Receiving a Packaging Accessibility Rating for the health system

Food packaging can be a major barrier to patient nutrition, because if patients can’t open the packaging, they can’t eat the food inside. This in turn increases food waste and most importantly can result in poorer patient nutrition¹.

Research conducted in NSW hospitals revealed that 1 in 2 patients have some form of malnutrition², which can double hospital stays and triple complications. Hard-to-open packaging contributes to this issue. Over 80% of elderly patients experienced difficulties or were unable to open one or more food packaging items³. Nearly 50% of patients of all ages struggled to open food packaging an average of three items³.  Most importantly, according to a 2014 study conducted in a Tasmanian hospital, only 1 in 3 patients who experienced difficulty opening packaging asked for assistance, making it critical that consumers receive packaging they can open.

In response to these findings, HealthShare NSW and HealthShare VIC (formally Health Purchasing Victoria (HPV)), have put the patient at the centre of the procurement process. They did this by mandating that single serve food and beverage products on their tenders provide a Packaging Accessibility Rating, which show how easily their products can be opened by patients, many of whom are frail, aged or unwell. This information is then considered when selecting between different products listed on the Packaging Accessibility Rating Database.

1 Peter Garling  ‘Acute Care Services NSW Public Hospitals’, Garling Report 2008
2 Nutrition Matters – Diagnostic Report – Northern Sydney & Central Coast Health District 2007
3 According to multiple patient studies in NSW Hospitals 2011-2015, HealthShare NSW 2015

Arthritis Australia’s Accessible Design Division is the approved testing authority for issuing a Packaging Accessibility Rating. The Rating is issued as part of an Initial Scientific Review (ISR) design report, which is a brief two-page report that also identifies key design issues and suggests possible modifications to resolve such issues.

Example ISR report

The Rating, which estimates the percentage of the population who can open and read packaging, is based on the Accessibility Benchmarking Scale. The highest result on the scale is a +8 Rating, which indicates that 95% of consumers are able to easily and safely open the packaging as well as read the labelling. The lowest result is a -8, which signifies that a product is hard-to-open for over 40% of the population and that consumers are exposed to an increase risk of injury due to the likely need to use a tool to open the product.

Testing generally takes between 3-6 weeks and suppliers should contact Arthritis Australia’s Accessible Design Division to begin the process. Once the ISR is completed, the supplier will need to provide the products ordering codes to be added with the Rating to the Packaging Accessibility Rating Database.

The Packaging Accessibility Rating Database allows users, including HealthShare NSW and HealthShare VIC, to make an informed decision on what products are easy or hard for patients to open and helps remove a major barrier to nutrition. The goal of the database is to enable patients to independently feed themselves by not requiring outside assistance to open their food packaging. Hard-to-open packaging also contributes to increased food waste, because consumers are unable to open the product.

The database is divided into different food categories, so that users can compare packaging within each category. Not all packaging formats will receive a +8 Rating. Instead, the databases purpose is to identify what are the best packaging formats available within each food category.

The database lists the company name, brand name, product name, Packaging Accessibility Rating, report ID, product ordering codes (Manufacturing ID and GTIN) for each product entry. HealthShare NSW and HealthShare VIC  retain the right to request the supplier provide the products full ISR report if further information is required.

To ensure the Packaging Accessibility Rating Database is accurate, all products listed need to be reviewed. To reduce the overall cost of testing a product range, Arthritis Australia’s Accessible Design Division has developed a Sufficiently Similar category of testing that can extend the ISR’s Rating to additional products, but only after testing is conducted to prove the accessibility result is consistent across the product range.

To see if your range would fall under this category, please provide 15 samples of each product to the Accessible Design Division for preliminary testing. The Division will then deem if the products fall under this category and provide a quote based on this.

If you have a significantly large range requiring testing (over 20 products in your range), please contact the Accessible Design Division to discuss your needs.

1. Send 15 samples of each product that you would like tested to Arthritis Australia’s Accessible Design Division at

Level 2, 255 Broadway, Glebe NSW 2037

If products require refrigeration, please provide prior notification before delivery.

2. Preliminary testing will be undertaken to see if all or some products in a range are Sufficiently Similar and a quote will be provided.

Formal testing will begin on approval of the quote and will take between 3-6 weeks.
Clients will also be required to sign a standard testing agreement.

3. Once testing is completed, the results and an invoice will be sent to you, as well as a request to share your Packaging Accessibility Rating results on the Packaging Accessible Rating Database used by organisations including HealthShare NSW and HealthShare VIC (formally Health Purchasing Victoria (HPV)), along with the products’ ordering codes (e.g. GTIN or Manufacturing ID).

Initial Scientific Review (ISR) report – issues a product with a Packaging Accessibility Rating: the two-page report also identifies design features, potential design issues and provides suggested modifications.

Single product report: $2,990 (excluding GST)
Additional product reports: $2,500 per report (excluding GST)
Note: this is a completely new report with a new Packaging Accessibility Rating.

