Nutrition - UK wide resources

You can use this page to familiarise yourself with nutrition national drivers, including overarching strategies, standards and policies for each of the UK countries.

In other sections of this resource you can also:

The resources are arranged by country:

Some of the resources on this page are in PDF format - see how to access PDF files.

England

Care Quality Commission (CQC): Dignity and nutrition NHS
This programme of themed inspections looked at the care provided to older patients at 50 NHS trust hospitals in England during 2012, focusing on dignity and nutrition. It followed a programme of inspections of 100 hospitals in the previous year looking at the same broad themes. "Comparing the results of the 2011 dignity and nutrition review with these latest findings, we were pleased to see that broadly more hospitals were meeting people’s nutritional needs..... On the other hand, there were fewer hospitals where we saw that patients were always treated with dignity and their privacy and independence respected." See the full reports:

Care Quality Commission (2011) Dignity and nutrition for older people: national review
The CQC undertook a targeted inspection of a number of NHS hospitals in England looking at whether older people are treated with respect and whether they get food and drink that meets their needs. The review took place between March and June 2011. The individual inspection reports can also be viewed.

Care Quality Commission (2010) Essential standards of quality and safety. Guidance about compliance
The essential standards of quality and safety consist of 28 regulations (and associated outcomes) that are set out in two pieces of legislation: the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. In order to be registered, providers must demonstrate they meet essential standards of quality and safety across all the services they provide. It includes the following standard: 'Meeting nutritional needs: People are encouraged and supported to have sufficient food and drink that is nutritional and balanced, and a choice of food and drink to meet their different needs.' 

Care Quality Commission and Royal College of Nursing (2010) Observation prompts and guidance for monitoring compliance with outcome 5: meeting nutritional needs
The document produced jointly by the CQC and the RCN explains how those monitoring compliance with standards can use observation to gather information during visits, to help assess whether a provider is meeting outcome 5 - meeting nutritional needs. It provides guidance on when and how observation might be used and expands on some of the issues around meeting nutritional needs. The document can be downloaded from this list of outcome tools.

Department of Health (2012) Principles for hospital food
The Department of Health has published a set of basic principles which set out what patients can expect from good hospital food. They cover the quality of food, nutritional content and choice for patients and will be backed up by assessments led by patients.

Department of Health (2010) Essence of care
Essence of Care has been refreshed and now contains 12 benchmarks, following a consultation exercise in 2009. It aims to support localised quality improvement, by providing a set of established and refreshed benchmarks supporting frontline care across care settings at a local level. View the Essence of Care 2010: Benchmarks for Food and Drink (PDF 513KB).

Department of Health (2007) Improving nutritional care
A joint action plan from the Department of Health and Nutrition Summit stakeholders. The Nutrition Action Plan outlines how nutritional care and hydration can be improved and suggests five key priority areas through which managers and staff working in health and social care can address this.

Department of Health: Nutrition
This web page provides nutrition related information and useful links. There is a link to the eatwell plate which aims to make healthy eating easier to understand by giving a visual representation of the types and proportions of foods needed for a healthy and well balanced diet that meets Government recommendations. View the Eatwell plate.

National Institute for Health and Clinical Excellence (2011) NICE to develop 31 new quality standards
NICE is to develop 31 new quality standards in clinical areas including a quality standard on nutrition in hospital, including young people. NICE quality standards are markers of excellence in patient care and are aimed at patients and the public, healthcare professionals, public health practitioners, commissioners and service providers.

National Institute for Health and Clinical Excellence Public Health guidance PH11 (2008) Maternal and child nutrition. Guidance for midwives, health visitors, pharmacists and other primary care services to improve the nutrition of pregnant and breastfeeding mothers and children in low income households
This guidance aims to address disparities in the nutrition of low-income and other disadvantaged groups compared with the general population. It is relevant for all women who are pregnant (or planning to become pregnant), mothers of children aged under five and others who care for children aged under five.  

National Institute for Health and Clinical Excellence (2006) Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition (CG032)
This guideline offers best practice advice on the care of adults who are malnourished or at risk of malnourishment. This web page links to several versions of the guideline including the full guideline and a quick reference guide. Information about implementing the guidance locally is provided including implementation advice, a costing report and template, and presenter slides. 

