Egwyddorion a Safonau Maeth ac Arlwyo Cymru Gyfan ar gyfer Darparu Bwyd a Hylifau i Gleifion yn yr Ysbyty (2026)

The All‑Wales Nutrition and Catering Principles and Standards for Food and Fluid Provision for Hospital Inpatients, together with its supporting guidance, set out the national expectations for meeting the nutritional and hydration needs of people receiving hospital care in Wales.

The document promotes effective, equitable and sustainable provision of food and fluids, and addresses:

• the full range of dietary requirements
• the needs of nutritionally vulnerable and nutritionally well patients
• the needs of individuals with therapeutic, specialist, religious, cultural and lifestyle needs

This document replaces the All‑Wales Nutrition and Catering Standards for Food and Fluid Provision for Hospital Inpatients (2011).

The revised principles and standards apply across all hospital settings, including paediatric services, and reflect:

• changing demographics
• contemporary clinical practice
• relevant patient safety alerts in place at the time of publication

For the first time, the document introduces an All‑Wales self‑assessment tool, enabling NHS organisations to:

• review current arrangements for nutrition and hydration
• identify strengths
• target areas for quality improvement

The self‑assessment tool will provide a consistent basis for:

• monitoring improvement in the quality of nutrition and hydration provision over time
• demonstrating improvement in the quality of nutrition and hydration provision over time

It will also:

• link directly to organisational quality reporting and quality improvement plans
• support assurance against the seven national principles set out within these standards.

1.1 Identifying the need

1.1.1 Malnutrition and dehydration

Malnutrition and dehydration are significant issues in hospitals, necessitating robust nutritional standards.

• malnutrition remains a significant public health issue, affecting up to 3 million people in the UK, with a notable prevalence among hospital inpatients
• all patients, on admission, should be screened for malnutrition
• dehydration is prevalent among hospital patients, particularly older adults, and is linked to increased mortality and other health complications

1.1.2 Nutritional vulnerability

Nutritional requirements vary widely among patients, requiring tailored menu planning and food service systems.

• a significant proportion of hospital patients are nutritionally vulnerable, requiring diets that are more energy and nutrient dense.
• nutritionally vulnerable patients include those with poor appetites, chronic illnesses, or increased nutritional requirements
• all patients' dietary needs should be identified on admission and reviewed at various points in the patient pathway

1.1.3 Food service systems

A whole-systems approach is essential for effective food and fluid provision.

• Various catering systems are used across NHS Wales hospitals, including traditional cook fresh, cook-chill, cook-freeze, and hybrid systems.
• The choice of catering system should consider the needs of the patient population, kitchen equipment, storage capabilities, and staff availability.
• Food delivery needs to consider the needs of the patients within each setting including the ward environment, timing of meals including missed meals and the ability of patients to eat and drink.
• Many patients receive care outside traditional ward settings. Catering services should extend to these areas and should also consider the needs of residential carers.

1.1.4 Sustainability and environmental considerations

Sustainability in food systems is crucial for long-term health and environmental benefits. This should be considered alongside the hospital population's dietary needs.

• the document emphasises the importance of sustainable food systems
• hospitals are encouraged to monitor food waste and explore new technologies to reduce waste
• hospitals should consider offering more plant-based options on patient menus and reducing the use of highly processed foods on menus

Providing food and fluid to hospital inpatients is complex.

This document sets out the considerations, guidance and standards in various sections but to deliver safe and effective provision, a whole systems approach is essential.