Sufficiently Similar products: Products that are part of a product range and pass preliminary testing can have the Packaging Accessibility Rating of the main product featured in an ISR report extended to them. Preliminary testing conducted by the Accessible Design Division will check consistencies in the opening forces, size and labelling. Sufficiently Similar testing must occur at the same time as the ISR report on the main product and only the Accessible Design Division can deem if a product is Sufficiently Similar.

Sufficiently Similar testing: $330 per product (excluding GST)
Note: an additional third page will be added to the primary products ISR report identifying the Sufficiently Similar product/s and each will be issued with a unique code.

What is the Packaging Accessibility Rating Database?

The Packaging Accessibility Rating Database contains Accessibility Ratings from a variety of pre-packaged and portion controlled foods available in the foodservice industry. When a product has been tested for accessibility via an Initial Scientific Review (ISR) it is given an Accessibility Rating. The product and the Accessibility Rating can then be added to the Packaging Accessibility Rating Database with the relevant ordering codes.

Organisations which use the database can then compare the Accessibility Ratings of different products to ensure they are considering the accessibility needs of the population when choosing between different options. Organisations such as HealthShare NSW, HealthShare VIC, members of the Institute of Hospitality in HealthCare (IHHC) as well as other hospitals across the country, use the database when awarding tenders in a variety of food categories. The product with the highest Rating in a food category has an increased chance of being selected for tenders, particularly when cost is comparable.

Are you a public or private hospital or nursing home that would like access to the database? Contact the Division to find out more.

Who uses the Packaging Accessibility Rating Database?

The ISR database is used by organisations such as HealthShare NSW and HealthShare VIC when making decisions on pre-packaged food tenders in relation to packaging accessibility. The database is also available to IHHC members through a secure login.

How do I test a product for the Packaging Accessibility Rating Database?

The Packaging Accessibility Rating Database is maintained by Arthritis Australia’s Accessible Design Division. A product that would be used in the foodservice system can be tested through an ISR and have its Accessibility Rating and ordering codes added to the database.

Why accessible packaging is important for the health system

Various single serve foods and portion controlled packaging have been available in health environments for a number of years, but these products are often difficult to open for many patients due to the level of dexterity, strength and fine motor skills required. When patients cannot open packaging and adequate assistance is not provided, patients become unable to feed themselves. This has the potential to reduce their nutritional intake, delay patient recovery and increase the risk of complications.

The issues associated with single serve food packaging were identified in the Report of the NSW Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals 2008 (Garling Report). The report found that food packaging is not only a barrier to nutrition but that many patients require help in opening their food packaging, assistance for which may not always be available. Because of this, the ease to which products can be opened has become a key selection criterion in the procurement process for HealthShare NSW and HealthShare VIC.

Why is the Packaging Accessibility Rating Database important?

The Packaging Accessibility Rating Database provides food-purchasing organisations with important information regarding the consumer’s experience. In hospitals this is particularly important as there is an increased percentage of consumers with functional limitations, who can find hard-to-open packaging a barrier to accessing their food and therefore their nutrition can suffer. If an organisation purchases a product that has a low Accessibility Rating, then they also need to be aware that users are more likely to require further assistance when opening the packaging at meal and snack times.

Can Packaging Accessibility Rating Database users access the full ISR report on a product?

Users of the database can request to see the full ISR report of a product with the supplier.

Who developed the ISR?

Arthritis Australia’s Accessible Design Division developed the ISR report in collaboration with HealthShare NSW, Nestlé and a world leader in measuring accessible design Dr Brad Fain at the Georgia Tech Research Institute (GTRI).

How are Accessibility Ratings used by the foodservice industry

The Ratings are used on a comparative basis, which means if a product rates higher than a competitor, then this product will have a competitive advantage because more people can open it. The ISR is designed to reward innovation and allows companies to compete on more than price.

There is no minimum Rating for a supplier to aim for because Ratings vary significantly according to packaging formats. There is recognition that many products receive Ratings less than +8. HealthShare NSW and other state health authorities have often replaced existing suppliers when a new product obtains a +4 to +8 Rating.

What ordering codes do I need to supply for the database after testing

Suppliers need to provide ordering codes for each product tested, these codes can be either the National Product Catalogue – GS1 GTIN barcode or Manufacturing ID. The codes allow database users to easily purchase a product based on the Packaging Accessibility Rating results featured on the database.

National Product Catalogue – GS1 GTIN barcode: The GTIN or Global Trade Item Number is an identifier for trade items developed by GS1 and which is used in the National Product Catalogue (NPC). The NPC is endorsed by all State, Territory and Federal Health Departments and is a single repository of product, pricing and healthcare data for all catering and food service products. These identifiers are used to look up product information in a supplier, manufacturer, distributor, and retailer databases.

Manufacturing ID: This is the code or identification number used by a company internally to identify products. This is commonly provided if a company does not yet have GTIN codes for their products.

How do I update product ordering codes on the database

Please contact the Accessible Design Division to update your product ordering code/s.

How often do suppliers have to retest their products?

Suppliers must have their product retested if they have made any changes to their product, including changes to the labelling artwork. These results are then updated on the database.

If you believe a product has changed since this testing, please inform Arthritis Australia’s Accessible Design Division.