Home Enteral Tube Feeding Services
Five years of change: a view from patients and carers An innovative nutritional products contract, awarded in 2007, was the catalyst for significant development of the Home Enteral Tube Feeding (HETF) support for adults and children across Nottinghamshire. Changes made during this period had clear benefits for service provision and costs, but the impact on patients and carers had never been formally reviewed. Gillian White Dietitian
Five years on seemed a good time to canvas the views of patients and carers made possible by a small Research into Practice Grant from The East Midlands Collaboration for Leadership in Applied Health Research and Care (CLAHRC). Although I had been part of the Nottingham HETF service since 1999 and was involved in many of the changes that had taken place, at the time of the project I had little direct patient contact and would be unknown to the patients and carers. Background
Gillian has dietetic experience in oncology, palliative care and nutrition support. She held the post of Therapy Services Manager at Nottingham University Hospital, which included leading the development of Nottinghamshire’s Home Enteral Tube Feeding Service, until October 2013.
NICE Guidance (2006) recommended a multi-professional team approach for tube-fed patients at home, with individualised care plans, including monitoring and aims, and training for patients and carers to manage tubes, delivery systems, procedures and regimen, recognise risks and troubleshoot common problems. Routine and emergency contact numbers, information about delivery and regimen, contact details for delivery company and instruction manuals should also be provided. Before 2007, small, separate dietetic teams of one to three staff provided HETF support throughout Nottinghamshire, aiming to meet NICE guidance, but struggling to cope with growing demand and complexity. Since 2007, gradual change has led to the creation of one service based within a single organisation, aiming to provide consistent best practice for all HETF patients within Nottingham and Nottinghamshire. Combining existing budgets with new funding, specifically for nutritional
products and ancillaries, enabled better use of existing funds (e.g. economy of scale, shared approach), with savings ploughed into service development including staffing. A coordinated service with increased staffing, including specialist nursing and support workers, meant that there was time to provide training for all patients and carers, as well as school and community nurses and care homes. Commercial partners were monitored more carefully and liaison with partners in hospital and community were strengthened. The overarching direction of change was from inconsistency and a ‘fire fighting’ approach towards planned and equitable care. In 2012, Nottinghamshire had a single HETF Service with a team of dietitians and dietetic assistants (18wte cf 5wte in 2007) based together and working to shared guidelines to support adults and children. A locally agreed patient pathway allowed better monitoring of patients and resources, a flexible response to external change and the development of a supportive team approach, including close working relationships with hospital dietitians and other partners. This service change happened in the context of many NHS changes and increasing pressure on funding, with further change being planned to ensure future sustainability. The project
I carried out a small retrospective survey of home enterally tube-fed patients and their carers who had been in contact with NHDmag.com July 2015 - Issue 106
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