Recurring concern
Inadequate management of patients' nutrition and hydration needs
Pin
Get email alerts
Request correctionFirst reported 2 Jul 2014•Latest report 24 Feb 2026
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
- Individual concerns
- 44
- Date range
- 2014–2026
- Stated actions
- 80
Distinct published reports
A report can raise multiple concerns
First to latest report issue date
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.
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.
-
Concerns raised1
Failure to provide adequate dietary and fluid intake support
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach 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.4
-
Action
Train all care staff and nurses in communication, documentation, reporting, nutrition, malnutrition and dehydration.
Stated by Caring Moss Cottage Ltd -
Action
Disseminate relevant record-keeping, care, nutrition, hydration, bowel-care, accountability, delegation and leadership policies through the quality compliance software reading list.
Stated by Caring Moss Cottage Ltd -
Action
Revise daily handovers to record dietary intake, fluid consumption and elimination for earlier intervention.
Stated by Caring Moss Cottage Ltd
-
Action
Add fluid-balance charts and bowel activity to the manager’s daily walk-round checks.
Stated by Caring Moss Cottage Ltd
-
Concerns raised1
Failure of intentional rounding and nursing practices to ensure adequate hydration and nutrition for vulnerable ward patients
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach 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.4
-
Action
Continue enhanced auditing of appropriate food-chart commencement for three months to assure consistent nutrition monitoring across WTWA hospitals.
Stated by Manchester University NHS Foundation Trust -
Action
Provide additional nutrition and hydration monitoring through quality and safety walk rounds led by nursing directors, with real-time feedback.
Stated by Manchester University NHS Foundation Trust -
Action
Formalise Ward Manager and Matron walkarounds to increase assurance of mealtime preparedness and real-time patient feedback.
Stated by Manchester University NHS Foundation Trust
-
Action
Increase the volume and frequency of peer dining audits from March 2026, reporting results through senior nursing and nutrition governance.
Stated by Manchester University NHS Foundation Trust
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
-
Position
The Trust considers its comprehensive care approach, including nutrition and hydration support for vulnerable patients, sufficient to address the concern.
Stated by Manchester University NHS Foundation Trust
-
Concerns raised1
Insufficient nutritional support for inpatients
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 concernsEach 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
Require admission and weekly MUST screening, real-time monitoring, automatic Dietetics referral for high risk or poor intake, and multidisciplinary review of repeated nutrition or hydration refusal.
Stated by East Sussex Healthcare NHS Trust -
Action
Continue quarterly audits of MUST compliance, referral timeliness, and weight monitoring, with results reported through governance arrangements.
Stated by East Sussex Healthcare NHS Trust -
Action
Run a BETU nutrition-improvement pilot using additional Dietetic staffing, equipment review, and strategies to improve nutrition, then roll learning out across the Trust.
Stated by East Sussex Healthcare NHS Trust
-
Concerns raised1
Failure to accurately and completely record fluid and food 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 concernsEach 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.4
-
Action
Use electronic fluid-balance charts in Nevercentre to improve accessibility, calculation and documentation accuracy.
Stated by University Hospitals of Northamptonshire NHS Group -
Action
Roll out updated food-and-fluid charts across both hospitals, including prompts for chart commencement, visitor-provided food and oral nutritional supplements.
Stated by University Hospitals of Northamptonshire NHS Group -
Action
Audit MUST completion and the accuracy of food-and-fluid charts through Nutrition Nurses and use findings to monitor compliance.
Stated by University Hospitals of Northamptonshire NHS Group
-
Action
Deliver evaluated monthly nutrition and hydration training through the Clinical Skills Nursing Programme, including documentation standards.
Stated by University Hospitals of Northamptonshire NHS Group
-
Concerns raised1
Failure to monitor and record malnutrition-risk interventions
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 concernsEach 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.5
-
Action
Require Divisional Directors of Nursing to provide assurance that patients’ nutrition and hydration needs are assessed, met and accurately recorded.
