• Two patients die, seven suffer serious harm, and 270 less serious harm after confusion over term “soft diet”
  • NHS Improvement calls for an end to the use of the term 
  • Local organisations must revise food ordering systems by April 2019

NHS Improvement has issued an alert following the death of two patients and hundreds of other incidents where people with swallowing difficulties were given inappropriate food.

The regulator’s national reporting and learning system has received reports of two patients dying, seven coming to significant harm, and 270 other incidents where patients suffered “less serious harm”, following staff confusion over the term “soft diet”.

The alert highlighted that in cases where patients were supposed to be given minced or pureed food, they were instead given solid food, such as mince or peas.

The 270 reports of patients experiencing “less serious harm”, included brief choking or coughing episodes.

Details about where the deaths occured, and when, have not been provided.

Due to this confusion, NHS Improvement, The British Dietetic Association and the Royal College of Speech and Language Therapists are calling for an end of the use of “soft diet”.

They say providers must adhere to new international guidelines and terminology for describing food appropriate for patents with swallowing difficulties.

NHSI has given organisations a deadline of 1 April 2019 by which to ensure that they have successfully revised systems of ordering food and “adapted protocols and patient information, as well as training”.

Local organisations have also been told to identify a clinical leader to bring together a multidisciplinary team, including speech and language therapists, dietitians, nurses, pharmacists and catering services to eliminate confusing terminology.

NHSI’s executive medical director and chief operating officer Kathy McLean, said: “Vulnerable patients have died or been harmed because there is confusion in the way people describe what type of food is suitable for those with swallowing or chewing difficulties.”

“We are calling on everyone providing NHS-funded care to start using precise terminology to help avoid further harm. This will help save lives and make the NHS safer,” Dr McLean said.