NHS Ayrshire & Arran alongside East, North and South Ayrshire Health & Social Care Partnerships recognise the importance of ensuring the nutritional wellbeing and hydration of the population they serve.
Nutrition and adequate hydration is important for the prevention, treatment and recovery from disease, illness and injury and is an integral part of the work of many staff disciplines providing clinical care.

The purpose of this policy is to:

• Promote how individuals’ food, fluid and nutritional requirements must be appropriately addressed to enhance nutritional wellbeing and hydration.
• Outline our commitments to the provision of good nutritional care locally.
• Ensure that a framework is in place to monitor the strategic action plan (only available on Athena) which accompanies this policy is completed and reviewed.

This policy relates to all staff across NHS Ayrshire and Arran including health and social care teams with responsibilities linked to the achievement of the highest standards of food, fluid and nutritional care. This applies only to all hospitals – acute, Mental Health and community.

The scope of this policy does not include care provided by social care or independent private care staff, or care provision within a care home.

NHS Ayrshire & Arran and the three area Health and Social Care Partnerships support the delivery of safe, effective and person centered care. This Policy is underpinned by the following commitments, in that NHS Ayrshire & Arran and Health & Social Care Partnerships will:

• Recognise the importance of food and fluid to individuals recovering from disease, illness and injury who have different nutrition and hydration needs from the general population.
• Provide food and fluid to identified patient groups (e.g. in-patient population).
• Recognise the importance of identifying individuals at risk of malnutrition and dehydration in hospital and community settings, and addressing those patient’s needs.
• Ensure vulnerable groups such as individuals with disabilities, some older individuals and individuals with learning disabilities who may need special assistance with eating and drinking in hospital or care settings, is provided.
• Ensure where individuals have specific requirements including cultural, ethnic and religious preferences, food allergies and / or may require a therapeutic diet, these are catered for.
• Ensure food is prepared and delivered in accordance with all current legislation and regulation governing these activities.
• Ensure all relevant non legislative standards and guidelines (e.g. Food Fluid and Nutritional Standards; Complex Nutritional Care Standards; Food in Hospital) are implemented across the Board geographical area.
• Ensure an appropriate monitoring framework is in place to monitor the delivery of nutritional care, identify any improvements required and ensure improvements are delivered.
• Continue to implement national programmes to support the delivery of food and fluids locally such as protected mealtimes.
• Continue to engage with patient’s relatives; visitors and third party organisations to support the delivery of nutritional care.
• Recognise the importance of education about food, fluid and nutritional care.

Having outlined the key principles underpinning this policy above, this document will continue to set out roles and responsibilities of members of staff (including external contractors where applicable), in the delivery of our commitments.

Guidelines relating to specific topics in support of the delivery of nutritional care are available on AthenA which when followed should maximize the nutritional wellbeing and hydration of individuals.

Providing person centred nutritional care

The provision of food, fluid and nutritional care for individuals will be achieved by:

• Providing a coordinated and whole-system approach to the delivery of food and fluid by different health and care professionals for people in Ayrshire and Arran that recognises individual needs and preferences.
• Determining a person’s preferences, food allergies and cultural needs, defining his or her physical requirements, and then providing the person with what is therapeutically required.
• Following a person’s progress through an illness, by responding to changing nutritional and fluid requirements.
• Monitoring and reassessing nutritional and hydration status at regular intervals, referring for specialist care when appropriate, and communicating with services within and across care settings.
• Recognising that ethical issues relating to feeding difficulties may arise in people with particular physical or mental disabilities including cognitive impairments; individuals whose capacity is limited / legally devolved or those at ‘end of life’. The full facts of the situation should be understood by all involved to enable a person-centered decision about artificial nutrition and hydration and the means of delivery.
• Making staff aware of the importance of applying the food, fluid and nutritional care policy.
• Ensuring that staff adhere to local guidelines e.g. Guideline for the Provision of Oral Nutritional Supplements, Adult Dysphagia policy and Mealtime Co-ordinator Guideline.
• Ensuring staff have the knowledge and training to undertake the necessary actions to improve and maintain food, fluid and nutritional care.
• Ensuring individuals have timely access to appropriate food, fluid and nutrition information.
• Monitoring adherence to the policy through a strategic action plan.

