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Improvement actions

How to improve nutrition and hydration

The CQC’s Dignity and nutrition inspection programme: national overview (1) identifies three key points:

  • the role of leadership throughout an organisation in creating a culture that prioritises dignity and nutrition and supports staff to deliver care that meets the expected standard
  • the importance of staff attitudes in preserving, or diminishing, dignity.
  • the risks associated with under-resourcing that make poor care more likely.

Concerns identified in the report:

  • patients not given the help they needed to eat, meaning they struggled to eat or could not eat
  • patients being interrupted during meals and having to leave their food unfinished
  • patients' needs not being properly assessed, meaning they didn’t always get the care they needed – for example, specialist diets
  • records of food and drink not being kept accurately, so progress was not monitored
  • patients not being able to clean their hands before meals.

What organisations can do

To raise the standard of nutritional care, organisations must make sure (2):

  • malnutrition is actively identified through screening and assessment
  • malnourished patients and those at risk of malnutrition have appropriate care pathways
  • frontline staff in all care settings receive appropriate training on the importance of good nutritional care
  • management structures are in place to ensure best nutritional practice.

Many trusts have done one or more of these but have not achieved sustainable improvement across all four areas. A strength in one area (good screening rates consistently achieved) can mask a deficit in another (failures in delivering the care plan that is required for patients identified at risk).

Recommended Actions:

According to the British Association for Parenteral and Enteral Nutrition (BAPEN) (3) and the National Patient Safety Agency (NPSA) organisations should:

  • appoint a clinical lead with responsibility for nutrition supported by a senior manager
  • encourage patients and carers to help design nutrition services
  • form dedicated teams to carry out improvement programmes
  • secure top level backing for improvement programmes to help spread best practice
  • create educational opportunities around nutritional care and set related appraisal objectives.


1. Care Quality Commission (2011) Dignity and nutrition inspection programme: National overview. London: CQC.

2. Stroud M (2011) A lot on your plate. Health Service Journal 121(6271) 25 August. pp.26-27.

3. BAPEN (2012) Toolkit for Clinical Commissioning Groups and providers in England: Malnutrition matters: meeting quality standards in nutritional care, 2nd ed. (PDF 4.6MB), Redditch: BAPEN.

4. Healthcare Improvement Scotland (2011) Improving nutrition, improving care. Healthcare Improvement Scotland website.

5. Healthcare Improvement Scotland (2012) Improving nutrition ... improving care: Final report from the Improving Nutritional Care programme. Edinburgh: Healthcare Improvement Scotland.

6. Department of Health, Social Services and Public Safety (2011) Promoting good nutrition: a strategy for good nutritional care for adults in all care settings in Northern Ireland 2011-2016. Northern Ireland government services website