Dysphagia, or difficulty swallowing, is a critical concern in educational settings, particularly in specialist (SEN or SEND) schools supporting students with complex needs. However, due to various risk factors, dysphagia can present itself across all school settings, so a robust strategy should be in place to meet requirements safely as needed. OHK is at the forefront of supporting schools in developing comprehensive dysphagia management approaches, providing training, guidance and practical solutions to improve food safety, quality and accessibility for students affected by dysphagia.
Who is at risk?
Students at high risk for swallowing disorders include those with:
Nutritional deficiencies, low birth weight, ADHD and eating disorders.
Medication-related side effects (diuretics, antihypertensives, antidepressants).
In specialist (SEN or SEND) schools, dysphagia prevalence is significantly higher due to the complexity of student needs.
Guidance for students with dysphagia includes clinical recommendations from Speech and Language Therapists (SLTs), therapeutic interventions, and food and drink texture modifications. These modifications are critical to ensure safety and accessibility, requiring collaboration between teachers, support workers and catering teams.
Texture modification and IDDSI standards:
Key challenges
Ensuring food safety for students with Dysphagia
School catering teams implement rigorous food safety measures, including HACCP systems and allergen controls. However, texture modification introduces additional complexities and should be identified as a food safety risk:
Food safety risks arise if recommended texture levels are not maintained throughout preparation and service.
Schools must ensure that modified meals do not compromise on choice, quality or appeal to students.
KEY CHALLENGE:Creating safe and nutritious texture modified meals that showcase well-established favourites and appeal to young people.
Commitment to best practices in schools
Recognising the need for structured training, schools and contract caterers are increasingly integrating IDDSI-aligned training programs. This ensures that:
Catering staff are well-trained in dysphagia-friendly preparation methods.
Schools implement dysphagia catering strategies at a policy level.
Students with dysphagia should have access to the same menu choices as their peers and caterers should be able to produce these modified options with minimal additional resources – especially time, skills, equipment and budget.
Integrating catering for dysphagia into school kitchens is achievable, however it does require a confident and well organised team. Catering skills in school kitchens are of a high standard and can be used very effectively to create foods for IDDSI diets.
Key outcomes from IDDSI-trained catering teams:
Improved safety and compliance in dysphagia meal preparation.
Reduced food waste and cost savings through efficient preparation methods.
Enhanced dining experience with meals that maintain quality and appeal.
Operational challenges and solutions
Providing a safe dysphagia food service requires maintaining food texture integrity from kitchen to consumption. Challenges include:
Ensuring texture consistency when food is held in canteen serveries or transported within the school.
Ensuring staff across departments understand the importance of food safety in dysphagia management.
Contract caterers often face additional challenges, such as inadequate equipment for IDDSI-compliant food preparation.
Feedback from ISS: “The OHK training will improve the confidence of our catering teams when producing IDDSI meals for children and young people. We feel OHK is the most suitable programme for ISS because of the rare, and high level, of expertise and knowledge both James and Preston can impart with our placemakers. The IDDSI framework, and in turn, the production of IDDSI meals is a specialised area. It is imperative training in this field is detailed and correct, to minimise any potential risk with the production and service of these meals within our Education business.” Clare Harper – Nutritionist, ISS UK
Developing a systematic approach to Dysphagia catering
Each school must tailor its dysphagia meal provision to local needs while maintaining core principles of best practice. Key factors include:
Effective communication between catering, education, and healthcare teams.
Structured menu design that accommodates dysphagia-friendly modifications.
Ongoing training to ensure staff competency.
Investment in appropriate kitchen equipment to support IDDSI-compliant meal preparation.
Streamlined delivery and service workflows to maintain food texture integrity.
Proof of success: A systematic approach with FASSCO led to 100% compliance over a three-month testing period in a complex production and delivery system.
Enhancing safety through a whole-school approach to Dysphagia awareness
Safety in school meal provision is maximised when all staff – teachers, catering teams and support workers – are equipped with the knowledge to identify and support students with dysphagia.
Best practice guidelines enhance staff confidence in managing dysphagia risks.
Collaboration ensures students receive the best support possible.
Implementing the ED&S competency framework led to measurable improvements in patient safety and staff confidence in East Sussex Healthcare NHS Trust. With an initial 85% reduction in choking incidents, continual improvements year on year, and no ‘never’ events, it’s now seen as a vital part of MDT training within the Trust.
The training has also created a positive impact in Orchard Hill College & Academy Trust.
“The EDS e-modules have been an invaluable resource to the Speech Therapy Service across our different college sites.
