Dietitians in Focus
As part of our Trust a Dietitian campaign, we are keen to highlight the variety of places dietitians work and make a real difference.
Firstly we spoke with Sue Baic MSc MBDA about her invaluable work for a Bristol based food charity.
I volunteer as a dietitian for The Matthew Tree Project (TMTP) charity in their network of Food PLUS Centres in Bristol. TMTP Food PLUS network provides food aid for around 730 people in need each month. The project has been running since June 2011 and clients are referred by a variety of health, council and community support services including agencies supporting asylum seekers, young offenders and housing tenants, as well as rehabilitation agencies, and schools. TMTP clients' stories reveal a set of complex circumstances, often combined with personal misfortune that leads them into hardship, undermining their physical health and mental wellbeing. For many, we provide food for a short, but crucial, period. For example, for people waiting for delayed welfare benefit payments, or those who need to make savings within their household budget due to unmanageable debts or exceptional one-off expenses. We receive financial support from local businesses, faith-based organisations and individuals. We also rely on the generosity of food purveyors, particularly Asda and Morrisons supermarket chains for allowing us to do food appeal collections in store, and for their regular contributions.
TMTP Food PLUS's model is very different from the traditional food banks in that clients are supported over a longer period of time. For each referral clients can receive seven days worth of food collected each week for up to six weeks. We deal mainly in ambient food at the moment due to lack of cold storage but this is supplemented with some fresh fruit and vegetables donated from a local market. However within this limitation I am still able to use the Eatwell Plate as a model to plan the proportions of food we aim to offer from each of the five key food groups. Rather than giving a food parcel, clients pick the foods they want from within each food group similar to a shop using food weight allowances rather than cash.
The Matthew Tree Project (TMTP) now also offers malnutrition screening to clients using a validated malnutrition screening tool (MUST) taking into account Body Mass Index (BMI) and percentage weight loss. We also run a nutrition and cookery course for all clients. Evaluation measures are used to assess whether participation increases knowledge and skills before and after the course and participants are assessed for changes made to diet and their intentions to eat a healthier diet in future.
Catch up with Sue online at @SueBaic | Nutrition Basics | Food Inside Out
Find out more about the Matthew Tree Project.
Read on for our Q and A with Mandakini Patel, Clinical & Professional Lead for Nutrition & Dietetics, at the North Middlesex University Hospital NHS Trust, who along with her physiotherapy and occupational therapy colleagues, and with tremendous support from her dietetic staff, introduced a seven-day working dietetic service from October 2013. North Middlesex Hospital is the first dietetic department in London to provide a seven-day service.
How does seven day working function?
We found that the way we have introduced seven-day working was the best and most efficient way to capture new patients for the trust without having huge resource implications, which includes cover during week-days. Majority of patients come via A&E, and are then transferred to the acute assessment unit or acute medical ward, thereafter to other wards.
From the outset we agreed on acute medical and paediatric unit staffing, which means we save by not needing more staff, as long as services are not extended. Staff who work on Saturdays, Sunday’s and all Bank holidays, work on site from 9am until 2pm.
Which staff are involved in seven-day working?
The staff involved in seven-day working include all adult and paediatric dietitians, including those in managerial roles. This is all Bands. Dietitians are autonomous practitioners and able to work on their own - all staff are instructed to work within their scope of practice, whatever their Band.
Why did seven-day working come about?
Overall, and based on patient needs, there was an obvious requirement for a weekend service. This included patients that were being discharged over weekends but not referred to us, and then re-admitted; unsafe discharges; and lost opportunities for early interventions for some conditions etc. This was further flagged up in audits which highlighted the need to see more patients overall such as our yearly hospital MUST audit and enteral feeding audit. Additionally, local commissioners were asking for seven-day working. It also fitted in with Care Quality Commission requirements and London Quality Standards (2013).
How do you know that seven-day working is, well, working?
