL READY MEALS 0% 0% TOTAL READY MEALS 0% 0% TOTAL READY MEALS 0% 0% TOTAL READY MEALS 0% 0% TOTAL READY MEALS 0% 0% TOTAL READY MEALS 0% 0%
TOTAL SANDWICHES (RS) 0% TOTAL SANDWICHES (RS) 0% TOTAL SANDWICHES (RS) 0% TOTAL SANDWICHES (RS) 0% TOTAL SANDWICHES (RS) 0% TOTAL SANDWICHES (RS) 0% TOTAL SANDWICHES (RS) 0%
TOTAL COOKED MEATS (RS) 0% TOTAL COOKED MEATS (RS) 0% TOTAL COOKED MEATS (RS) 0% TOTAL COOKED MEATS (RS) 0% TOTAL COOKED MEATS (RS) 0% TOTAL COOKED MEATS (RS) 0% TOTAL COOKED MEATS (RS) 0%
TOTAL VOLUME OF DESSERTS 0% TOTAL VOLUME OF DESSERTS 0% TOTAL VOLUME OF DESSERTS 0% TOTAL VOLUME OF DESSERTS 0% TOTAL VOLUME OF DESSERTS 0% TOTAL VOLUME OF DESSERTS 0% TOTAL VOLUME OF DESSERTS 0%
GBSF Menu Analysis - Patient Menus Week 1.
GBSF Menu Engineering