In the face of difficulties with recruitment of dysphagia trained SLTs and high agency support staff turnover, the e-learning modules and programme provide by OHK has opened possibilities for the SLT Service to allocate support staff onto the e-modules which cover dysphagia awareness, dysphagia care plan implementation and identifying need for amended mealtime plans.
The e-modules allow the SLT service to capture which staff completed the modules with baseline measurements of EDS awareness and competencies across different locations and college sites. In turn, this has freed up time for the Speech Therapists to focus resources more effectively on more complex dysphagic students’ and related MDT work across our integrated services team.” Lindsay Walker, Orchard Hill College
Want to ensure safe, high quality, inclusive meal services?
Speak with OHK, global experts in food texture modification and IDDSI. OHK is committed to supporting schools in delivering safe, high-quality, and inclusive meal services for students with dysphagia. By implementing structured training, adopting IDDSI standards, and encouraging cross-department collaboration, schools can create sustainable, effective dysphagia management strategies that enhance student safety and dining experiences.
Malnutrition is a growing concern in the UK health and social care sectors, impacting the overall health, recovery and quality of life of residents in care settings.
A BAPEN report also showed that while in 90% of care homes in the UK, nutrition screening was standard, there were inconsistencies in using and calibrating the equipment as well as translating the findings into care plans for individuals.
These figures showcase the critical need for comprehensive, whole team training in care settings to effectively identify and manage dysphagia and reduce the risk of malnutrition.
The impact of malnutrition on health and quality of life
Malnutrition – characterised by insufficient intake of energy, protein, or nutrients – is particularly detrimental for older adults and individuals with conditions like dysphagia. This issue, often under-recognised and undertreated, has severe consequences, including increased vulnerability to illness, delayed recovery and higher mortality rates.
Common consequences include:
Weakened immune systems, leading to higher infection risks.
Muscle wastage and frailty, reducing mobility and independence.
Slower recovery from illness or surgery, prolonging hospital stays.
Poor mental health, with increased depression, confusion and lethargy.
Residents with dysphagia are especially vulnerable to malnutrition as difficulties with swallowing often lead to reduced food intake or reliance on unsuitable, unmodified diets.
Early recognition and management
One of the main barriers to combating dysphagia and malnutrition is a lack of awareness and early recognition of symptoms. Too often, teams rely on individual champions or senior staff for guidance, but this approach leaves gaps when those individuals are unavailable or leave their roles. Recognising malnutrition and symptoms of dysphagia requires vigilance and knowledge from everyone involved in a resident’s care – from kitchen staff to care assistants, nurses, and managers.
Whole team training equips care home teams to:
Identify the early signs of dysphagia and other symptoms of malnutrition, such as unintended weight loss, reduced appetite and fatigue.
Ensure accurate referrals to dieticians or Speech and Language Therapy (SALT) teams for timely interventions.
Improve mealtime experiences, offering bespoke catering solutions and encouraging residents to eat well and stay hydrated, safely.
As highlighted in our recent white paper, produced with Care England, an inclusive training approach not only empowers teams to manage dysphagia but also plays a key role in tackling malnutrition across care settings.
Why this matters NOW
Professor Martin Green OBE, Chief Executive of Care England, highlights the urgency of addressing malnutrition, stating: “Malnutrition is a silent crisis in care homes. It is entirely preventable, but it requires a comprehensive, whole team approach to training. By ensuring that all staff are equipped with the right knowledge and skills, we can deliver safer care, reduce hospital admissions and vastly improve residents’ quality of life.”
Data from Age UK further reinforces the scale of the issue, with 1 in 10 older adults in the UK estimated to be malnourished or at risk of malnutrition. The consequences extend beyond physical health; malnutrition can exacerbate cognitive decline, increase falls and significantly reduce independence.
The call for proactive training
To reduce the impacts of conditions such as dysphagia in exacerbating malnutrition, care providers must move towards sustained, whole team training. This approach promotes collaboration, consistency, and increases confidence across teams, reducing the risks associated with dysphagia and improving residents’ quality of life.
Explore how whole team training can transform dysphagia care in your organisation and help combat malnutrition
Download the white paper we’ve developed in collaboration with Care England to learn how sustained training strategies using validated, up to date resources can address the risks of dysphagia, including malnutrition, and improve resident outcomes and quality of life.
Addressing Staff Turnover and Knowledge Retention in the Health & Social Care Sector: How Whole Team Training Can Help.
In the UK care sector, staff turnover remains a significant challenge, with around 30% of employees leaving their roles annually. This revolving door of staff not only impacts operational continuity but also creates critical gaps in skills and knowledge, directly affecting patient safety and the quality of care provided.
