Implementing nutritional standards: the Scottish experience.

In the United Kingdom, 5% of the population are underweight or have features of malnutrition. The prevalence of malnutrition rises with age and is more common in the north of England than in the south, but comparable data are not available for Scotland. In 2003, the National Health Service Quality Improvement Scotland (NHS QIS) developed a standard for food, fluid and nutritional care in hospitals (FFNCH). In 2006, a peer review of Scottish health boards was published. The reviewers reported that all Scottish health boards had started to implement the standards, but not across all clinical areas. Every health board had set up a nutritional care group to oversee and advise on the implementation of the standards, but none had produced a financial framework to support the work of the groups. Most health boards had not fully developed a policy or strategic plan to improve nutritional care as required, and there was a shortage of specialist nutrition nurses and clinical and nutrition support teams to supervise the treatment of patients with complex nutritional needs. The Scottish experience emphasizes the size of the task that health services face to bring about change.