NHS Institute for Innovation and Improvement (2010) Keeping nourished, getting better
In 2009, nurses and midwives from across the UK were invited to identify examples of good practice that have had the most impact on patient care, quality and efficiency. As a result of the submissions, eight key action themes emerged. High Impact Actions for Nursing and Midwifery is a joint initiative by the NHS Institute for Innovation and Improvement, the Royal College of Nursing, the Department of Health, the Royal College of Midwives and the Nursing and Midwifery Council and is led by the strategic health authorities. Nutrition was one of the themes. This web page includes full chapter from the Essential Collection, links to case studies and a literature review.  

NHS Information Centre for health and social care: Patient Environment Action Teams (PEAT)
In 2011 the management of PEAT transferred from the NPSA to the NHS Information Centre. PEAT is an annual assessment of inpatient healthcare sites in England that have more than 10 beds. It is a benchmarking tool to ensure improvements are made in the non-clinical aspects of patient care including environment, food, privacy and dignity. The assessment results help to highlight areas for improvement and share best practice across healthcare organisations in England.

Northern Ireland

Clinical Resource Efficiency Support Team (CREST) (2004) Guidelines for the management of enteral tube feeding in adults
These guidelines include all aspects of the management of enteral tube feeding and apply to both primary and secondary care settings. This is made available on the Guidelines and Audit Implementation Network website.

Department of Health, Social Services and Public Safety (DHSSPS) (2011) Promoting good nutrition - A strategy for good nutritional care for adults in all care settings in Northern Ireland 2011-2016
The overall vision of the strategy is to improve the quality of nutritional care of adults in Northern Ireland in health and social care, whether delivered or commissioned, through the prevention, identification, and management of malnutrition in all health and social care settings including peoples own homes. The strategy builds on and incorporates developments arising from the 'Get your 10 a Day: Nursing Care Standards for Patient Food in Hospital' launched in 2007. View the strategy report (PDF 2.8MB).

Department of Health, Social Services and Public Safety (DHSSPS) (2007): Get your 10 a day! The Nursing care standards for patient food in hospital (PDF 1.9MB)
The 10 care standards were developed in partnership by the DHSSPS Directorate of Nursing and Midwifery and the Royal College of Nursing's Northern Ireland Office. They have been developed for use in all inpatient facilities in the health and social care trusts across Northern Ireland.

Scotland

Care Inspectorate: Best practice nutrition publications
This page provides guidance for early years nutrition and care homes for adults and older people. It includes a link to the Nutrition Inspection Notebook (2011). This is a tool to assist inspectors evaluate food and nutrition care in relation to the National Care Standard 13 - Eating Well Care Homes for Older People. View: Nutrition Inspection Notebook (PDF 80KB).

Healthcare Improvement Scotland: Improving Nutrition... Improving Care final report
This report celebrates the work of Healthcare Improvement Scotland’s Improving Nutritional Care Programme, from June 2010–March 2012, and sets out the next steps for ensuring integration and alignment of nutritional care work. The Improving Nutritional Care Programme builds on the work of the Food, Fluid and Nutritional Care in Hospital Standards and National Overviews and the subsequent Integrated Programme for Improving Nutritional Care (2007-2009).

Healthcare Improvement Scotland (2011) Improving nutrition...improving care. Care home services (PDF 1.2MB)
This report looks at residents' and carers' experiences of food and nutrition in care homes. The Improving Nutritional Care Programme, led by Healthcare Improvement Scotland, aims to improve nutritional care for adults who are at risk of malnutrition. Priority areas for this work included the development and local testing of a communication tool to improve transitions between hospital and care home settings and the development of 'Making meals matter' resources to assist in improving meal time processes. View the Making meals matter pack (2011).

Healthcare Improvement Scotland (2011) Nutritional care communication tool
Effective communication of individual needs is a vital part of transition between care home and hopsital in order to ensure that individuals receive appropriate and safe nutritional care, and assistance. The tool was developed by a sub-group of the Improving Nutritional Care Programme. 