The 7 key principles are overarching themes that need to be in place to deliver safe and effective food and fluid for hospital inpatients and are set out below:

1. All Health Boards and Trusts in Wales must have a designated Executive Director responsible for food and drink for inpatients (nutrition, hydration and safety) and be responsible for reporting on compliance with these standards.
2. Organisations must proactively recognise and monitor the nutrition & hydration needs of the hospital population. This will include screening for malnutrition and hydration needs as well as any dietary requirements.
3. Organisations must invest in a high calibre workforce, sufficient staffing and recognise the complex knowledge and skills required by chefs and food service teams in the provision of safe food and drink services.
4. Organisations must be able to demonstrate that they have an established training matrix and a learning and development programme for all staff involved in healthcare food and drink services.
5. Organisations must monitor, manage and work towards reducing the environmental impact of food production and waste, and improve accessibility to and offer more sustainable options on hospital menus.
6. NHS organisations must be able to demonstrate that they have suitable 24 hours 7 days a week food service provision, which is appropriate for their hospital population and considers those outside of traditional ward settings.
7. Organisations are required to provide food and beverages that meet the nutritional needs of the hospital population across all age groups, while accommodating therapeutic, specialist, religious, cultural, and lifestyle dietary requirements. Meals should be highly palatable to maximise consumption and therefore support general well-being and recovery from ill-health.

The principles set out within these standards align with and support the implementation of the Health and Care Quality Standards 2023, providing a framework for NHS organisations to strengthen the quality, safety and person-centredness of nutrition and hydration provision.

Adherence to the standards is supported through the accompanying Self-Assessment Tool, which is intended to help organisations:

• monitor implementation
• identify opportunities for improvement
• provide assurance on progress over time

Following the implementation period, NHS organisations will be expected to demonstrate ongoing application of the standards through local governance, quality improvement and assurance arrangements.

2.1 Delivering the Standards

2.1.1 Screening and Monitoring

• implement malnutrition screening within 24 hours of admission and repeat it at least weekly thereafter
• use standardised tools like the All-Wales Adult Nutritional Risk Screening Tool (WAASP) and the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP)

2.1.2 Training and Collaboration

• provide training for all staff involved in food service, including healthcare professionals, catering staff, and ward staff
• foster collaboration between dietitians, catering staff and other healthcare professionals to ensure that patients' nutritional needs are met

2.1.3 Menu Planning

• ensure menus provide a combination and balance of foods from the 5 food groups
• ensure that meal timings meet the needs of the hospital population
• offer a variety of portion sizes and menu choices to meet patients' diverse nutritional and dietary requirements
• provide food and fluids outside mealtimes, including missed-meal services, between-meal snacks and ward provisions

2.1.4 Sustainability and Catering Practice

• monitor and seek to reduce the environmental impact of food production, including by reducing and recycling packaging and monitoring and reducing food waste during production
• monitor plate waste and identify opportunities to reduce it where possible
• improve access to plant-based options on menus while maintaining patient choice and managing food waste
• consider reducing the volume of meat in meat-based recipes and increasing plant-based ingredients, while ensuring that protein content is maintained
• reduce the use of highly processed foods on menus where possible

2.1.5 Nutritional and Dietary Needs

• offer a range of meals, snacks and fluids that meet the diverse nutritional needs of the hospital population.
• identify the dietary requirements of all patients
• develop hospital protocols for the provision of therapeutic, specialist, religious, cultural and lifestyle dietary needs, ensuring they meet any clinical treatment requirements and nutritional standards
• use standard recipes and accurate nutritional analysis for all dishes

2.1.6 Food Service Technology

• consider the use of food service technology to promote safe and efficient meal ordering
• explore digital technology capabilities to safely record and monitor patient intake and food waste

• undertake routine self-assessment and annual reviews to support implementation, continuous improvement and assurance against the principles and standards
• develop flexible and robust menu planning that caters to the diverse needs of patients
• invest in digital systems for meal ordering to improve efficiency and reduce waste
• ensure the availability of therapeutic and special diets, while also meeting religious, cultural and lifestyle dietary needs
• consider sustainability across food production, delivery and service, as well as in the foods offered on menus

This document establishes a clear, nationally consistent framework for nutrition and hydration provision across Welsh hospitals.

Through implementation of these principles, standards and supporting guidance, NHS organisations can:

• strengthen patient care
• support recovery and well-being
• demonstrate sustained improvement in the quality, safety and sustainability of food and fluid provision