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  7. Appendix 10: Legislation and Guidelines for Northern Ireland, Wales and Scotland

Appendix 10: Legislation and Guidelines for Northern Ireland, Wales and Scotland

Additional information on legislation, guidelines and standards for Northern Ireland, Scotland and Wales

Appendix 10.1

Promoting Good Nutrition (PGN), A Strategy for the Good Nutritional Care of Adults in all Care Settings in Northern Ireland 2011-2016 (1)

The Promoting Good Nutrition (PGN) strategy, which is focused on malnutrition, adopts and translates the 10 Key Characteristics of Good Nutritional Care into a framework for action describing what good nutritional care looks like for each characteristic. The overall vision of the strategy is the prevention, identification and management of malnutrition in all health and social care settings including the person’s own home.

The strategy is based on a series of core principles. These include prevention of malnutrition and identifying risk, care planning that is person-centred and respects the equality and diversity of people, promotion of a food-first approach with direction to support effective nutritional intervention where food or food alone is not appropriate, and appreciation of the significant contribution of family, carers and volunteers as well as the independent, community and voluntary sectors.

A regional implementation group was established by the Department of Health to develop and prioritise an action plan to realise the vision of the strategy. Each Northern Health and Social Care Trust (HSCT) has a multidisciplinary nutrition steering group. Part of the remit of these groups is to ensure implementation and on-going adherence to the PGN strategy. The HSCT nutrition steering groups are currently chaired by the Directors of Nursing who provide reports both to their HSCT chief executive, the DH and Chief Nursing Officer. HSCT Dietetic and catering departments work collaboratively to ensure patient hospital meals are analysed to ensure they meet the recommended standards and to code menus, as per local agreements to assist with patient selection.

One of the PGN task and finish groups developed a digital resource which aims to support social care workers to better understand what good nutrition is and how to support individuals who may be at risk of malnutrition and dehydration. This resource has more recently been updated, because of COVID-19, to support colleagues during the pandemic and it includes links to a dysphagia awareness training resource (2).

HSCT Dietetic managers meet regularly with Health and Social Care Board (HSCB) and Public Health Agency (PHA) Senior Pharmacy and AHP colleagues to co-design service provision within the clinical area of malnutrition. This has led to pharmaceutical clinical effectiveness. The two professions have recently facilitated a virtual stakeholder engagement event in advance of reviewing the oral nutrition chapter within the NI nutrition formulary (3).

The Regional Quality and Improvement Authority (RQIA), the statutory regulator for residential care homes uses both the PGN strategy and Public Health Agency guidance i.e., nutritional guidelines and menu checklist for residential and nursing homes to monitor practice within nursing and residential homes (4).

Updated minimum nutrition standards for catering in health and social care for staff and visitors were released in 2022 by PHA in collaboration with Health and Social Care, the Food Standards Agency and safefood (5). The aim of these standards is to make healthier food choices more available to staff and visitors in the health and social care setting. 

Appendix 10.2

More information on core standards for food and drink provision in health care settings in Scotland

Healthcare Improvement Scotland (HIS) Food, Fluid and Nutritional Care Standards were first published in 2003 and updated in 2014 (6).

The purpose of HIS is to drive improvements that support the highest possible quality of care for the people of Scotland. There are six standards:

  • Policy and Strategy to ensure that each NHS board has a policy, and a strategic and co-ordinated approach, to nutritional care.
  • Assessment, screening and care planning to ensure that all patients have a nutritional care assessment carried out and includes initial and ongoing screening for the risk of malnutrition, and that a person-centred care plan.
  • Planning and delivery of food and drink to ensure formal structures and processes are in place to plan the provision and delivery of food and drink in hospitals, in line with Food in Hospitals.
  • Provision of food and drink to patients in a way to minimise disruption to meals, ensure food provision meets specific dietary needs and increase patients’ enjoyment.
  • Patient information and communication to ensure that patient views are sought and used to inform decisions made about the food, drink and nutritional care provided.
  • Education and training for staff to ensure that staff have the necessary knowledge.

These mandatory standards are monitored through the Excellence in Care Assurance Scheme (7). Health Boards are responsible for their implementation and are required to consider them under the clinical governance agenda.

The HIS standards are due for review. Monitoring of these mandatory standards is carried out by a peer reviewed self-assessment process, which should include an action plan to demonstrate how each health board would meet each specification. Action plans should then be submitted to Health Facilities Scotland (HFS) for approval.

HFS is a division of National Services Scotland and provides operational guidance, establishes professional and technical standards and best practice to NHS Scotland bodies on a range of healthcare facilities topics to improve health and well-being services. Working groups within HFS are taking forward various national action points related to food and drink provision in care settings in Scotland, including the development of a catering strategy which seeks to centralise catering provision for Scotland, a central national database of standard, nutritionally analysed recipes for use in NHS Scotland hospitals, and a National Catering Information System (NCIS). The need for a National Catering Information System (NCIS) was identified, with a requirement for improved ability to improve stock planning, management and control, production planning, purchasing and waste management, recipe costing, nutritional analysis and bedside electronic patient meal ordering and delivery.

Concerns about food security, food poverty, health and environmental consequences led to the Scottish Government publishing a national food and drink policy “Becoming a Good Food Nation” in 2014 (8). This policy set a new vision for Scotland: that by 2025 Scotland will be “a Good Food Nation”, where people from every walk of life take pride and pleasure in, and benefit from, the food they produce, buy, cook, serve and eat each day.” It will place a duty on public authorities to:

  1. Make a policy about food.
  2. Have the food policy cover (where appropriate) the whole food system, including things like growing, harvesting, processing, marketing, selling, preparing, eating food and disposing of the waste. It would also include how people access the best food for themselves and their families, and how food is managed in places like schools and hospitals.
  3. Be clear about how they are going to measure progress.
  4. Think about this food policy when making decisions.
  5. Ask the public for their views when they are writing the policy.
  6. Make the policy publicly available.
  7. Look back at the policy every five years and update if needed.
  8. Report about how well they are doing every two years.

