18 Dec 2019

This guide is suitable for dietitians working in all four countries of the United Kingdom. It describes the steps that you can take to make the case for dietetics. You may wish to make the case for dietetics in order to either protect or expand and develop your service offerings. A fuller version can be downloaded in pdf form using the link to the left. 

There are nine main steps in the process each of which are described below:

1. Know your service

The first step in the process of protecting or expanding your dietetic services is to be able to clearly describe it. This will enable you to talk with confidence about your service to key stakeholders and will provide a starting base from which to make any alterations/improvements to your service. The checklist below covers some of the key things you should know:





Number of referrals and sources of referrals – consultant/practice/locality.



Proportion of inappropriate referrals.



Demand versus capacity information.



Length of waiting list and how this has changed/is changing/other variations during the year.



Where is the service (s) provided and access and by hard to reach groups.



Percentage of DNAs and cancellations and are there any trends.



How is the service paid for? Is the service undertaking activities that it is not paid to do?



What do patients think about the service? It is important that patients are included in the design and evaluation of services. This could be through different methods including focus groups, face to face interviews, case studies, patient stories and questionnaires.



Skill mix – who delivers what parts of the service?



What competences are needed to deliver the outcomes? Is there a gap between the competencies of staff versus the services required to be delivered?



What competences do the team have, how else could these competences be used?



Multi-professional or agency working – how does the service contribute to care pathways?



How does the service contribute to healthcare standards, implementing NICE guidance, implementing NSFs or reducing demand in other parts of the system?



What areas of good practice, case studies are there that could help demonstrate the service provided to patients?



What else does the service do which supports patients or other professionals to deliver nutritional care but which is not face to face contact and how much time does is allocated to this?



Can the service generate income? And if so how and by how much?



Do you have any results from audits or service evaluations or local research?



Summarise the costs of your existing service.


2. Research your local needs

You now need to research the needs of the local population and identify the priorities of the service leaders who are responsible for commissioning, leading or funding your service. Doing this research will enable you to review your current service offerings in the light of local priorities. It also helps you to determine what changes, if any, you need to make to protect your current service or what to target if you wish to expand and offer new dietetic services.

3. Research national guidelines

Keep abreast of the national guidelines (e.g. published by NICE and other bodies) and any new and relevant research into specialist areas of dietetics. 

You may wish to make contact with dietitians who are already running similar services in other areas to find out how they deliver them and what are the challenges you may have to face. The BDA can assist with this. 

The information from these sources will help support the case for dietetics. It is important to demonstrate that you have based your decisions on how to shape your service on the most up to date evidence.

4. Identify key stakeholders, 5. Analyse them and 6. Plan your engagement.

Armed with an extensive knowledge of your current service as well as the national and local priorities you can now start talking to the people who can help you achieve your aims to protect or expand your services. In other words, you can now start to ‘influence’ your key stakeholders in a positive way.

Your key stakeholders may seem obvious at the outset but it is worth dedicating some time to thinking who else may be influential and help your cause. It is also useful to note down those people who are influential but may hinder your cause and then plan carefully how to engage them with the intention of changing their views.

Read our guide to analysing and influencing your stakeholders for more advice. 

7. Develop a service model

Whether you are developing a new service, protecting existing provision or revising a current approach it is important to consider the following:

