Oral Nutritional Supplement (ONS) Replacement In Care Homes

For All Enquiries please contact : 

Leicestershire Nutrition & Dietetic Service: lpt.dietitiansphcadmin@nhs.net | 0116 222 7170

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From 1st September 2025, a new prescribing approach promoting food-based alternatives to Oral Nutritional Supplements (ONS) will be introduced in care homes across Leicester, Leicestershire, and Rutland (LLR).

Key Prescribing Update
Routine prescribing of ONS for care home residents is not recommended, unless one of the following clinical criteria is met:
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The resident is tube-fed (e.g., PEG, NG, or JEJ feeding) – For queries, contact the Home Enteral Nutrition Service (HENS): hens.team@nhs.net | 0116 222 7161
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The resident has a diagnosed swallowing difficulty (dysphagia) requiring thickened ONS and has been identified as malnourished using a validated screening tool (e.g., MUST) – Care home should refer directly to Community Dietetics using the care home referral form.
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Exceptional Circumstances: In rare cases where homemade nutritional supplements are unsuitable, a relevant healthcare professional may recommend prescribed ONS. This must be based on a clinical assessment, with a clear rationale to justify that food-based alternatives are inappropriate and how ONS will meet the patient’s specific nutritional needs for a defined period.

Download the ONS Care Home Comms that contains information about Training Opportunities & virtual informal Q&A sessions and other information.

Care Home Comms ONS (PDF, 4 MB)

ONS Replacement in Care Homes – Overarching Document
This is the consolidated resource pack, bringing together multiple guidance documents into a single, structured pack for ease of access.

ONS Replacement in Care Homes Overarching Document (PDF, 882 KB)

 It includes:

    • Position Statement – Use of prescribed ONS in care homes
    • Key Updates Effective from 1 September 2025
    • Care Home Malnutrition Management Pathway
    • Exclusion Criteria and Key Considerations
    • Relative/Carer Information – Supporting malnutrition management
    • Patient/Carer Information – Homemade supplements
    • Eating Well – Quick Guide
    • Eating Well for Small Appetites
    • Care Home Guidance – Fortifying food
    • Carer Guidance – Eating and drinking at the end of life
    • Care-Home-to-Dietetics Direct Referral Form

LLR ONS Replacement in Care Homes Training v2
These are the presentation slides used during the training

 ONS Replacement in Carehomes Training v2 (PDF, 2 MB)