Appendix 10.3

The All Wales Catering and Nutrition Standards for Food and Fluid Provision for Hospital Inpatients (9)

To aid practical implementation of the standards, an ‘All Wales’ Menu Framework group operates to develop a suite of nutritionally analysed recipes that meet the standards, so that Health Boards can devise menus utilising the recipes from the framework. This is continually monitored and revised with new and revised recipes added at intervals following piloting and evaluation by an operational planning group. Other work that has come from the group are an All Wales approach to patient satisfaction with a survey of food services and an accredited nutrition and food skills module for ward based staff serving food to patients.

The hospital nutrition and catering framework encompasses the Nutrition Care pathway which states that ‘’within 24 hours of admission to hospital all patients should be weighed and screened for risk of malnutrition using a validated nutritional screening tool’’ and details the pathway for the nutritional care throughout their hospital admission. The pathway is supported by the All Wales Food Record Chart and Fluid Chart with accompanying online training for nurses. An All Wales nutrition coordinators group led by nursing with dietetic and catering representation monitors the implementation of the nutrition care pathway and associated standards. These approaches to nutrition and hydration are encompassed within the NHS Wales Health and Care Standards which set out the Welsh Government’s common framework of standards to support the NHS and partner organisations in providing effective, timely and quality services across all healthcare settings. Standard 2.5 relates to Nutrition and Hydration and guidance supports self-assessment of the range of nutritional care standards (10). In addition, a unique lead dietitian role has been established within the NHS Wales food procurement service and has achieved several positive outcomes in relation to nutritional quality and rationalisation of food procured for the NHS, as well as having an advisory role to support Health Boards.

Since the standards were mandated in 2012, there have been changes and challenges along the way which affect food procurement, such as the Covid 19 Pandemic and Brexit. These difficulties are ongoing; however, they have been successfully managed due to meetings and communication between the groups that were formed to ensure that the original framework was followed smoothly. These groups are:

  • Catering and Leadership Group – the managers and the leaders of the catering teams meet up quarterly to discuss topics, issues and new products
  • All Wales Menu Framework Dietetic Group – dietitians from each Health Board in Wales meeting quarterly for discussions which are pertinent to their areas of expertise
  • All Wales Catering Group – this group consists of the cooks and staff who support in the kitchen, alongside dietitians. Recipes are developed and evaluated for patient suitability.
  • All Wales Strategic Group – consists of a wide range of experts who are leads in their area and have an interest in the wider All Wales strategic plan.

Over the past 4 years the Local Health Boards in Wales have procured and electronic ordering system, allowing patients to order their meals at the bedside using modern technology which is directly linked to the kitchen.

References

  1. Department of Health, Social Services and Public Safety. Promoting Good Nutrition: A Strategy for good nutritional care for adults in all care settings in Northern Ireland 2011-2016. https://www.health-ni.gov.uk/sites/default/files/publications/dhssps/promoting-good-nutrition_0.pdf [Accessed 11th April 2023]
  2. Northern Ireland Social Care Council. Promoting Good Nutrition. https://learningzone.niscc.info/learning-resources/90/promoting-good-nutrition [Accessed 8th April 2023]
  3. Northern Ireland Formulary. Guidance: Suggested 7 Steps to Appropriate Prescribing of Adult Oral Nutritional Supplements (ONS). https://niformulary.hscni.net/formulary/9-0-nutrition-and-blood/9-4-oral-nutrition/ [Accessed 8th April 2023]
  4. HSC Public Health Agency. Nutritional guidelines and menu checklist 2014 for residential and nursing homes. https://www.publichealth.hscni.net/sites/default/files/Nutritional_guidlines_and_menu_checklist_march_2014.pdf  [Accessed 8th April 2023]
  5. Public Health Agency. Nutritional standards for catering in health and social care for staff and visitors. https://www.publichealth.hscni.net/publications/nutritional-standards-catering-health-and-social-care-staff-and-visitors [Accessed 8th April 2023]
  6. Healthcare Improvement Scotland. Food, Fluid and Nutritional Care Standards. https://www.healthcareimprovementscotland.org/our_work/standards_and_guidelines/stnds/nutritional_care_standards.aspx [Accessed 11th April 2023]
  7. Healthcare Improvement Scotland. Excellence in Care. Assuring and Improving Nursing and Midwifery Care in Scotland. https://www.healthcareimprovementscotland.org/our_work/patient_safety/excellence_in_care.aspx [Accessed 11th April 2023]
  8. Scottish Government. Recipe for Success: Scotland's national food and drink policy, becoming a Good Food Nation. Available at: https://www.gov.scot/publications/recipe-success-scotlands-national-food-drink-policy-becoming-good-food/ [Accessed 11th April 2023]
  9. Welsh Government. All Wales Nutrition and Catering Standards for Food and Fluid Provision for Hospital Inpatients. https://www.bapen.org.uk/pdfs/e-learning/WalesNutritionCateringStandardsHospitalInpatients.pdf [Accessed 11th April 2023]
  10. Welsh Government. Health and Care Standards and supporting Guidance. http://www.wales.nhs.uk/governance-emanual/how-the-health-and-care-standards-are-st [Accessed 11th April 2023)