In care settings, some residents may have different requirements which need to be catered for. This is especially true when it comes to the food and drink they’re given since they need to be able to consume it safely, which is where things like the IDDSI Framework become useful.

Here, we’ll be explaining what this framework is, the different levels involved, and how you can implement it within your catering business to make sure the safety of those in care homes, hospitals and other care settings is never compromised.

What does IDSSI stand for?

IDDSI stands for International Dysphagia Diet Standardisation Initiative, which is a framework that sets the standard for serving textured foods and thickened liquids to those with chewing and swallowing problems. This was created by a group of volunteers from around the world who work in a variety of healthcare professions, including nutritionists, dieticians, occupational therapists, and nurses. Together, these people form the IDDSI board.

The main group of people who benefit from IDDSI is those who suffer from dysphagia, which means they find it difficult or uncomfortable to swallow food and drink. This is because it helps caterers in the care industry determine which foods and drinks would be easiest for people with this condition to consume.

IDDSI levels explained

IDDSI consists of eight levels ranging from 0 to 7, with drinks ranging from 0 to 4 and foods ranging from 3 to 7. These indicate the texture and thickness of foods and drinks and give some steer as to which ones are safest for somebody with dysphagia to consume.

Below you can see each level and what it means:


  • 0 – Thin
  • 1 – Slightly thick
  • 2 – Mildly thick
  • 3 – Moderately thick
  • 4 – Extremely thick


  • 3 – Liquidised
  • 4 – Pureed
  • 5 – Minced and moist (transitional foods)
  • 6 – Soft and bite-sized (transitional foods)
  • 7 – Regular and easy to chew (transitional foods)

Benefits of the IDDSI Framework

So, what are the main advantages of the IDDSI Framework? From reliable results to being easy to follow, we’ll go through the top reasons why it’s worth implementing this into your catering business practices. 

Produces scientific and reliable results

The testing for each level of the IDDSI is based on scientific findings and is designed to be easy to use so that you can get reliable results that can be used for patient safety.

NHS recommended

The NHS endorses and recommends using IDDSI terminology to help keep choking incidents to a minimum. Since there are levels to describe both food and liquid, this means that patient safety is well accounted for when eating or drinking.

The framework is prescriptive rather than restrictive

Because the framework is prescriptive rather than restrictive, patients should be offered all levels of foods and drinks they can manage safely. This means they have more food and drink options, and their overall quality of life can be improved rather than being held back.

Internationally recognised

Since the IDDSI framework is implemented worldwide, there’s less room for confusion about dysphagia descriptions and identification of safe foods and drinks. Ultimately, this means that patients can be kept safe wherever they are in the world when they require care.

Easy to follow

Caterers in care settings can easily follow the simple text labels, numbers and colour codes used to identify each level. This makes it easy to grasp and implement into your processes to keep patients safe.

Key tips on implementing the IDDSI Framework

When it comes to implementing the IDDSI Framework, there are a few critical things to remember. It’s also worth noting that implementation will look slightly different depending on what kind of care setting you’re operating in, the size of the business and other factors. Whether it’s training or reviewing current processes, find out what our top tips are below.

Ensure staff are aware of the IDDSI Framework and its significance

One of the most important things to do is make sure all staff members within your catering team are aware of why the IDDSI Framework is important, alongside knowing what it is and how it works. Without proper knowledge and understanding, it can be difficult to cohesively implement it into your processes. However, taking this step ensures that everybody on the team knows how and why this can improve patient safety. 

Review current processes

Reviewing current processes to find out how they need to change is also crucial. Take the time to understand the different levels and which foods or drinks fall where within your catering output.

Identify which levels you will serve

It’s also necessary to pick out which levels you’ll serve to patients. This will probably depend on how many patients suffer from dysphagia and how severe their condition is. For example, if all of your patients have dysphagia, it’s likely that you’ll only serve safer foods and drinks as a best practice.

Train staff

Finally, staff need to be trained on everything from testing methods to how any other changes will be implemented. You’ll need to spend some time making sure your catering staff can determine which level a food or drink falls into, which can involve things like funnels, flow test cards or syringes.

Whether you’re a caterer brushing up on food safety frameworks or work in a care setting and want to learn more about giving food and drink to those with dysphagia, we hope this guide comes in handy.

For more advice on food safety and health, check out our blog.