First reported 2 Jul 2014•Latest report 24 Feb 2026
Definition
What this concern includes
Includes failures of controls specifically dedicated to assessing, monitoring, recording, providing or reviewing patients' food and fluid intake and nutritional or hydration needs, including risk assessments, nutrition or fluid charts, prompting, prescribed nutritional support and escalation of inadequate intake.
Not included
Excludes medication, electrolyte or disease-specific treatment concerns unless the asserted deficiency directly concerns nutrition or hydration needs.
Excludes generic clinical record-keeping, staffing or care-planning deficiencies unless they directly impair the nutrition and hydration process.
Excludes food-service or dietary provision failures where no patient-specific nutrition or hydration safety need is identified.
Excludes malnutrition-only concerns that do not materially involve the broader nutrition and hydration management process.
Excludes isolated fluid-balance recording failures where the concern is limited to fluid records and does not support the wider nutrition and hydration condition.
Reports
39
Distinct published reports
Individual concerns
44
A report can raise multiple concerns
Date range
2014–2026
First to latest report issue date
Stated actions
80
Described in published responses
Reports over time
Reports over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Care Quality Commission5
Department of Health and Social Care3
East Sussex Healthcare NHS Trust2
University Hospitals Sussex NHS Foundation Trust2
A & B Healthcare Limited1
Academy of Medical Royal Colleges1
Amberley Hall Care Home1
Aneurin Bevan University LHB1
Athena Care Homes (UK) Limited1
Barts Health NHS Trust1
Cardinal HC Limited1
Care Outlook Ltd1
Care UK1
Care UK Community Partnerships Ltd1
Caring UK Limited1
NHS trust21
Private limited company8
Healthcare site6
Nursing home6
Health and social care service regulator5
Ministerial department4
Residential care home3
English unitary authority2
Executive non-departmental public body2
Independent healthcare provider2
Clinical commissioning group1
Company1
English county council1
English metropolitan district council1
Health professional body1
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
Manchester North
Concerns raised2
Failure to closely monitor food intake and purging behaviours
Failure to maintain nutrition and fluid charts
This report raised 14 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Mid Kent and Medway
Concerns raised1
Inadequate provision of food and fluid to meet patient needs
This report raised 6 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3
Action
Complete and weekly repeat MUST nutrition screening for all patients to identify deterioration and dietetic intervention needs.
Stated by Maidstone and Tunbridge Wells NHS TrustStated completedThe respondent said that this action was complete when they made their response on 16 December 2021.
Action
Recruit ward-based therapy assistants to support eating, drinking and speech and language therapy.
Stated by Maidstone and Tunbridge Wells NHS TrustStated in progressThe respondent said that this action was in progress when they made their response on 16 December 2021.
Action
Strengthen monitoring of inpatient food charts through multidisciplinary discussions with the neighbouring mental health Trust.
Stated by Maidstone and Tunbridge Wells NHS TrustStated plannedThe respondent said that this action was planned when they made their response on 16 December 2021.
West Yorkshire Eastern
Concerns raised1
Failure to create a plan for monitoring fluid and food intake
This report raised 6 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Inner North London
Concerns raised1
Failure to provide sufficient prompting and encouragement to maintain hydration
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Produce and distribute a dehydration-risk factsheet with recognition, preventive and urgent-response guidance for care workers.
Stated by Care Outlook LtdStated completedThe respondent said that this action was complete when they made their response on 9 February 2021.
Surrey
Concerns raised1
Failure to properly complete required food charts
This report raised 6 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Record nutrition assessments, care plans, MUST scores, BMI, weight loss, fluid intake and food intake in the Patient Bedside Safety Booklet.
Stated by Surrey and Sussex Healthcare NHS TrustStated completedThe respondent said that this action was complete when they made their response on 21 December 2020.
Inner North London
Concerns raised1
Failure to properly monitor patients assessed as fed at risk
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Inner North London
Concerns raised1
Failure to escalate and respond to prolonged inadequate fluid intake
This report raised 8 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
Action
Roll out Restore2 deterioration monitoring, placing records in care plans and requiring monthly nursing updates.
Stated by Care UK Community Partnerships LtdStated completedThe respondent said that this action was complete when they made their response on 9 April 2020.
Action
Introduce clearer fluid-balance and fluid-target charts, train staff in their use, and include them in documentation audits.
Stated by Care UK Community Partnerships LtdStated completedThe respondent said that this action was complete when they made their response on 9 April 2020.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Acute concerns about a resident’s oral fluid intake should be referred to the visiting GP for consideration and advice.
Stated by Care UK Community Partnerships LtdRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
South Yorkshire (West)
Concerns raised2
Delays in displaying nutritional requirements at the bedside
Failure to provide food consistent with specialist nutritional requirements
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.8
Action
Update, disseminate and make available the ward meal-service SOP covering mealtime safety huddles and dietary requirements.
Stated by Sheffield Teaching Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 14 January 2021.
Action
Record IDDSI eating, drinking, texture and fluid requirements on the Electronic Whiteboard and populate multidisciplinary handover sheets.
Stated by Sheffield Teaching Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 14 January 2021.
Action
Provide wards with IDDSI diet signage and related patient information forms, including visible IDDSI level descriptions.
Stated by Sheffield Teaching Hospitals NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 14 January 2021.
Action
Add mandatory IDDSI training to Job Specific Essential Training for staff involved in mealtime procedures.
Stated by Sheffield Teaching Hospitals NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 14 January 2021.
Action
Implement the finalised Meal Service Safety e-learning package covering IDDSI, the SOP, mealtime safety huddles and hot-food handling.
Stated by Sheffield Teaching Hospitals NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 14 January 2021.
Action
Expand the HANAT and Power of 3 audits to monitor IDDSI, SOP and hot-food-handling compliance.
Stated by Sheffield Teaching Hospitals NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 14 January 2021.
Action
Mandate the Meal Service Safety e-learning package within the Prepare to Care programme for trainee clinical support workers.
Stated by Sheffield Teaching Hospitals NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 14 January 2021.
Action
Maintain Mealtime Safety Huddles as an additional safety barrier for staff involved in mealtimes.
Stated by Sheffield Teaching Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 14 January 2021.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
COVID-19 operational pressures prevent implementing all planned safety changes in the near future.
Stated by Sheffield Teaching Hospitals NHS Foundation TrustUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
North Wales (East and Central)
Concerns raised1
Inadequate management oversight of staff deployment for residents requiring choking-risk or one-to-one food and fluid assistance
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
Action
Provide trained mealtime staff in the dining room to oversee dysphagia-trained staff assisting residents at choking risk.
Stated by Coed DuonStated completedThe respondent said that this action was complete when they made their response on 14 August 2019.
Action
Provide a registered general nurse in the dining room throughout mealtimes.
Stated by Coed DuonStated completedThe respondent said that this action was complete when they made their response on 14 August 2019.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
A registered general nurse is always present in the dining room during mealtimes.
Stated by Coed DuonExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Stoke-on-Trent and North Staffordshire
Concerns raised1
Failure to ensure accurate recording of patients’ nutritional intake
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
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Includes failures of controls specifically dedicated to assessing, monitoring, recording, providing or reviewing patients' food and fluid intake and nutritional or hydration needs, including risk assessments, nutrition or fluid charts, prompting, prescribed nutritional support and escalation of inadequate intake.