NHS Ayrshire and Arran and North, South and East Health and Social Care Partnerships responsibilities

NHS Ayrshire & Arran and its Partners have a responsibility for producing a Food, Fluid and Nutritional Care policy and a strategic action plan in line with the Healthcare Improvement Scotland (HIS) Food, Fluid and Nutritional Care Standards 2014. This will promote and support ongoing improvements by:

• Acting on previous advice and instruction from the Scottish Government on the importance of improving the Scottish diet for the health of the population in Scotland.
• Implementation of the HIS Food, Fluid and Nutritional Care Standards 2014 within all hospital settings and embedding these into daily practice.
• Noting the importance attached to food, fluid and nutritional care by International and National organisation’s; National Government and quality of care indicators / monitors for example, through the HIS Food, Fluid and Nutritional Care Standards, reports by Audit Scotland, Healthcare Improvement Scotland and the Mental Welfare Commission.
• Noting the importance attached to being a service provider is a uniquely strong position to positively influence the health of people/clients, staff and the wider community for example through implementation of the Health Promoting Health Service CEL14 (2008).
• Supporting recommendations made by the Scottish Government through Food in Hospitals: National Catering and Nutrition Specification (2016).
• Continuing to develop the Board’s and Local Authorities other responsibilities and commitments within its service improvement plans for food, fluid and nutritional care.
• Integrating food, fluid and nutritional care into other relevant improvement and change programmes.

Area Nutritional Strategic Group (ANSG)

The NHS Ayrshire & Arran ANSG operates to ensure a co-ordinated and integrated approach to nutritional care across the NHS Board and HSCPs and to provide assurance to various Governance Committees that the local health care system is discharging its duty of care in relation to food, fluid and nutritional care.

The group is multi-disciplinary in nature and strives to have public representation on it. The remit of the group is to co-ordinate the implementation, monitoring, evaluation and review processes relating to the implementation of all national guidance in relation to food, fluid and nutritional care as appropriate. The strategic group is supported by sub groups, which have specific remits / focus to support operational delivery of the Board’s strategic plan. Other Board groups link to the ANSG as required to ensure an area-wide co-ordinated approach is in place.

The terms of reference and membership of this group can be located on the Nutritional Care pages on AthenA

Key national documents that support the provision of food, fluid and nutritional care within a healthcare environment are as follows (Please click on the title to view the documents):

Food, Fluid and Nutritional Care Standards (FFNC) (2014)
Food in Hospitals: National Catering and Nutrition Specification (2016)
Complex Nutritional Care Standards (2015)
HIS standards – Care of the Older person in Hospitals (2015)
Excellence in Care Framework (HIS)

Staff roles and responsibilities

All service users may require communication in an alternative format e.g. other languages or signing. Additionally, some may have difficulties with written material. At all times, communication and material should be in the service users preferred format. This may also apply to people with learning disabilities.

In some circumstances there may be religious and/or cultural issues which may impact on clinical guidelines e.g. choice of gender of health care professional. Consideration should be given to these issues when treating/examining service users. Some people may have a physical disability or impairment that makes it difficult for them to be treated/examined as set out for a particular procedure requiring adaptations to be made.

Peoples’ sexual orientation may or may not be relevant to the implementation of this guideline; however, non-sexuality specific language should be used when asking people about their sexual history. Where sexual orientation may be relevant, tailored advice and information may be given.

This policy has been impact assessed using the NHS Ayrshire & Arran Equality Impact Assessment Tool Kit. No additional equality and diversity issues were identified.