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GBS Menu Analysis - Patient Menus Week 1.
LUNCH MONDAY WK 1 Saturated Fat (g) Reducing Salt LUNCH TUESDAY WK 1 Saturated Fat (g) Reducing Salt LUNCH WEDNESDAY WK 1 Saturated Fat (g) Reducing Salt LUNCH THURSDAY WK 1 Saturated Fat (g) Reducing Salt LUNCH FRIDAY WK 1 Saturated Fat (g) Reducing Salt LUNCH SATURDAY WK 1 Saturated Fat (g) Reducing Salt LUNCH SUNDAY WK 1 Saturated Fat (g) Reducing Salt
Tomato Soup YES Cream of Leek & Potato Soup YES Golden Vegetable Soup YES Cream of Tomato & Lentil Soup YES Minestrone Soup YES Mulligatawny Soup YES Mushroom Soup YES
Fruit Juice Fruit Juice Fruit Juice Fruit Juice Fruit Juice Fruit Juice Fruit Juice
Chicken Breast & Stuffing in Gravy 1.5 YES Roast Beef & Yorkshire Pudding 2.1 YES Roast Turkey in Gravy 1.3 YES Roast Lamb in Gravy 2.6 YES Fish in Batter 1.1 YES Stewed Steak & Dumplings 3.4 YES Roast Pork in Gravy 1.8 YES
Steak & kidney Pie 8.9 YES Fish in Parsley Sauce 2.6 YES Chilli Con Carne & Boiled Rice 5.1 YES Fish in Cheese Sauce 6.1 YES Chicken a La King 3.9 YES Minced Lamb Bolognaise 2.9 YES Chicken Korma & Boiled Rice 4.7 YES
Mushroom & Bean Stroganoff 4.6 YES Plain Omelette 3.5 YES Vegetable Lasagne 10.4 YES Vegetable Goulash 2.3 YES Cauliflower & Broccoli Pasta 8.5 YES Plain Omelette 3.5 YES Lentil Cottage Pie 3.3 YES
TOTAL READY MEALS 67% 100% TOTAL READY MEALS 100% 100% TOTAL READY MEALS 67% 100% TOTAL READY MEALS 67% 100% TOTAL READY MEALS 67% 100% TOTAL READY MEALS 100% 100% TOTAL READY MEALS 100% 100%
Egg Mayo & Sliced Egg S/W (white) YES Cheese Sandwich YES Cream Cheese & Chive Sandwich YES Egg Sandwich YES Cheese Sandwich YES Egg Mayo Sandwich NO Cheese Salad Sandwich YES
Turkey Salad Sandwich NO Tuna Salad Sandwich YES Egg Mayo & Bacon Sandwich NO Ham Sandwich NO Beef Sandwich NO Chicken Salad Sandwich YES Ham Sandwich NO
TOTAL SANDWICHES (RS) TOTAL SANDWICHES (RS) TOTAL SANDWICHES (RS) TOTAL SANDWICHES (RS) TOTAL SANDWICHES (RS) TOTAL SANDWICHES (RS) TOTAL SANDWICHES (RS)
Mackerel Salad YES Chicken & Pasta Salad YES Cottage Cheese Salad YES Cous Cous Salad YES Rice & Bean Salad YES Cream Cheese & Chive Salad YES Scotch Egg Salad NO
Cottage Cheese & Pineapple Salad YES Cheese & Egg Salad YES Pork Pie Salad YES Beef Salad NO Sausage Roll Salad YES Italian Chicken Pasta Salad YES Mackerel Salad YES
TOTAL COOKED MEATS (RS) TOTAL COOKED MEATS (RS) TOTAL COOKED MEATS (RS) TOTAL COOKED MEATS (RS) TOTAL COOKED MEATS (RS) TOTAL COOKED MEATS (RS) TOTAL COOKED MEATS (RS)
Creamed Potatoes Creamed Potatoes Creamed Potatoes Creamed Potatoes Creamed Potatoes Creamed Potatoes Creamed Potatoes
Roast Potatoes Saute Potatoes Boiled Potatoes Roast Potatoes Chipped Potatoes Saute Potatoes Roast Potatoes
Cabbage Cauliflower Sprouts Cabbage Mushy Peas Julienne Carrots Country Vegetables
Sweetcorn Peas Cauliflower Peas Mixed Vegetables Garden Peas Carrots
Chocolate Sponge Rhubarb Crumble Blackcurrant Frangipane Baked Lemon Tart Sticky Toffee Pudding (Contains Dates) Apple Pie Bakewell Tart
Vanilla Ice-Cream Vanilla Ice-Cream Vanilla Ice-Cream Vanilla Ice-Cream Vanilla Ice-Cream Vanilla Ice-Cream Vanilla Ice-Cream
Cheese & Biscuits Cheese & Biscuits Cheese & Biscuits Cheese & Biscuits Cheese & Biscuits Cheese & Biscuits Cheese & Biscuits
Thick & Creamy Yoghurt Thick & Creamy Yoghurt Thick & Creamy Yoghurt Thick & Creamy Yoghurt Thick & Creamy Yoghurt Thick & Creamy Yoghurt Thick & Creamy Yoghurt
Banana Apple Banana Apple Banana Apple Banana
Orange Pear Orange Pear Orange Pear Orange
Fruit Cocktail in Natural Juice Peaches in Natural Juice Pears in Natural Juice Fruit Cocktail in Natural Juice Peaches in Natural Juice Pears in Natural Juice Fruit Cocktail in Natural Juice
Mandarins in Natural Juice & Ice Cream Pineapple in Natural Juice Fruit Cocktail in Natural Juice Mandarins in Natural Juice & Ice Cream Pineapple in Natural Juice Fruit Cocktail in Natural Juice Mandarins in Natural Juice & Ice Cream
TOTAL VOLUME OF DESSERTS TOTAL VOLUME OF DESSERTS TOTAL VOLUME OF DESSERTS TOTAL VOLUME OF DESSERTS TOTAL VOLUME OF DESSERTS TOTAL VOLUME OF DESSERTS TOTAL VOLUME OF DESSERTS
100% 100% 50%100% 100% 100% 50%
50% 50% 50%
50% 100% 50% 50% 50% 50% 50%
50% 50% 50% 50%
GBSF Menu Engineering

