Choking Risks in Care Settings

Choking is one of the most serious and distressing risks faced in care settings. It is also a risk we are seeing more frequently across insurance claims and Health and Safety prosecutions within the care sector.

For providers, choking incidents can have devastating consequences for residents, families and staff. They can also expose directors and senior leaders to significant regulatory scrutiny where risks were not properly assessed, managed or evidenced.

Why choking risk is under increased scrutiny

Choking is rarely viewed by regulators as an unavoidable accident. Investigations typically focus on whether appropriate controls were in place and whether staff followed them in practice.

We are seeing increased enforcement action where there is evidence of:

• Inadequate choking risk assessments
• Poor communication of dietary needs
• Lack of staff training around swallowing difficulties
• Failure to follow care plans or speech and language guidance
• Insufficient supervision during mealtimes

Where these failures are identified, prosecutions often follow, particularly where serious injury or fatality has occurred.

The Health and Safety Executive has been clear that choking is a foreseeable risk within care environments. This places a duty on providers to actively manage the risk rather than respond only after an incident.

Key risk management considerations for care providers

Effective choking risk management should be embedded into everyday practice rather than treated as a standalone policy.

At a minimum, providers should ensure:

• Individual choking risk assessments are completed and regularly reviewed
• Care plans clearly reflect dietary requirements and swallowing risks
• Texture modified diets are correctly prepared and clearly labelled
• Staff receive regular training on choking risks and emergency response
• Mealtime supervision reflects the needs of each resident
• Advice from speech and language therapists is documented and followed

However, having policies and care plans in place is not enough. Providers must also be able to demonstrate that staff are following them consistently.

Recent claims experience shows that incidents often arise not because guidance was absent, but because written instructions were not followed. Regular supervision, observational audits and spot checks during mealtimes can help identify issues early and reinforce good practice before a serious incident occurs.

Crucially, all controls must be evidenced. Regulators will look beyond written policies to assess whether procedures were actively applied and monitored in practice.

Where Directors and Officers liability comes into play

When choking incidents result in serious harm or prosecution, attention often shifts beyond frontline staff to senior leadership.

Claims frequently centre on breakdowns in day to day compliance rather than policy design. Where organisations cannot evidence monitoring of staff practice or demonstrate that deviations from care plans were identified and addressed, directors may face questions around governance and oversight.

This is where Directors and Officers insurance (D&O) becomes particularly relevant.

D&O cover can respond to legal defence costs and personal liability claims arising from allegations of:

• Failure to implement effective risk management frameworks
• Inadequate training or supervision arrangements
• Poor monitoring of compliance with health and safety obligations
• Failure to respond appropriately to known risks within the service

Without appropriate cover in place, directors may find themselves personally exposed during lengthy and stressful investigations.

Taking a proactive approach

Choking risks will always exist within care environments, but many claims and prosecutions can be avoided through robust risk management supported by strong governance.

Now is a good time for providers to review:

• Choking risk assessments and care planning processes
• Staff training records and refresher schedules
• Mealtime supervision arrangements
• Monitoring, supervision and spot check processes
• Incident reporting and learning procedures
• Whether insurance arrangements adequately protect senior leaders

At Quality Care Group, we work closely with care providers to support both practical risk control and appropriate insurance protection. Our aim is to help reduce exposure before an incident occurs rather than after the damage is done.

If you would like support reviewing choking risks within your service or understanding how your Directors and Officers cover responds in practice, our risk and claims team are always happy to help.