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

A selection of extra breads, including brown and wholemeal, must be available as an accompaniment to all meals.

A selection of wholegrain breakfast cereals must be available at breakfast time.

Bread is a good source of energy offering extra bread with every meal will allow those with higher energy requirements to increase energy intakes.

Wholegrain breakfast cereals are a good source of fibre and can be useful in managing individuals with constipation (>3g fibre/100g).

(Offering extra bread to 'nutritionally vulnerable' patients who are likely to have a small appetite may not be appropriate).

The menu must provide the opportunity for patients to choose at least five servings of fruit and vegetables across a day's menu providing as wide a variety as possible

There is increasing evidence that consuming >400g of fruit and vegetables every day may reduce the risk of developing chronic diseases such as coronary heart disease and some cancers.

It is also beneficial in the management of constipation.

Fruit and vegetables are generally a good source of vitamin C which has a role to play in wound healing and also immune function.

The menu must provide a choice of meat or meat alternatives at both midday and evening meals.

The menu must provide a choice of fish a minimum of twice a week, one choice of which should be an oily fish variety.

Meat and fish are key sources of protein, iron, zinc and vitamin B12 in the diet.

It is recommended that the maximum intake of processed red meat must not exceed 90g/day for an individual. This should be considered in menu planning.⁴¹

Oily fish provides long-chain omega-3 fatty acids that are deficient in the Scottish diet. Appendix 4.⁴²

There must be provision for a minimum of 600 mls of milk for each patient every day.

A choice of whole milk and lower fat milk (semi-skimmed) must be available.

Milk is a key source of protein, calcium, and vitamin B12 in the diet. 600ml allowance is based on provision for breakfast cereal (200ml) and drinks throughout the day (400ml). Providing a choice of both whole and lower fat milk and milk-products will enable the dietary needs of both those choosing a 'healthier diet' and 'higher energy and nutrient-dense' diet to be met.

Offer a choice of butter and spreads including those low in fat, at all meals where a spreading fat is offered.

Spreads should be rich in Poly-Unsaturated Fatty Acid (PUFA) or Monounsaturated Fats (MUFA)

Only spreads and oils that are rich in polyunsaturated and monounsaturated fats should be used in cooking.

Increasing the intake of poly or monounsaturated fats in place of saturated fats may help reduce the risk of diseases such as cardiovascular disease and stroke.

Provision of additional spreading fats including butter at mealtimes can increase the energy density and palatability of the diet, which can assist those individuals with poor appetites and also those with increased energy requirements.

There must be a provision of water and beverages to ensure patients are able to access a minimum of:

1.6L of fluid per day for woman

2L of fluid per day for men

Potable Water must be available at all times, (preferably this should be chilled mains water)

Sufficient fluids are needed to ensure optimal health, including digestion and absorption of nutrients, renal, cardiovascular and respiratory function.

Insufficient intakes can contribute to constipation, confusion and pressure ulcers. Mild dehydration often begins before the sensation of thirst is triggered; this is particularly the case in older people and children thus drinks should be offered and encouraged throughout the day.