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Monday Week 1. Lunch Monday Week 1. Evening Meal
Tomato Soup
Fruit Juice
Chicken Breast & Stuffing in Gravy Shepherds Pie
Steak & kidney Pie Fish in Parsley Sauce
Mushroom & Bean Stroganoff Vegetable Goulash
Egg Salad Sandwich Cheese Sandwich
Turkey Salad Sandwich Tuna Mayonnaise Sandwich
Mackerel Salad Corned Beef Salad
Cottage Cheese & Pineapple Salad Mixed Cheese Salad
Creamed Potatoes Creamed Potatoes
Saute Potatoes Jacket Potato
Cabbage Green Beans
Sweetcorn Sliced Carrots
Chocolate Sponge Rice Pudding
Vanilla Ice-Cream Vanilla Ice Cream
Cheese & Biscuits Cheese & Biscuits
Thick & Creamy Yoghurt Thick & Creamy Yoghurt
Banana Apple
Orange Pear
Fruit Cocktail in Natural Juice Peaches in Natural Juice
Mandarins in Natural Juice Pears in Natural Juice & Ice Cream
Starter
Main Course
Salads & Sandwiches
Desserts
Vegetables & Potatoes
GBSF Compliant
Example Patient Menu - Monday Week 1.
GBSF Compliance …
Reducing Salt; soup meets Responsibility
Deal targets - GBSF MET
83% of Ready Meals on today’s menu
contain less than 6g saturated fat - GBSF
MET
100% of Ready Meals on today’s menu meet
Responsibility Deal salt targets - GBSF
MET
75% of Pre-Packed Sandwiches meet
Responsibility Deal salt targets - GBSF
MET
50% of Desserts are based on fruit - GBSF
MET
1.5g
4.6g
5.6g
2.6g
2.3g
GBSF: At least 75% of ready
meals must contain 6g or less of
saturated fat. ‘Ready Meals’ are your
cook-chill/freeze main course items.
GBSF: At least 50% of pre-
packed sandwiches meet
Responsibility Deal Salt Targets.
GBSF: At least 50% of desserts
are based on fruit.

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Questions & Concerns You may Have
Will I be able to source sufficient products/produce to be compliant?
Yes! NHS Supply Chain have already identified and product flagged many
products that comply with GBSF and are continuing to work with suppliers.
As demand grows supply will change to meet demand.
How much work is involved?
Time taken to research products and re-engineer menus can be considerable,
however help is at hand. Handouts, spreadsheets, contacts.
Will GBSF be more costly? I am currently on a tight budget.
Re-engineering menus to ensure GBSF compliance could prove to be
be more expensive. Experience tell us that quite often ‘ready meals’ containing less
saturated fats can cost more, reduced fat cheese does in fact cost more!
● Example; cost effective menu engineering

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Ready Made Product In-house Production
Creamed/Mashed Potato
Average supplier cost = £0.21 per portion
HEY provides approximately 1000
portions per day
Total cost per day = £210.00
Total cost per annum = £76,650.00
Fruit Crumbles
Average supplier cost = £0.46 per portion
HEY provides approximately 1400
portions a week
Annual cost = £33,488.00
Creamed/Mashed Potato
Average in-house production cost = £0.11
per portion
Total cost per day = £110
£40,150 per annum
Saving of £36,500
Fruit Crumbles
Average in-house production cots = £0.15
per portion
Total cost per week = £210.00
Annual cost = £10,920
Saving of £22,568
2 in-house products generate a cost saving of £59,068
in-house products can be enhanced to increase kcal and
protein for nutritionally at risk patients.

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Hull and East Yorkshire Hospitals NHS Trust - therapeutic diets are produced
in-house within our diet bay.
● We have developed a range of ‘energy dense’ foods for patients who are nutritionally
at risk. Our ‘energy dense’ range is unique containing very high levels of both kcal
and protein.
● All our products are made from natural, wholesome ingredients and contain no
protein enhancers, preservatives or colourings.
● Patients who are ‘at risk’ could consume up to 2000 kcal per meal and 70g protein.
● Food Tasting - during lunch please try our ‘energy dense’ soups and desserts; soups
contain up to 555 kcal and 12g protein, desserts contain up to 700 kcal and 10g
protein.
Therapeutic and Energy Dense Food Provision

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Malnutrition in England
The cost of doing nothing