The State Hospital (NHS Scotland) (2010) Food, fluid and nutrition standards. Guidance for patients (PDF 135KB)
These six standards aim to address the risk of under-nutrition in hospitals. They are listed along with the action to be taken by the hospital and what this means for the patient.

NHS Education for Scotland Knowledge Service (2011) Care for Older People portal: nutrition
This portal provides information, resources and education for health and social care staff who support older people in Scotland. Nutrition is one of the topic areas within the portal. It provides information relating to nutrition and older people arranged under the following headings: legislation and government publications; policies and guidelines; standards; information for service users; their carers and families; organisations. Much of the information is freely available but NHS Scotland staff can also access relevant books, journals and evidence summaries if they have registered for Athens through The Knowledge Network. 

NHS Education for Scotland (2010) Making a difference: the evolution of the nutrition champion role in NHSScotland (PDF 429KB)
The Improving Nutritional Care Programme (INCP) was set up in October 2007 to support NHS Scotland in meeting the NHS Quality Improvement Scotland (NHS QIS) Food, fluid and nutritional care in hospitals (FFNCH) standards. This document reflects on the evolution of the nutrition champion role.

NHS Education for Scotland: Nutritional care in hospitals 
This online resource aims to support all staff involved in nutritional care in hospitals, 'ensuring that they have the knowledge, skills and capabilities to optimise nutritional care as part of the patient experience. It serves to promote the development of nutritional thinking at each of the key stages in the nutritional care process'. 

NHS Education for Scotland (NES): Core Nutritional Pathway
This core nutritional pathway has been developed in consultation with staff from across NHS Scotland, incorporating the Malnutrition Universal Screening Tool (MUST). It is intended to clarify what patients should expect in terms of effective nutritional care. It identifies six key stages or critical points in the patient's journey from Admission (Stage 1) to Discharge (Stage 6). These can be used to explore the effectiveness and patient centredness of care to determine how it measures against best practice.

NHS Quality Improvement Scotland (2007) Caring for children and young people in the community receiving enteral tube feeding: best practice statement
This statement specifically addresses issues in nasogastric, gastrostomy and jejunal feeding. The importance of communication and sharing of information between local and regional services is key to ensuring best practice for those children and young people and this is reflected throughout the statement.

NHS Quality Improvement Scotland (2003) Food, fluid and nutritional care in hospitals: clinical standards
This document introduces NHS Quality Improvement Scotlands Clinical Standards for Food, Fluid and Nutritional Care in Hospitals. The document outlines the standards that should be in place to ensure that hospital patients in Scotland receive the nutritional care they require. View the Understanding the standards for food fluid and nutritional care booklet for an explanation of the standards. Local reports presenting findings from the hospitals peer reviews are available.

Nursing and Midwifery Practice Development Unit (2002) Nutritional Assessment and Referral in the Care of Adults in Hospital Best Practice Statement
This best practice statement offers guidance to nurses, midwives and health visitors on best practice relating to nutritional assessment and referral in the care of adults in hospital.

Nursing and Midwifery Practice Development Unit (2002) Nutrition for physically frail older people: best practice statement
This best practice statement offers guidance on meeting the nutritional needs of physically frail older people within continuing care facilities including community hospitals, nursing homes and care homes. It includes the following sections: assessment and care planning, promoting a nutritious diet, the environment of care, the management role of the nurse, and education and training.

Scottish Government (2011) Improving maternal and infant nutrition: a framework for action
This framework is aimed at a variety of organisations with a role in improving maternal and infant nutrition. It includes indicators for short, medium and long term outcomes and provides case studies of some of the good practices already in place across Scotland.

Scottish Government (2009) Older People Living in the Community - Nutritional Needs, Barriers and Interventions: a Literature Review
This report presents the findings of a literature review summarising the nutritional needs, barriers to and possible interventions to improve nutrition of older people living in the community. View the research findings.

