Rebecca's serving up tasty meals for patients with swallowing difficulties

A Swansea Bay ward hostess is on a mission to provide patients who have swallowing difficulties with tasty, nutritious meals after seeing her elderly nan struggle to eat.

Rebecca Holt, who manages a meals service for patients on Morriston Hospital’s Gower Ward, has put together a range of leaflets, an information board and a guidebook for colleagues, patients and their families to help them adapt to living with dysphagia, or difficulties with swallowing.

Around one in 25 people worldwide will experience dysphagia during their lifetime, with conditions like Parkinson’s Disease, Multiple Sclerosis and Dementia commonly associated with swallowing difficulties. But other people may have dysphagia as a result of a medical procedure like a tracheotomy and with time, should be able to fully recover their ability to swallow normally.

Whatever the cause, swallowing difficulties create real distress and discomfort for many people and making the right modifications to how meals and drinks are prepared and presented, including the correct thickness and texture, is essential.

Rebecca has worked closely with speech and language therapists (SLTs), who assess individual needs and then recommend a food texture or thickness for people with dysphagia. This has helped to ensure the resources she put together in her spare time are as accurate and informative as possible.

And after positive feedback on the impact of her work from patients, families and colleagues, Rebecca is hoping that her learning resources can now be rolled out more widely across the health board.

She said: “I love seeing the progression in the patients. It’s so nice to see them happy and enjoying something with flavours they enjoy but can eat and manage comfortably.

“I get patients asking me what’s tasty, what I’d recommend for them.

“I feel really passionate about this, partly because my nan had dementia and as is often the case, it was hard for her to swallow. I remember asking at her nursing home what she’d eaten on one particular day and they told me 10 packets of Quavers crisps.

“It breaks your heart. But of course, there are ways to prepare good food for people who find it hard to chew and to swallow and who find some textures difficult to manage.”

The IDDSI, or International Dysphagia Diet Standardisation Initiative, is a globally-recognised framework which offers clear descriptions of texture modified foods and thickened drinks to help tailor meals to the specific requirements of what a patient can safely tolerate.

Pictured: Rebecca with one of the guidebooks she has put together

Difficulty with swallowing can lead to choking and aspiration of food (when it enters the airway, potentially causing infection), so it is essential guidelines on texture are followed precisely. 

Rebecca’s work is helping to improve awareness and understanding of dysphagia and importantly, how to approach modifications to ensure patients are able to eat the foods which will help them recover and to increase their energy levels.

Rebecca added: “It can be a case of starting from scratch, often because of complex neurological needs.

“For me it’s all about giving patients a boost, trying to get them something that they will like to eat and enjoy.

“I try to really interact with patients. It’s about making sure I’m doing everything I can to get it right.

“I’m trying to be creative with the presentation as well. If you put a bit of thought into how you present food it can make such a difference to how a patient feels about eating.

“My role as ward hostess is to manage pretty much everything to do with food, such as ordering and making sure there are enough things like snacks available.

“My background before joining the NHS has always been in food, I’ve worked in restaurants and cafes.

“It can be hard because sometimes people really don’t want to eat. But it’s clearly so important for them to get the nutrition they need, it has a massive bearing on recovery.

“We know patients need to get up and moving as soon as possible after procedures and treatment, they often need to get out of bed for physiotherapy. But if you’re struggling to eat and get the nutrition you need it’s going to be harder to get up and about. It’s fundamental.”

“I’m also a big believer that when we can, we should be helping people out of their beds to eat.

“It can be a default setting in hospital for people to eat their food in bed but it’s so much better for their health in general, not least their digestion, to get more upright and into a chair. In what other setting would people regularly eat their meals in bed?

“We have patients with conditions like acid reflux. Eating in bed and then immediately lying down again is really not good for them, so whenever possible, I encourage people to get up for their meals.

“As for next steps, in an ideal world I’d like the resources I’ve put together to be available for staff and patients across the health board.

“I’ve got leaflets I can give to patients and to their relatives. I can talk things through with people and find things they like and will work for them.

“I’ve also got a very good booklet designed for staff, for new staff in particular. I’ve sourced the leaflets and booklets myself from an IDDSI website.

“I’ve also contacted our caterers, worked closely with SLTs and I’ve been in touch with diet techs to make sure that the information I’m passing on is absolutely correct.

“It covers the dos and don’ts, textures and thicknesses, with pictures and diagrams. It’s all there.”

Colleagues are right behind Rebecca’s efforts to spread the word.

“What Rebecca has put together in her own time is a great resource,” said Specialist Speech and Language Therapist Jemma Pullen.

“She has taken on the initiative herself and the material is used on the ward to ensure patients get the food which is right and safe for them.

“She feels really passionately about this area of patient care and has put this into action to forge improvements. It’s really great to see.”