By Emily Stuart RD, on behalf of the Food Services Specialist Group (FSSG) of the British Dietetic Association (BDA)

Launch of the 3rd edition of the BDA’s Nutrition and Hydration Digest

While hospital food has historically suffered a poor reputation, the importance of nutrition in a patient’s recovery has been recognised since the first hospital food guidelines in the 1940’s. Since then, the nutritional standards have come a long way, with the latest instalment being released this week. This blog post will delve into the background of these guidelines, what they are and how this Dietitian led document has made its way into national legislation – helping to ensure nutritious, safe, and appropriate food provision in our hospitals.

The BDA’s Nutrition and Hydration Digest (often referred to as simply  ‘The Digest’) is a fundamental resource for all involved in the provision of quality food services in the healthcare setting. It is often affectionately referred to as ‘The Bible’ for hospital caterers and Food Service Dietitians. It is a document packed with information that dietitians from all backgrounds will find useful, including the minimum energy and protein targets for hospital menus, the nutritional criteria for various menu codes, guidance on catering for a range of therapeutic diets and practical advice on menu planning and nutritional analysis.

The Digest began its life back in 2012 when the first edition was published. Shortly after this, in 2014, the first Hospital Food Standards were published and these legally-binding standards referenced the Digest as one of the five core required standards for hospital food – a proud moment for all Food Service Dietitians, who make up a relatively small (but ever-growing) group of the wider profession where more resource is needed. The second edition of the Digest was published in 2017 and then updated in 2019 to reflect the launch of the International Dysphagia Diet Standardisation Initiative (IDDSI) Framework.

Work on the third edition of the Digest began in February 2021 with the formation of a working group of 35 Dietitians and caterers from across the UK, chaired at the time by Megan Hughes (nee Cameron-Lee), who was later joined by Elise Kelly as co-chair. Each of these working party members volunteered their time to support with updating this invaluable resource. This cross-discipline group of professionals from the BDA and the Hospital Caterers Association (HCA) came together to ensure the Digest reflected recent evidence, changes in relevant guidance and legislation, and shared best practice in hospital food and drink service. This process included a stakeholder consultation event in July 2021, many follow up meetings and a BDA member poll in May 2022 to ensure the changes we were considering were warranted and achievable. Each chapter lead was allocated a buddy and relevant supporting working party members, so they could then begin the work of researching and updating their specific chapter. In addition to updates to the content, we have worked hard to improve the layout of the document, ensuring its workability as a reference guide with better online accessibility, and links to further information.

British Dietetic Association's 3rd Edition The Digest











As part of these structural changes, we have reordered the layout and made way for some exciting new content. Some of the key changes include:

  • A brand-new chapter on sustainability
  • Updates to the nutritional standards to meet the latest evidence, including a higher protein target and menu code
  • Business case guidance to help embed a Food Service Dietitian role
  • Alignment with the new National Standards for Healthcare Food and Drink

The National Standards for Healthcare Food and Drink were published in November 2022 and are part of the legally binding NHS standard contract in England. The standards outline key requirements each NHS Trust must have in place, including compliance with the Digest, to ensure they are providing safe, nutritious, sustainable, and appropriate food and drink to their patients and staff.

The latest updates in the 3rd edition of the Digest reflect key requirements from the National standards for healthcare food and drink, including:

Another important change for the 3rd edition of the Digest is a move to an accessible, online version. Healthcare Food Service is a fast-paced industry, with constantly changing evidence, legislation, and guidance. The online version of the Digest will allow it to become a ‘live’ document that can be updated between traditional review periods. Additionally, it will provide improved navigation, so that readers can easily access the relevant section to their task at hand.

The Digest is an essential tool for Food Service Dietitians and caterers, but it is also packed with information that all dietitians and healthcare professionals will undoubtedly find helpful. It covers legislation and guidance around food labelling and allergen control, practical application of nutritional analysis, the criteria behind the diet codes commonly found on menus and how to cater for several different therapeutic diets. The Digest also contains information for nutrition and dietetic departments that are interested in putting a business case together for a Food Services Dietitian, plus an example job description and person specification.

Collaboration has been a key part of the creation of this resource. The Digest working group have consulted with a wide range of clinical dietitians and experts from each of the four nations of the United Kingdom. As previously mentioned, we have worked closely with the HCA and are thrilled to have Phil Shelley, previous HCA chair and Senior Operational Manager for NHS Improvement, speaking at our launch event on June 15th. Many of the Digest working group are FSSG group and committee members. Compared to some of the clinical specialist groups of the BDA, the FSSG are a relatively small group, although last year our membership saw growth above that of any previous years within our 20-year history, with an increase of 22%. It is an exciting time to be working in food service dietetics where we have a real opportunity to shape the future of food services in healthcare.

We want to thank all the Digest working party members for their hard work on this document and hope that readers will appreciate the input from such a wide range of specialists, knowledgeable and experienced in the field of hospital food service dietetics.