The evaluation so far has highlighted that there is less pressure on the front of house and patients are receiving earlier and timelier interventions. Also, as a service, we are experiencing fewer late Friday issues, as these can now be addressed the next day, Saturday or Sunday. Overall, it is felt across the team that productivity levels have increased and we are delivering an enhanced service, which is a better for patient care.
Were there any challenges the service had to overcome to bring in seven-day working?
A small number of members of the team would have preferred not to work over the weekend, but when put in context of patient care (that this is about the future of our profession, the importance of nutrition as part of the patient treatment plan, raising the profile of nutrition, teamwork within the department, and flexibility in the rota system), this was resolved and all team members are involved in seven-day working. Our Head of Therapies also had to secure funding to ensure we had one dietitian working each day on Saturdays and Sundays. Since the introduction of seven-day working, the Trust is now looking at extending the service possibly to other areas.
Anything else you would like to say about seven-day working?
The need for nutrition does not end at 5.00 pm on Friday and restart at 9.00am on Monday. Nutrition is an essential part of the overall treatment for holistic patient care, in order to get the very best possible result for patients. I believe that as a dietitian my role and my expertise are needed to work with patients every single day of the week, regardless of the name of the day! This is an opportunity to raise our profile and demonstrate that nutrition is as important as other treatments for achieving good patient care. This is why I came to work in the NHS and at the end of the day. Dietitians are the experts and when it comes to food and nutrition, patients’ outcomes and patient safety, I say Trust a Dietitian!
We also spoke with Gemma Sampson about her work as an industry dietitian.
After working clinically as a dietitian for about five years, when my NHS contract was coming to a close and no other clinical positions were available in my local area I broadened my horizons and ventured into industry. For the past 18 months before this interviewed, I have worked as a company dietitian for Dr Schär UK, prior to commencing my new role with Vitaflo International.
Your role as an Industry Dietitian
As an industry dietitian I have designed and led practical gluten-free baking sessions for undergraduate and postgraduate nutrition and dietetic students at a local university. I would also attend conferences, organise CPD events and training for HCPs, read relevant journal articles, develop HCP newsletters, update nutrition content on the website, complete applications to register products on prescription, analyse the nutrition content of recipes, create resources for HCPs, provide input into product literature, as well as looking at health claims and how food products could be further improved nutritionally.
In my current position I am particularly focused on research within inherited metabolic disorders. My role is to look at the nutritional profiles of metabolic supplements, comparing these to nutrition guidelines across various countries, advising on changes required to improve them as well as design and lead research trials. I also use my clinical background, knowledge and expertise to develop new products which will benefit patients and HCPs within the NHS and care settings.
Industry differs from the NHS
Within the NHS there are a lot of time-constraints, which can impact the level of support you are able to provide to your patients. At Dr Schär people could ‘Ask a Dietitian’ by email or phone where I would answer questions on coeliac disease, gluten-free diets or IBS on a daily basis. Often it was someone newly diagnosed with coeliac disease who was overwhelmed with questions and wouldn’t be seeing a dietitian for a while. I found that working in this role in industry I could spend more time supporting these patients and pointing them in the right direction than I would have been able to do within the NHS.
Industry Dietitian benefiting public health
Often you hear people joke that you’ve “gone to the dark side”, when you say you are an industry dietitian. I think this is mainly because many people don’t understand what we do on a day-to-day basis and what being an industry dietitian truly is. Anyone who’s ever met me knows how passionate I am about being a dietitian, promoting our profession inside and outside of work and helping people to improve their lifestyle and eating habits. Some people would go as far to say that dietitians shouldn’t work in industry, but I wholly disagree. If we don’t have dietitians working in industry, how else can products and the food supply improve? As a dietitian I am still held accountable by ethics and a code of conduct and need to maintain ongoing CPD which influences me at work every day.
If we as dietitians don’t get involved with industry, nutrition-savvy companies will go to other ‘nutrition experts’ for their advice. We also want companies to ‘Trust a Dietitian’ for our nutrition advice, promoting our profession and ensuring the public knows that we are actively working to improve nutritional foods & products at all levels.
Catch up with Gemma online at @DietNoBorders | Dietitian Without Borders