Table 5.

Problem areas and suggested options for political action.

Problem Area	Political Action
Education of all healthcare professionals directly involved in patient care in disease related malnutrition and nutrition care insufficient.	Mandatory inclusion of disease related malnutrition and nutrition care processes in curriculum for nurses, doctors, dieticians, etc.
Limited awareness of the importance of nutrition in disease states in the public especially the population at risk.	National nutrition care campaigns targeting the general population, residents of nursing homes and also targeted nutrition campaigns run through general practitioners. Availability of an education platform for patients and families.
Nomination of responsible person or team for patient nutrition care missing. No monitoring of nutrition care processes part of hospital quality control.	Mandatory designation of a nutrition team/responsible person in each hospital with a threefold responsibility: coordination of expertise, definition of processes and regular benchmarking of applications of processes through initiatives like nutritionDay, the Dutch nutrition benchmarking program, the British malnutrition awareness week and the analysis of electronic patients records.
Inconsistent screening and collection of data. Missing documentation of nutrition risk factors and communication of nutrition status and care at discharge to the next sector.	Mandatory inclusion of data in a nutrition care benchmarking program. Definition and inclusion of mandatory harmonized fields for a systematic collection and documentation of nutrition risks factors and nutrition care processes in the electronic patient record. Inclusion of planned nutrition treatment recorded in patient’s discharge letter/information to patients and relatives.
Missing patients and families empowerment due to insufficient communication of nutrition status and care to the patients and their families.	Mandatory monitoring of communication processes in quality assurance programs.
Lack of a harmonized reimbursement schemes for nutrition related processes such as screening, assessment and treatment such as oral nutritional supplements, enteral or parenteral nutrition.	Clear reimbursement schemes.
Missing a partnership for hospital food provision and of a positive image for hospital food.	Creation of a public best practice platform for food provision in hospitals. Supported use of local food in hospital kitchen for the creation of wealth not only for the community using the hospital but also for the local community.