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Supporting Guidance Standard 2.5

Health and Care Standards

Supporting Guidance

Standard 2.5:  Nutrition and Hydration


What is the Standard about?

The standard is about ensuring that patients, service users, staff and visitors have access to safely prepared and stored food and fluids. Patients and service user’s individual nutritional and personal requirements must be based on appropriate nutritional screening.  Foods and fluids served must comply with the All Wales Nutrition and Catering Standards for Food and Fluids for Hospital Inpatients, in line with the All Wales Menu Framework.

Ensuring people’s nutritional and hydration needs are met.


Who is it for?

All health services in all health settings

In relation to the standard criteria (in bold) the following key questions need to be considered

People’s nutritional needs and physical ability to eat and drink are assessed, recorded and addressed. They are reviewed at appropriate intervals and are referred to dietetic services as required for specialist advice and support.

  • How have you embedded the All Wales Nutritional Care Pathway in daily practice?
  • How do you ensure you follow recommendations for nutritional screening?
  • How have you implemented any recommendations from Audit reports?
  • For patients who require a food and/or fluid chart, is there evidence that they are being kept up to date and evaluated?
  • Do patients understand the information they have been given?
  • If the patient has a sensory loss, ensure that you are acting in accordance with the All Wales Standards for Accessible Communication and Information for People with Sensory Loss to ensure that patients are able to understand and engage with conversations about their safety and well-being.

Where food and drink are provided: a choice of food and drink are offered, which is prepared safely and meets the nutritional, therapeutic, religious and cultural needs of all; and is accessible 24 hours a day.

  • How do you ensure that procurement of food and fluids complies with All Wales NHS Food procurement contracts?
  • How do you ensure that you meet the EU Food Labelling legislation?
  • How do you know that your food provision adequately meets the diverse nutritional, therapeutic, religious and cultural needs of patients, service users, carers and staff?
  • How do you implement the findings of the national food and catering patient survey as relevant to your health board?
  • What arrangements are in place for ensuring healthy options are provided and promoted to patients (where appropriate) and staff?
  • Are you fully compliant with menus devised from the All Wales Menu Framework which meets Nutrition and Catering Standards for Food and Fluids for Hospital Inpatients?
  • How are you monitoring and improving your food service?
  • What arrangements do you have in place for 24 hour access to food and fluids?
  • How do you ensure that patients with sight loss are given menu information in a format that is accessible to them, so that they can independently choose food?

People are encouraged to eat nutritious, varied, balanced meals, hygienically prepared and served at regular times.

If a meal is missed, alternative food is offered and/or snacks and drinks can be accessed at any time.

  • How do you promote the food and catering services to patients and staff?
  • What steps are you taking to promote independence in eating and drinking?
  • Does a Registered Nurse supervise every meal time?
  • Is there evidence that all members of the nursing team are engaged in the mealtime service?
  • How do the ward, nursing and catering services work and communicate together to ensure this provision?
  • Are a range of snacks available for patients who have missed a meal or who are hungry between meals?
  • Are all staff aware of the availability of higher energy snacks and who requires them?

Food and drink are served in an acceptable setting, with minimal interruption and are at the right temperature and attractively presented. People have a positive eating experience.

Carers and family members who wish to support people at meal times are encouraged and enabled to do so.

  • How do you ensure protected meal times?
  • Have you optimised the dining environment and ensured patients are encouraged to eat socially
  • Prior to meal times, are patients that require help assisted into a suitable position?
  • Prior to meal service, are bed tables and communal areas cleared and tidied for the meal?
  • Are patients meals placed within easy reach?
  • Are all patients given the opportunity to wash or cleanse their hands with hand wipes prior to eating meals?
  • Are patients given the opportunity to go to the toilet before meal time?
  • How do you ensure patients with sight loss know when their food has arrived, where it is and what it is?
  • Do you ask patients whether they need help?
  • Do staff describe what the meal is, and where food is located on the plate?
  • How do you inform and ensure that carers and family members are welcome at meal times to assist? 

Fresh drinking water is available at all times, and water and appropriate fluids are encouraged throughout the day for people to meet their hydration requirements, except when restrictions are required as part of treatment.

  • How do you ensure that all staff are aware of the importance of drinking regularly and actively promote it?
  • Are water jugs changed 3 times daily?
  • Are water jugs and glasses accessible to everyone?
  • How do you check that patients with sight loss know where water jugs are located and are able to access them?
  • Do you ask if they need support to access fresh water?
  • If patients need help to access fresh water, how do you ensure assistance is offered regularly?

People are provided with therapeutic diets in accordance with their medical needs.

  • How do you ensure the correct meals are provided and meet individual needs?
  • Does the clinical area have access to weighing scales and a height measurement stick in good working order?

If eating and/or drinking cause people difficulties, they receive prompt assistance to eat or drink encouragement and appropriate aids or support.

  • What arrangements do you have for the nutritional screening of patients and service users? 
  • What support are you offering to those that cannot eat or drink independently?
  • What arrangements do you have for the timely assessment of swallowing difficulties?

People with swallowing difficulties are assessed by a speech and language therapist and where necessary training in assisting people to swallow food or drink safely is given.

  • Is there evidence in the nursing documentation that those patients, who on admission have been assessed as requiring a swallowing assessment, have had this completed within 24 hours of their admission?

People are supported who require artificial nutritional support via enteral or parenteral routes.

  • How do you ensure prompt referral to dietetic services.


Legislation and Guidance

EU Labelling Legislation

All Wales Menu Framework

People’s oral / dental health can affect their ability to eat and drink. Patients in hospital and residents living in care homes for older people may need an oral health risk assessment and care plan as part of their overall nutritional assessment. Advice is available from the links below

Improving Oral Health for Older People Living in Care Homes (WHC 2015/001)



Nutrition and Hydration Week