Provision of food and drink
The arrangements and best practice for providing food and drink to elderly patients require constant review, monitoring and implementation.
- NHS England published the National Standards for Healthcare Food and Drink in November 2022, setting eight mandatory standards for all NHS organisations. These include board-level accountability for food and nutrition, a food strategy requirement, dietetic input, 24/7 food provision appropriate to patient demographics, and workforce investment in food services. The standards note that "malnutrition affects a quarter of all patients in hospital" (NHS England, National Standards for Healthcare Food and Drink, November 2022).
- The "10 Key Characteristics of Good Nutrition and Hydration Care" is a requirement embedded in the NHS Standard Contract, mandating that providers demonstrate good practice in nutrition screening, care planning, and mealtime management (NHS England, 10 Key Characteristics).
- Protected mealtimes operate on wards across the NHS, with all non-urgent clinical activity ceasing during mealtimes to support patients in eating. The red tray system highlights patients at nutritional risk who may need additional assistance with eating and drinking.
- Patient-Led Assessments of the Care Environment (PLACE) include food quality assessment: the 2023 national scores were 90.98% for ward food and 91.17% for organisational food, based on 1,069 assessments (PLACE 2023, DHSC).
- CQC assesses nutrition and hydration under its inspection framework, with specific attention to whether patients receive adequate food and drink.
How was this evidence gathered?
Response
Accepted
Response
AcceptedThe government published "Hard Truths: the Journey to Putting Patients First" (Cm 8777) on 19 November 2013, responding to all 290 recommendations of the Francis Report. This followed an initial response "Patients First and Foremost" in March 2013. Key reforms included a new Chief Inspector of Hospitals, strengthened Care Quality Commission inspection regime, a statutory duty of candour, and the fit and proper person test for NHS directors. Volume 2 (Cm 8754) contains the government's detailed responses to each of the 290 recommendations. See: https://assets.publishing.service.gov.uk/media/5a7cd486ed915d63cc65d167/34658_Cm_8777_Vol_1_accessible.pdf
Published Evidence
Published assessments of progress from inspectorates, select committees, official progress reports, and other sources. Source type badge indicates whether each assessment is independent or government self-reported.
Research published 2023 marking ten years since the Francis Report found mixed results. Structural and legislative changes largely delivered (duty of candour, FPPR, CQC overhaul, revalidation, Freedom to Speak Up Guardians). However, cultural change not fully embedded; understaffing, fear of speaking up, and poor complaint handling persist in parts of the NHS.
Monitor merged with the Trust Development Authority to form NHS Improvement from 1 April 2016. NHS Improvement then merged with NHS England from 1 July 2022 under Health and Care Act 2022. Francis recommended incremental merger of system regulatory functions between Monitor and CQC; this was partially achieved through structural reorganisation.
Government published "Culture Change in the NHS" (Cm 9009) reporting progress on all 290 recommendations. Key achievements: 19 hospitals placed in special measures; those trusts recruited 109 additional doctors and 1,805 additional nurses; 129 board-level changes made; excess avoidable deaths fell by 450 in less than a year.
Government published "Hard Truths: The Journey to Putting Patients First" (Cm 8777) in two volumes. Vol 1 set out new actions; Vol 2 provided detailed response to each of the 290 recommendations. Approximately 204 of 290 recommendations were fully accepted.