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Making Christmas special for those with dysphagia

How chefs at St Andrew’s Healthcare are creating a specially-crafted Christmas lunch



Kimberlee Ferrari, lead Speech and Language Therapist at St Andrew’s Healthcare, discusses creating different levels of graded meals and treats we all associate with the festive season

Christmas is a time of year that often revolves around eating, drinking and socialising. At St Andrew’s Healthcare, we make sure that those with dysphagia can enjoy the same classic food traditions as everyone else. 

St Andrew’s Healthcare has a dedicated, award-winning dysphagia kitchen at our Northampton site, which offers a wide choice of modified foods on a daily basis for patients who have swallowing difficulties. At Christmas time, the dysphagia chefs offer a special festive menu, which makes the most of fresh, local produce, whilst adhering to IDDSI (International Dysphagia Diet Standardisation Initiative) guidance on texture modification. 

All the classics are included: roast turkey, pigs in blanket, stuffing balls, potatoes, roast parsnips, Brussels sprouts, with a dessert choice of Christmas pudding or chocolate log. The chefs also create an alcohol free ‘mulled wine’ dessert for those with dysphagia to enjoy on Christmas Eve, as well as dysphagia safe mince pies to be served at festive events in the lead up to Christmas. 

Creating an IDDSI Level 4 pureed mince pie is not as simple as just putting the pudding in a blender – our dysphagia chefs blend it with cream and additional mincemeat to ensure it remains moist, before passing it through a fine sieve (sometimes multiple times) to guarantee a smooth texture. 

Our chefs work closely with the on-site Speech and Language Therapy and Nutrition and Dietetics teams to create a menu that is nutritious, safe and delicious, and they implemented IDDSI in January 2019. The IDDSI framework consists of a continuum of 8 levels (0 – 7), where drinks are measured from Levels 0 – 4, and foods are measured from Levels 3 – 7. The IDDSI Framework provides a common terminology to describe food textures and drink thickness and is endorsed by the Royal College of Speech and Language Therapists (RCSLT), NHS England and The British Dietetic Association (BDA).

The kitchen undergoes regular audit of the approximately 90 food items produced to ensure adherence to this international guidance. The audit involves evidence-based IDDSI testing methods, which are intended to confirm the flow and textural characteristics of a particular product at the time of testing, for example fork drip, fork pressure and spoon tilt tests.

Once cooked, the dysphagia meals are moulded to resemble the original food item. This makes the meal more visually appealing for patients, but is particularly important in the care of people with dementia, where recognition can be a vital aspect of food acceptance. 

The standard internationally-available moulds are aimed at elderly patients with small appetites, but many St Andrew’s patients required larger portions, therefore the catering team commissioned bespoke moulds in order to deliver a better portion size and improve the calorie intake of the patients. This resulted in some seriously vulnerable patients putting on weight and improving their overall physical health. The dysphagia kitchen also offer off-menu innovative dysphagia snacks such as a cheese on toast to support with nutritional intake of those who are at end of life. 

As well as preparing meals, the chefs in the dysphagia kitchen provide teaching opportunities for Speech and Language Therapists who are completing their dysphagia competencies, as well as offering discussions directly with patients and staff members about the process of creating the meals.

It is vitally important that patients with dysphagia are given food prepared at the appropriate consistency identified from specialist Speech and Language Therapy assessments. If the wrong consistency is given, this significantly increases the risk of negative health consequences for patients with dysphagia, including choking, pneumonia, chest infections, dehydration, malnutrition, or weight loss. In the worst cases, poorly managed dysphagia care can result in death.

Having an on-site dysphagia kitchen offers flexibility to ensure that we can provide a high-quality, individualised, person-centred approach to the care of a diverse group of patients with complex mental and physical health needs. This means that we can make sure everyone at St Andrew’s has a very merry Christmas.