PAEDIATRIC COMMUNITY
SUPPORTING A FOOD-FOCUSED FUTURE WORKFORCE Evelyn Newman Nutrition and dietetics advisor: care homes NHS Highland
In December 2012, NHS Highland took the lead agency role for adult care services, overseeing all services previously managed by Highland Council. This included responsibility for the 73 care homes and a number of independent and inhouse care-at-home teams.
Award winning dietitian, Evelyn Newman, is well known throughout the profession for her writing, volunteering with the BDA and innovative work. She currently holds a unique role in The Highlands.
By April 2014, I had been appointed to my current role, working within the corporate senior social work team. The expectation was that I would work with care home managers and owners to support both catering and care staff to assist residents and service users to receive safe, nutritious, high quality meals and mealtimes. Health and care standards1 provide broad guidance about a number of aspects related to eating and drinking, which service users should be able to expect when living in any care home. It became clear to me, however, that many care staff were not as well informed about food, fluid and nutritional care as their health service counterparts. I carried out a training needs analysis to be clearer about how staff might feel better equipped to best support residents’ needs, using a personcentred, asset-based approach. Many staff had historically received little or no formal nutrition training and contact with healthcare staff had usually been via 1:1 consultations. It wasn’t unusual for them to look to (unevidenced) articles on the web, or in magazines and newspapers, for nutrition information. Very few care catering staff were familiar with therapeutic diets, except perhaps diabetic and weight management (often from personal experiences). The key to engaging the workforce was to understand what would work best for them, in whatever location or situation they found themselves. Conventional training in one central
@evelynnewman17
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location was certainly not going to work, given the very remote and rural landscape of the largest health board, by geographical area, in Scotland. Eighty percent of our care home residents have a degree of cognitive impairment and with that comes the prospect of dysphagia, which can result in a 70% risk of dehydration and a 50% risk of malnutrition. I like to make use of educational games, such as the Dysphagia game2 to support informal, fun, interactive learning for staff, residents and relatives. Highland care homes were also used to test the Hydration game,2 which I helped to develop in 2016/17. Since August 2014, I have coordinated quarterly texture modification training sessions, in a variety of locations across the north Highlands to maximise attendance. These are very practical, interactive and always positively evaluated. SLT, OT, dental colleagues and a professional chef contribute to these, demonstrating the impact of poor positioning and the dangers of not assisting someone to eat safely. Hundreds of care staff have attended to date and have experienced first-hand, the vulnerabilities of residents being fed by them, especially when food looked very unappetising. When we first started this work, it wasn’t uncommon to hear that meals were being liquidised, or that residents were taking up to 40 minutes to eat an ultimately cold meal. A number of staff left the session close to tears as they realised how they had been
Conventional training in one central location was certainly not going to work, given the very remote and rural landscape of the largest health board, by geographical area, in Scotland. inadvertently letting people down. Many changes were soon implemented in care home kitchens, in particular the purchase of more suitable equipment and improvements to the presentation of texture modified food. Residents in Highland care homes are fortunate that such a large investment in training and awarenessraising information on the subject has led to so many positive improvements to the texture modified meal service and dining experience. In Scotland, the duty for monitoring and grading standards of care lies with the Care Inspectorate. My role is very much a supportive rather than an inspection role. Care inspectors are able to objectively highlight inaccuracies with residents’ nutrition screening, which can have a knock-on effect to their personal care plans and the potential to inappropriately refer to dietitians. Links to the BAPEN MUST site and use of the MUST calculator are encouraged to assist more accurate person-centred nutrition screening. MUST training continues to be made available throughout the Highlands, either in individual care homes, or as part of larger nutrition and hydration events. We are all encouraged to consider how new technologies can support better care, so the purchase and completion of the BAPEN e-MUST tool is proactively promoted. Quarterly newsletters, provide examples of good practice from Highland care settings, residents’ perspectives and a seasonal themed focus on nutritional aspects of care.3 They are well evaluated and provide another perspective, sharing
insights and encouraging new practices. They also offer NHS staff an insight into the valuable work being delivered in social care settings. I work closely with community dietitians within our three operational units. They are a scarce, valuable resource and, most recently, we have delivered a huge change to the way nutritional support is delivered to residents. We are building on all the good work on nutrition and hydration, which care chefs and staff have been developing. We are now proactively promoting a food-first approach rather than recommending the prescribing of oral nutritional supplements. This allows dietetic time to be more focused on supporting the care of the most vulnerable highpriority individuals and has many benefits for residents and staff. This supports Highland’s delivery of the Scottish government’s vision for ‘Realistic medicine’.4 The development of innovative social care dietetic placements5 supports a changing workforce profile for the future and has allowed a greater appreciation and understanding of residents’ lives, their rich histories and has helped students to understand a social model of care, which puts the resident in control, rather than a conventional clinical model, which is dominated by organisational standards and regimented routines. In Evelyn's next article she will describe the opportunities, successes and insights which have come from this award-winning, widely recognised work with HEIs, NES, the BDA and Highland care homes. www.NHDmag.com October 2018 - Issue 138
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