Scottish Government (2008) Food in hospitals: National catering and nutrition specification for food and fluid provision in hospitals in Scotland
This report has been developed to support Scottish NHS Boards in implementing the NHSQIS Clinical Standards for Food, Fluid and Nutritional Care in Hospitals specifically standards 3, 4 and 5 which aim to address the risks of malnutrition in hospital patients, and the delivery of a healthy balanced diet for patients who are considered to be 'nutritionally well'.

Wales

Welsh Government (2011) All Wales nutrition and catering standards for food and fluid for hospital inpatients
The Welsh Government, the Royal College of Nursing and Local Health Boards have been working in partnership to improve the patient experience of food provided in hospitals. These standards are for caterers, dietitians and nursing staff responsible for meeting the nutritional needs of patients who are capable of eating and drinking. They are key to the delivery of the All Wales hospital nutrition care pathway protocol. All hospital settings in Wales are expected to achieve full compliance by April 2013. There is an accompanying concise guide and implementation plan.

Welsh Government (2011) Nutrition in community settings. A pathway and resource pack
This All-Wales pathway for the management of malnutrition in the community and supporting resource pack have been developed for health and social care professionals, the third sector, care home staff, relatives and carers. Its purpose is to improve standards of nutrition for people living in the community, by providing tools and best practice.

Welsh Assembly Government (2009) Free to lead free to care - All Wales food record chart and nutritional care pathway
The pathway supports and promotes the implementation of the food services aspects of the Council of Europe Resolution on food and nutritional care in hospitals.

Welsh Assembly Government (2008) Free to lead, free to care
This report set out 35 proposals which aimed to improve the patient's experience of hospital, hospital cleanliness, and hospital food and nutrition. These improvements were to be achieved primarily by giving greater authority to ward sisters and charge nurses, enabling them to run their wards more effectively.

Welsh Assembly Government (2004) National minimum standards for care homes for older people
This document sets out national minimum standards for care homes for older people issued by the Welsh Assembly Government. Standard 16 covers meals and mealtimes.

Welsh Assembly Government (2003) Fundamentals of care: guidance for health and social care staff: improving the quality of fundamental aspects of health and social care for adults
Fundamentals of Care is a Welsh Assembly Government initiative included in the plan for Wales as part of 'Improving Health and Care Services', which aims to improve the quality of aspects of health and social care for adults. It is aimed at staff of all grades who provide care and the organisations who employ them. Practice indicators for 12 areas of care are provided including eating and drinking (practice indicator 9). This covers the choice, presentation and availability of food as well as helping those who need assistance to eat and drink.

Europe

Council of Europe (2003) Food and nutritional care in hospitals how to prevent undernutrition: report and recommendations of the committee of experts on nutrition, food safety and consumer protection
This key international publication outlines the standards that should be in place to ensure that hospital patients receive the nutritional care they require.

BAPEN: Council of Europe resolution food and nutritional care in hospitals (PDF 195KB)
This leaflet includes '10 key characteristics of good nutritional care in hospitals' and 'Council of Europe Resolution 12/11/2003: Food and nutritional care in hospitals.

European Commission: nutrition
This website has links to a range of information about EU activities relating to nutrition.

European Commission: Public Health - Nutrition and physical activity
This web page links to policy, strategy and key nutrition related documents. 

European Nutrition for Health Alliance (2011) Tackling Malnutrition: Oral nutritional supplements as an integrated part of patient and disease management in hospital and in the community
This report draws on the key elements of a comprehensive systematic review of the evidence base for the management of disease-related malnutrition.

European Nutrition for Health Alliance (2006) From Malnutrition to Wellnutrition: Malnutrition among older people in the community
A comprehensive set of policy recommendations for tackling the forgotten problem of malnutrition in the community setting, specifically among older people.

European Society for Clinical Nutrition and Metabolism: Guidelines and position papers
A range of guidelines from ESPEN including adult enteral nutrition, paediatric parenteral nutrition, and percutaneus endoscopic gastrostomy (PEG).

World Health Organisation (WHO): Nutrition
This health topic includes links to nutrition related WHO projects, initiatives, activities, information products, and contacts. There is also a link to the e-Library of Evidence for Nutrition Actions (eLENA). This is an online resource which provides links to the latest evidence-informed WHO guidelines, commentaries and evidence resources. Visit: eLENA.