Making a real difference

The 2010 NHS White Paper ‘Equity and excellence: Liberating the NHS’ outlined drastic changes to the way the NHS in England will operate. With commissioning consortia controlling most of the country’s NHS budget they will direct services and spending, with a vast role in commissioning services for patients. The Allied Health Professions (AHPs) – of which there are 12 including dietetics – need to organise themselves to ensure representation on the consortium boards and to influence the commissioning agenda. As Karen Middleton, chief health professions officer, wrote in ‘Dietetics Today’ last year: “This is not about the status of allied health professionals. It’s about making sure that the commissioning decisions are informed by those services that can make a real difference to the true outcome for the patient.”
Dietitians, through their skill and training in nutrition, are uniquely placed to lead a change in quality, improving outcomes for patients. Investing in dietetic and nutrition services will result in patients who are more content and get better quicker; cutting costs as patients leave care earlier and are less likely to return.
“Dietitians have a key role to play. They can often prevent a problem that can cause significant complications, and can compromise quality of life and lead to considerable cost for the health and social care system,” noted Baroness Greengross when discussing AHPs in a House of Lords debate in October last year.

Share My Good Idea
The British Dietetic Association (BDA), the professional association for dietitians, set up the Share My Good Idea scheme to demonstrate how dietitians are meeting the challenges of innovative practice, saving money or improving safety or effectiveness of care. The scheme gives dietitians the chance to share their successes, giving the BDA examples of best practice with which to promote the added value of dietetics to healthcare.
One such good idea centred on reducing inappropriate prescribing. With the NHS in Scotland spending £946 million a year on prescription drugs in primary care , medicines management is key to reducing costs.
Grampian based dietitian Carole Noble set up two education programmes to address inappropriate oral nutritional supplement (ONS) prescribing. The first was a session for each GP practice in the area and the second a training programme for care homes aimed at cooks, care staff and managers. The main issues were lack of knowledge and long standing attitudes/opinions of staff towards nutrition and the use of ONS.
Following the GP sessions, the number of patients referred for nutritional support rose from 37 per cent to 77 per cent, 40 per cent of which were subsequently managed without the need for ONS. The number of items prescribed decreased by 6 per cent and the rate of increase in spend reduced from 20-30 per cent to 4 per cent.
The care home training outcomes were also impressive, with a 22 per cent reduction in ONS use and a 20 per cent reduction in community dietetic caseload, freeing time to focus on sustaining the changes. These results are consistent with the results obtained in other ONS projects, including ones across London and Warwickshire.

Recognising excellence
Dietitians are neither comfortable nor familiar with singing their own praises, but this will have to change in an environment where competition to provide services is becoming increasingly fierce.
The profession is receiving recognition for its contribution to healthcare, most recently by entering and winning three categories in the 2011 Advancing Healthcare Awards. The ten awards, supported by all four UK health departments, recognise professionals that lead innovative healthcare practice, making a real difference to patients’ lives. The Chief Health Professions Officer’s Award for Leadership (England) – promoting the winner as a leader within allied health – was won by dietitian Vicky Chudleigh-Emson for her home enteral tube feeding service.

Feeding tubes
Over the past five years Vicky Chudleigh-Emson has developed the home enteral tube feeding (HETF) service, covering Plymouth and part of Cornwall and Devon PCTs, working across both primary and secondary care. The service, which enables patients to be self-caring, has shown to improve health outcomes and increase patient satisfaction.
Additionally it has extended the role of the dietitian to cover the care of enteral feeding tubes/stoma tracts and has reduced the need for routine and emergency hospital admissions and the incidence of both infection and complication. HETF alongside Plymouth medicines management services made significant cost savings by changing medicines administered via enteral feeding tubes. Further, HETF has met six of nine standards of care above 95 per cent and the remaining three above 85 per cent, despite an increase in patient turnover from 45 per cent to 76 per cent since the service began.

Other winners
Dietitians Debbie Provan and Sharon Little won the Achieving Excellence in Learning and Development award for their nutritional care in cancer education programme. The programme, set up in NHS Ayrshire and Arran in response to a staff survey, harnesses multi-media technology to deliver peer-assisted learning and multi-professional networking, enabling the sharing of good practice. Outcomes include improved nutritional knowledge and staff confidence leading to better nutritional care of cancer patients.
The Enhancing Public Health and Creating Healthy Communities award was given for a scheme encouraging fast food outlets to sell healthier food, set up by dietitian Michele Sandelson and environmental health officer Altan Ahmet. Established in the London Borough of Tower Hamlets (which has one of the worst childhood obesity rates in England against one of the highest concentrations of fast food outlets), the scheme included nutrition workshops, healthier frying and healthier cooking lessons for food business outlets (FBOs).
Nearly 90 FBOs have now been given a gold, silver or bronze award for changing the food they sell and had their business added to a borough map to encourage the community to use the healthier outlets. Improvements include an Indian takeway providing customers with free salad and fresh fruit, and a pie and mash shop cutting all hydrogenated fat out of their pastry and reducing saturated fat content by 20 per cent.
The BDA is committed to supporting the changing healthcare climate, fighting to ensure trained dietitians are at the forefront of services, an integral part of multidisciplinary healthcare teams and remain a trusted source for advice. Armed with evidence-based knowledge and practical experience, dietitians are essential in ensuring the population achieves better nutritional status against the bleak backdrop of declining public health.

For more information