The impact of staff turnover on patient safety Frequent staff changes disrupt the continuity of care and can result in the loss of vital knowledge, particularly in specialised areas such as dysphagia management. Dysphagia – difficulty swallowing – requires precise and consistent care to prevent choking, malnutrition, aspiration pneumonia and in the worst cases, unnecessary deaths. When experienced staff leave, their expertise often goes with them, leaving teams underprepared to address such complex conditions.
We’ve also found it is common practice for care settings to nominate subject matter ‘Champions’ for specific training, along with select senior staff members. While this approach can initially appear effective, it can have its drawbacks. When those trained leave their roles, the knowledge base within the organisation can rapidly erode, creating gaps in care and increasing the risks of late or misdiagnosis and compounds other safety concerns.
This can be exacerbated further as access to Speech and Language Therapy (SALT) teams can be limited across settings. Together, this creates an important argument for adopting a whole-team approach to training.
“Despite its prevalence, dysphagia is often underdiagnosed due to insufficient training across all staff levels, leading to preventable suffering and increased healthcare costs,” said Professor Martin Green OBE, Chief Executive of Care England in our recent white paper on dysphagia management. “The white paper highlights the urgent need for stronger regulation and a comprehensive, whole-team approach to training and knowledge-sharing to address these gaps and improve patient outcomes. Every care team member should be equipped to recognise the symptoms of dysphagia and confidently recommend appropriate next steps. Without empowering entire teams, we risk exacerbating issues like malnutrition and, in some cases, avoidable deaths.”
Recruitment challenges in the care sector Another layer to this issue is the recruitment process. It raises the question: Are recruitment agencies equipped to identify and place candidates with the specialist skills required in many of our care settings? In our experience, recruitment businesses can lack an understanding of the unique demands of the sector, which can lead to mismatches between candidates and roles.
There is a growing argument for recruitment agencies to undergo specialist training themselves, to ensure they are better positioned to assess the specific skills and attributes needed in care environments. As Care England’s Professor Martin Green OBE has previously noted, “Investing in workforce development is key to ensuring sustainability and quality in the care sector.”
The solution: Sustained, whole team training To address these challenges, organisations must adopt a whole team approach to training. This means moving beyond training select individuals and ensuring that every team member – from frontline carers to kitchen staff – receive consistent, high quality, specialist training. For dysphagia management, this ensures that every staff member not only understands the signs of dysphagia and how to refer or make a management plan, but they also understand the importance of texture modified diets, fluid thickening, and preparing individualised meal plans for a better dining experience.
Whole team training helps create a culture of shared responsibility and reduces reliance on individual champions. It empowers all staff to confidently address issues as they arise, improving safety, enhancing the quality of care, and ultimately boosting staff retention through a happier, collaborative workforce.
Explore how whole team training can transform dysphagia care in your organisation Download the white paper we’ve developed in collaboration with Care England to learn how sustained training strategies using validated, up to date resources can address the challenges of staff turnover and ensure better outcomes for residents.
By prioritising workforce development and inclusive training strategies, care providers can mitigate the impact of staff turnover, improve care quality and create safer environments for residents.
Invest in your most valuable resource: your people, and help provide better care to those most vulnerable in our communities.
The UK care sector is fast-paced, ever changing and inherently budget-poor. The staff turnover rate currently sits at a staggering 30% post-Pandemic, so sustainable, flexible and comprehensive health and social care training is more important than ever.
The constant change of personnel means that knowledge and skills can quickly dissipate, leaving care facilities vulnerable and under-equipped. This is where the value of investing in robust, validated dysphagia training becomes apparent – in particular e-Learning for dysphagia – as this can be a much more cost-effective, flexible and accessible option that suits the transient nature of the health and social care workforce.
The hidden costs of “free” training
At first glance, free training options might seem like a no-brainer for care facilities with tight budgets. However, these options often come with hidden costs that can outweigh their initial appeal, as well as data longevity and validation concerns. Free training typically lacks the depth and breadth necessary to fully equip staff with the skills they need to provide high quality care. In a similar vein, face-to-face training can be costly and much more difficult to organise and control with a varied, diverse rota-based workforce.
Without a structured and comprehensive approach, training may not be up-to-date with the latest industry standards and practices in dysphagia management. In a sector as crucial as healthcare, where the wellbeing of individuals should be front and centre of any care organisation’s mission, cutting corners on training can lead to significant risks. Inadequate training can result in mistakes, slower diagnosis and referrals, lower quality of care, and ultimately increases risks to patient outcomes.
