What is the IDDSI framework?
The IDDSI framework is a global standard for describing texture-modified food and thickened drinks for people with dysphagia. Published by the International Dysphagia Diet Standardisation Initiative, it puts everything a person eats or drinks on one continuum of eight levels, numbered 0 to 7. Levels are identified by numbers, text labels and colour codes, although Levels 3 and 4 carry both a food name and a drink name, and Level 7 has two descriptors (Regular and Easy to Chew) that share the number.
IDDSI replaced the older UK texture descriptors. The British Dietetic Association announced its support for formal UK adoption on 5 October 2017, and an NHS Improvement alert of 27 June 2018 set 1 April 2019 as the date for organisations providing NHS-funded care in England to complete the change, so it is now the shared language of British hospitals and care kitchens.
What is dysphagia?
Dysphagia is difficulty swallowing. It is common after a stroke and in people living with dementia or Parkinson’s disease, and it becomes more likely with age. If food or drink is the wrong texture it can block the airway or slip into the lungs, so what leaves the kitchen is a safety decision.
The two main risks are choking and aspiration pneumonia, a lung infection caused by food or liquid going down the wrong way. Both can kill.
What are the IDDSI levels?
Drinks cover levels 0 to 4: thin, slightly thick, mildly thick, moderately thick and extremely thick. Foods cover levels 3 to 7: liquidised, pureed, minced and moist, soft and bite-sized, and regular. The two lists overlap at 3 and 4 because a food and a drink at those levels behave the same way.
Level 7 has two descriptors. Regular has no texture restrictions. Easy to Chew covers soft or tender everyday foods in pieces of any size, and IDDSI says it “Requires the ability to chew and orally process soft/tender foods without tiring easily” and could present “a choking risk for people with clinically identified increased risk of choking”. Which level a person needs is the clinician’s decision.
How do you test a texture in a working kitchen?
With a fork, a spoon and one piece of specified equipment: a 10 ml slip tip syringe whose 10 ml scale measures 61.5 mm between the zero and 10 ml marks, which IDDSI says you must check because syringe lengths differ. Drinks are graded with the IDDSI flow test, which measures how much of a 10 ml sample is left in a slip-tip syringe after ten seconds. Foods use the fork drip test, the spoon tilt test and fork pressure checks to confirm a sample drips, holds its shape or squashes as its level requires.
A level 4 puree, for instance, should hold its shape on a spoon and slide off in one piece when tilted, with no lumps. On the fork drip test a small amount may form a short tail below the prongs, but it must not flow or drip continuously through them.
Why does shared terminology matter so much?
Because before IDDSI, “soft diet” could mean one thing to the speech and language therapist and something else entirely at the stove. When the plate does not match the assessment, the resident carries the risk. A number removes the guesswork: if the care plan says level 5 minced and moist, there is exactly one right answer at the pass.
Agency cover and hospital transfers get safer too, when both sides count from the same eight levels.
Is IDDSI training a legal requirement?
No. IDDSI is an international standard, not UK legislation. Providers regulated by the Care Quality Commission do, though, have a duty under Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to meet nutritional and hydration needs, which includes serving food and drink that suits a person’s assessed condition.
Inspectors check whether meals match speech and language therapy recommendations, and choking deaths where they did not have featured in coroners’ reports.
Who needs this course?
Cooks, chefs and kitchen assistants in care homes, hospital catering, supported living and day services, plus home care staff who prepare meals. It pairs naturally with Food Hygiene Level 2, and anyone supporting people after a stroke will find the stroke information and management course explains why swallowing changes in the first place.
The course ends with a CPD accredited certificate, and the £35 covers it along with 130+ other courses for 12 months for one person, backed by a 14-day money-back guarantee, provided you have not downloaded a certificate.