  • Develop the service to meet the specification/local health priorities
    • Is this what commissioners or service leaders want? And does it fit with priorities?
    • Does the proposed service meet the specification?
    • Is this a clinically effective service that will benefit patients? If you can, describe exactly how patients will benefit i.e. what outcomes you expect.
  • Develop the service model with the dietetic team and other professionals
    • Define whether a bid is uni-disciplinary or multi-disciplinary.
    • You may wish to work with other Allied Health Professionals and/or nurses. If so engage early with the specialist multi-disciplinary team.
    • Define how much of the dietetic service is required for the integrated care pathway.
    • Could you be working with social services, public health or voluntary services?
  • Consider innovative and radical ways of working
    • Making use of technology to help to reduce the costs of your service.
    • Skill mix or new ways of working. Learn from local colleagues – maybe you can share a service model and so benefit from economies of scale.
    • Learn from other expert colleagues nationally.
    • Can you help patients to self-manage their condition? 
    • Could your service be co-produced?
  • Develop a service model with patients
    • Ask potential service users to examine with you how a service could develop, from the start. 
    • Consult with a draft model and options based on evidence, best practice and local needs and the views of service users.
    • How do you currently use service user feedback to develop and change the service?
  • Develop a patient pathway
    • A clear pathway describing the user’s journey ensures the model remains patient focused.
    • Ensure it is easy to understand for the patient/public involved in the development.
    • Identifying a clear model of cost savings released in some areas and cost pressures in others.
    • It is essential to make sure the model you develop is accessible to everyone.
  • Build evaluation into your service model
    • New ways of working have to have integral robust evaluation. Audit needs to be on-going throughout and specific. There should be an agreed method of data analysis right from the start and baseline comparison.
    • Can the service be compared/benchmarked with other similar services in other areas?
    • What would happen if the service closed?
    • Are quantitative outcomes being measured such as hospital admission avoidance, or qualitative outcomes such as the patient experience?
  • Prepare the cost of your service - you will need to demonstrate how cost effective your service is, for example:
    • Staff costs
    • Clinical, management costs
    • Admin, finance, training etc.
    • Resource costs
    • Technology
    • Buildings

Overall, make sure you can answer some key questions about your proposed service:

  • What are the benefits of the services to patients?
  • What evidence is there to prove worth?
  • How can value for money be demonstrated?
  • What is the cost of the service?
  • How will a service be evaluated?
  • What examples of best practice are there?
  • What examples of patient stories and/or case studies are available?
  • What are the risks and options?

8. Write a business case

The key components of a business case include: 


Include name of patient pathway / service and who will be providing the service

Make sure it does it do what it says on the tin!

Ensure it is clear if it is draft for consideration or final version

Executive summary

Remember that those reading a business case are busy people!

Do not assume any information is known about the case you are presenting

The purpose of the case, who the case is to be read by, what is being asked for and why should all be contained in the executive summary

How does the case fit with national and local policy and context

Reference specific national policy, NICE/SIGN guidance, NHS policy to set the case in context

Current situation Reason for the case, the case for change and scope

These should be clearly demonstrated

Detail the service criteria / scope of service.

Detail assumptions you have made.

Detail assumptions the commissioner/service lead has made.

Clinical roles / activities proposed and staffing, WTE, grade, activities Pathway for patients/ patient access to service/speed of referral

How the services link together if multidisciplinary pathway Present MDT pathways in a joined-up way – not uni-professional


Benefits of the case

Consider why commissioners/service leaders would wish to consider your case over others

Detail throughout how the model relates to commissioners/service leaders priorities such as: length of stay, reducing admissions, waiting lists

How does it help them with delivering their priorities?


Detail the risks of model to:

  • Patients
  • Commissioner/Service Leader
  • Dietetic service/provider
  • Other identified stakeholders i.e. local authority, other dietetic service providers Costs & benefits realisation

Costs of providing service less costs of current service, or allocated funds or efficiencies. 

Undertake an option appraisal.


Provide a succinct summary of the case


Be clear what is being recommended and why

Next steps - it is helpful to be clear on what you propose as the next steps.

For example, this could be to share the business case with x colleagues to gain their views in x timescale.

9. Learn lessons

It may be difficult to motivate yourself to do this but is always worth reviewing your engagement with any stakeholder. Ask yourself did it go well? What could I have done better? What information did I learn from my stakeholder that I didn’t know before? What can I do now to follow this up?

Write is down –it’s a good discipline and a good CPD activity! You may wish to refer to your notes at a later date when approaching your stakeholder again or when handing your notes to a deputy.

The same principle applies to bidding for a tender. Its good practice to review how well you think you did and of course how successful you were. Try to find out what the commissioners thought and what they could suggest would have improved your bid. Write it down – it will be helpful for when you put in another bid.