The value of proper training investment
Investing in quality training programs, like the OHK EDS Site Training Bundle, offers a robust solution to these challenges. With an annual licence that covers staff for facilities with 1 to 100+ beds, the OHK training bundle ensures that every team member receives comprehensive and up-to-date training thanks to the ongoing clinical partnership with East Sussex Healthcare NHS Trust. The continuity of purchasing the annual licence is crucial in maintaining high standards of care, even as staff members come and go.
By committing to a thorough and continuous training program, care facilities can create a sustainable learning environment. OHK’s e-Learning is flexible, accessible and self-paced – meaning that new hires can be immediately enrolled in the training and access modules from any device, anywhere, ensuring they quickly reach the level of proficiency required to deliver quality care. This seamless transition helps preserve the collective knowledge within the care setting, reducing the disruptions that can be caused by high turnover rates.
Longer term benefits extend beyond knowledge retention
The benefits of investing in quality training extend beyond immediate knowledge retention. Quality training leads to higher staff satisfaction and retention, as employees feel more competent and valued in their roles. This in turn reduces turnover rates and the associated costs of recruiting and training new staff. Also, it’s a much agreed fact that well trained staff provide better care, leading to improved patient outcomes and an enhanced reputation for the care setting.
Investing in training that’s mapped to industry and globally-recognised standards and procedures such as IDDSI and the Eating, Drinking, Swallowing Competency Framework futureproofs the training, and also aligns with regulatory requirements and industry best practices, ensuring that care facilities remain compliant and avoid potential legal issues. For example, failure to comply with CQC standards for safe swallowing measures have resulted in substantial regulatory fines. The imposed fines are now becoming notably high, with one care home being fined £1.5 million for “not understand how to prepare the correct diet or to safely support the resident to eat and drink” as well as poor record keeping.
Speak with OHK today for your free consultation
While free or low-cost training options might seem tempting, the longer-term benefits of investing in comprehensive and high-quality training programs far outweigh the initial savings. The OHK EDS Site Training Bundle offers an invaluable solution to the challenges posed by high staff turnover in the UK care sector. By providing continuous, up-to-date training for all staff members, care facilities can ensure sustainable, high-quality care and create a more stable and competent workforce.
OHK’s validated, specialised courses can meet the EDS and IDDSI needs across your whole team. Unsure what training you need? Speak to us and we can help you identify areas of risk and demonstrate to regulators evidence of scrutiny and improvement.
The collaboration between OHK and specialist Speech & Language Therapists in ESHT and the Royal College of Speech & Language Therapy (RCSLT) launched a specialist, cost-effective e-learning programme that has been vastly improving the lives of those suffering with dysphagia since launch.
The HSJ Awards recognise an outstanding dedication to improving healthcare and effective collaboration with the NHS. OHK is owned and directed by Preston Walker and James Ball, both experts in the area of care catering, IDDSI and the texture modification of foods.
With 28 separate categories this year, the winners were announced during an impressive ceremony held at Evolution London, hosted by Miles Jupp. The event was attended by representatives from the NHS, and both the private and third sector as well as key players from non-clinical backgrounds, all coming together to celebrate the importance of positive partnerships and acknowledging how these underpin the future sustainability of the NHS.
The OHK and ESHT partnership was established in 2020 to create an interactive, immersive, and educational program tailored to address the diverse training needs of ESHT staff and enhance patient safety. Following the introduction of the eLearning-based there were no ‘never’ events or near misses and vast improvements in incident numbers being reported and acted upon. The collaboration and project was selected and put forward for the award based on its ambition, value and the positive outcomes that the project has had on both practitioners and patients.
James Ball, Director at OHK, comments: “Winning ‘gold’ in the Patient Safety Collaboration of the Year category validates our efforts in implementing the successful e-learning program. Everyone deserves the right to safe nutrition, and we are delighted to continue to work with NHS teams across the country to push this agenda forward. We’re committed to improving the lives of as many dysphagia patients as possible with our specialist training and support, and with our NHS colleagues, help to make dysphagia everyone’s business.”
HSJ editor Alastair McLellan commended the winners, emphasising the crucial role of external suppliers in healthcare improvement: “This year’s awards demonstrate there is almost no NHS clinical or support service which does not rely – sometimes almost completely – on the efforts of external suppliers.
“Almost any attempt to improve NHS productivity – the service’s greatest challenge – without working in concert with suppliers starts at a major disadvantage. Indeed, many of the best ideas for improving productivity do and will come from suppliers. Every one of the businesses on the Partnership Awards shortlist has shown the kind of thinking and determination it takes to deliver change in healthcare services. They should all be very proud of the efforts, our 28 winners especially so.”
OHK looks forward to building on this success and continuing their mission to improve healthcare outcomes in collaboration with NHS partners.
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