Scottish Government Consultation on Proposed Options to Improve and Assure the Nutritional Standard of Food in NHSScotland Hospitals

The hospital menu must provide breakfast, lunch, meal and a minimum of two additional substantial snacks throughout the day.

400 kcal breakfast

The BDA Nutrition and Hydration Digest ⁸⁰suggests that breakfast for 'nutritionally well' should be 400kcal and 10 g protein but for 'nutritionally vulnerable' it should be 485kcal and 12g protein.

To provide a menu that will enable the range of energy and protein requirements of patients to be met i.e. 'nutritionally well' and 'nutritionally vulnerable'.

It assumes that breakfast, two hot meals with the minimum of two courses and a minimum of two substantial snacks per day are provided.

A minimum of 300kcal per main meal and 500kcal for an energy-dense main meal and 18 grams protein (protein source + starch + vegetables + sauce/gravy). ¹²

To provide a menu that will enable the range of energy and protein requirements of patients to be met i.e. 'nutritionally well' and 'nutritionally vulnerable'. This applies to the midday and evening meals (main course). It assumes that breakfast, two hot meals with a minimum of two courses and a minimum of two substantial snacks per day are provided.

A 'healthy eating' meal choice at each eating occasion (must fulfil criteria as specified in Table 18).

To provide a choice of foods for individuals who require or would benefit from following a diet based on 'healthy eating' principles to enable them to meet their nutritional requirements.

A 'higher energy and nutrient-dense' meal choice at each eating occasion (must fulfil criteria as specified in Table 16).

To provide a choice of foods for individuals with poor appetites or increased requirements to enable them to meet their nutritional requirements.

A vegetarian meal choice at each eating occasion

To provide for the dietary needs of individuals who follow a vegetarian diet. These dishes must comply with other nutrient and food-based standards based on local population needs.

A minimum of two courses at the midday and evening meals

To provide a menu that will enable the range of energy and nutrient requirements and dietary preferences of the patient population to be met.

The smallest portion served must meet the minimum standard of nutrient provision.

Larger portions should be available for those who need them.

To provide for the range of patients' appetites

The standard portion (will be the based on the smallest available portion) and should meet the minimum nutrient requirement.

Larger portions should be available for those patients who choose it. Larger portions can consist of any component of the main meal as indicated by patient choice.

A hot main meal option at midday and at the evening meal

To ensure the varying dietary needs and preferences of the patient population are met.

A variety of substantial snacks must be provided a minimum of twice per day.

Two snacks must be capable of supplying a minimum of 300kcal in total

Must include fruit as a snack option.

Provision of substantial snacks in addition to meals allows patients to maximise opportunities for patients to select foods enabling them to meet their energy and nutrient requirements.

It would be considered good practice to offer snacks three times per day for those individuals with increased energy and nutrient requirements (Section 5.2).^{3, 12}

Provision of fruit as a snack can enable individuals to meet the standard of 5 A Day.

On-ward provisions must provide the minimum food and beverage items (Table 13)

Increasing the choice, range and variety of food items and beverages available to patients in between meals will mean patients are more likely to eat something and meet their nutritional requirements.

Mandatory use of Standard recipes for patient meals must be used in all locations.

• There must be an up-to-date nutritional analysis of each menu item.
• In addition caterers must ensure the standard recipe includes up to date Allergy information

Standard recipes can help to ensure there is a consistent quality and nutritional content of dishes produced and ensure consistent budgetary control.

There are significant patient health and safety risks associated with not following standard recipes.

Up-to-date nutritional analysis of each menu item enables determination of whether the menu meets the nutrient and food-based standards set. Use of standard recipes is also good practice in non-patient catering

A system must exist to ensure allergy information is available to access for all involved in ordering and delivery of meals to patients

Healthier eating, higher energy and vegetarian dishes must be identified as a minimum on the hospital menu
(According to criteria provided in Section 5). *

This must be used to inform staff and patients of the suitability of menu items and guide patient choice.^[12]

This can be identified through a number of means including menu coding, ward manuals etc.

Food must be readily available for all patients who do not have the opportunity to have a meal at the normal mealtime (missed meals and out of hours).

The food offered must provide the minimum 300kcal and 18 grams protein, assuming that patients will only have one missed meal. Systems should be in place to record and manage consecutive missed meals.

There needs to be a flexible service and recognised procedures that provides for the dietary and nutritional needs of patients who miss meals at normal meal-times.