Stated by Frimley Health NHS Foundation Trust -
Action
Develop and deliver updated nutrition and hydration training covering documentation, mealtimes, trays, diets and supplements, with area-level compliance monitoring.
Stated by Frimley Health NHS Foundation Trust -
Action
Amend Epic care flowsheets to capture food and fluid intake in greater detail and disseminate supporting safety communications.
Stated by Frimley Health NHS Foundation Trust
-
Action
Implement a weight-loss flag that triggers a multidisciplinary swarm huddle and individualised care planning, with compliance monitoring.
Stated by Frimley Health NHS Foundation Trust -
Action
Run the Harm Free Care audit programme to monitor food-chart completion, nutritional care and significant-weight-loss escalation.
Stated by Frimley Health NHS Foundation Trust
-
Concerns raised1
Inadequate assessments of hydration status for ward patients
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 concernsEach 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
Deliver ongoing education and training on fluid balance and hydration assessment through Medicine and Quality Improvement teams.
Stated by Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust -
Action
Host a multidisciplinary Gastroenterology Masterclass addressing comprehensive nutrition and hydration assessment and fluid-intake monitoring.
Stated by Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
-
Concerns raised1
Failure to formally monitor dietary intake
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach 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.5
-
Action
Embed strengthened nutrition documentation and compliance monitoring within the Quality Management System.
Stated by Aneurin Bevan University LHB -
Action
Develop and deploy a Gold Standard food chart with a supporting staff briefing.
Stated by Aneurin Bevan University LHB -
Action
Reinforce red trays and visual identifiers for patients requiring dietary monitoring.
Stated by Aneurin Bevan University LHB
-
Action
Use AMaT data to assess and improve ward-level compliance with food-chart use.
Stated by Aneurin Bevan University LHB -
Action
Explore environmental barriers to dietary monitoring, including early tray clearance and single-room isolation.
Stated by Aneurin Bevan University LHB
-
Concerns raised1
Failure to escalate concerns about reduced food intake
This report raised 7 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach 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
Undertake an unannounced assessment covering visit duration, nutrition and hydration, health monitoring, escalation, record keeping, governance, safeguarding and decision-making.
Stated by Care Quality Commission
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
-
Position
The January 2020 inspection found no concerns about supporting people with eating, drinking, nutrition or hydration needs.
Stated by Care Quality Commission
-
Concerns raised2
Failure to ensure the recorded and implemented diet reflects identified nutritional needs
Failure to implement and maintain food charts after malnutrition risk assessment
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 concernsEach 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
Consolidate eating, drinking and nutrition assessments into one Nucleus section.
Stated by York and Scarborough Teaching Hospitals NHS Foundation Trust -
Action
Carry out quality-improvement work addressing poor compliance with nutritional assessment and food-chart requirements.
Stated by York and Scarborough Teaching Hospitals NHS Foundation Trust
-
Concerns raised1
Poor quality of fluid and nutrition charts
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 concernsEach 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.5
-
Action
Conduct an assessment and inspection of Downshaw Lodge to verify required changes, including staff training, accurate needs assessment, care planning, and documentation.
Stated by Care Quality Commission -
Action
Complete an IMPACT audit of documentation, nutrition and fluid-recording practice.
Stated by Qualia Care Limited (In Administration -
Action
Train staff in MUST, fluid and nutrition care, documentation, record-keeping and dietary-risk escalation.
Stated by Qualia Care Limited (In Administration
-
Action
Conduct regular management spot checks and dip-sampling of care records to verify documentation compliance and identify training needs.
Stated by Qualia Care Limited (In Administration -
Action
Monitor fluid and food intake charts and provide detailed handovers at every shift change.
Stated by Qualia Care Limited (In Administration
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
-
Position
Existing provider actions, multi-agency oversight and available documentation processes were considered sufficient to address identified care and recording risks.
Stated by Care Quality Commission
Data last updated 7 September 2026