Summer 2018

Newsletter of the Parenteral and Enteral Nutrition Group of the British Dietetic Association

Feature article

My Experience as a Dietitian within an NHS Vanguard

Robyn Collery,
Registered Dietitian

 

Introduction

The national New Care Models Programme brought together local health and care systems as ‘Vanguards’ to lead innovation and radically redesign care for their local populations. With 400,000 care home beds surpassing the entire NHS capacity of approximately 100,000 hospital beds,1 it was no surprise that care homes were chosen as the focus for one of these new care model programmes. Across England, six sites were chosen to be Vanguards in the Enhancing Health in Care Homes Programme. Within these six Vanguards, care homes worked closely with a range of different organisations to enhance the health and wellbeing of their residents.

Newcastle-Gateshead was one of the six sites awarded national Vanguard status by NHS England for its work to enhance the health of patients living in care homes. This Vanguard status put Newcastle-Gateshead firmly in the national spotlight as an example of best practice, as well as enabling us to go further and faster in improving the quality of life and healthcare for people living in care homes in the region.2 The population of Gateshead is projected to grow by 4.5% by 2037, but the growth in the elderly population will be more significant. The population aged 70 and over, which includes 83% of care home residents, is expected to grow by 49.5% while the number aged 85 and over will rise by 104%. Consequently, action needed to be taken and plans to appropriately care for this population needed to be made. The Newcastle-Gateshead Vanguard programme built on an extensive range of services to work together to support Newcastle-Gateshead’s 2500 care home residents and to improve people’s experience.2

Clinical engagement Group or ‘PoC’

Newcastle-Gateshead Clinical Commissioning Group worked with a range of partners including care homes, local authorities, NHS foundation trusts, independent sector care providers and the voluntary and community sector across Newcastle and Gateshead to ensure the right people were involved in developing new ways of doing things. Multi-disciplinary team (MDT) working isn’t just about being with the patient and around the patient, it can inform pathway development and even influence at a strategic level. Within the Newcastle-Gateshead Vanguard, our Clinical Engagement Group has been successful in doing this. Our Clinical Engagement or ‘PoC’ Group, standing for Pathway of Care group, met weekly in the Newcastle-Gateshead CCG offices to work together to ensure that patients best interests remained at the core of every initiative. The Clinical Engagement Group encompassed professionals and experts from eight different disciplines and nine organisations. The Clinical Engagement Group brought a wealth of experience in working within the care of older people. The PoC Group consisted of Specialist Nurses, Old Age Psychiatrists, GPs, Geriatricians, Care Home Staff, Social Care Workers, Voluntary Sector Workers, Educators, Researchers, Pharmacists, Occupational Therapists, Physiotherapists and Dietitians. The varied dynamic of the Clinical Engagement Group allowed each suggestion and project to be carefully considered and reviewed before reaching the stage of implementation. Learning and experience from frontline staff was shared amongst the team to ensure the best decisions were made for frail older people living in care homes.

My experience as a Dietitian within a Vanguard

Working as a Dietitian within the Pathway of Care team, and the wider Vanguard in Newcastle-Gateshead has been a unique and rewarding opportunity. I have been given full autonomy and trusted to produce my own Nutrition & Hydration Intervention within the Gateshead care homes. I produced a four-module education programme and piloted it in five local care homes. Alongside this, I introduced an Enhanced Dietetic Service, where domiciliary visits were provided every six to eight weeks for care home residents within the pilot. Evaluation of the training programme and enhanced service illustrated improved knowledge and confidence levels of care home staff, enhanced 'MUST' completion and reduced malnutrition levels from 36% to 22% of residents having a BMI <20 kg/m2 within the pilot. As a Dietitian in the Vanguard, I have had the opportunity to provide a voice for Dietetics and to raise nutritional concerns within the PoC Group. I had the opportunity to provide a malnutrition focused opinion and debate the importance of nutrition and hydration in all pathways and processes involving older people.

Being involved in such a forum has allowed me to shine a light on Dietetics and educate peers on the services we can provide to improve the lives of our care home residents. In the PoC Group, I felt I was given an equal opinion and looked to for advice on all matters concerning nutrition and hydration.

I was a valued member of the MDT. Because of the relationships the PoC Group has allowed me to develop,
I feel I could approach any of my peers for advice or support, even now after the Vanguard has finished. These relationships have been an invaluable part of the success of the PoC Group and its achievements. I have gained immeasurable experience in working with the care home population and those living with frailty in our community. My practice has developed in that I can view a patient as a whole and not just consider their dietetic needs alone.

I am now more mindful of the patient journey through the health and social care system as a whole, rather than singular, disjointed, events. I have a better understanding of the need for whole system working, rather than each service or provider working in silos. I have a better appreciation for the roles and responsibilities of the other MDT members and how building relationships and having that open communication amongst professions can enhance patient care. MDT working has featured heavily in my experience of Vanguard working. This was largely within the Clinical Engagement Group (PoC), but also within educational settings where best practice was shared regionally. The MDT professionals involved in the Vanguard facilitated a number of learning events held for care home staff.
The initial ‘Care Homes Matter’ event was based on the principal topics of the ‘Enhanced Health in Care Homes Framework’.3

Nutrition & Hydration was one of the nine topics discussed at this event. I also facilitated teaching sessions at three follow-on events within the ‘Care Homes Matter’ series: Infection Prevention & Control, Dementia & Delirium, and Nutrition & Hydration. In addition, I attended and contributed to local hydration workshops focused on the development of best practice hydration care, and local care home champions meetings where care home staff influence change in the region.

These experiences have allowed me to progress my skills as a Clinical Educator, as well as a Clinician.
My involvement in the Vanguard has exposed me to the wider workings of innovation within the NHS. I have attended quarterly reviews with NHS England where the work of the Newcastle-Gateshead Vanguard and its plans for sustainability post-Vanguard were showcased and commended as the most successful Vanguard of its kind!

The clinically focused approach of our Vanguard was celebrated as the key to our success: “It is the clinical stuff you guys do so well” – William Roberts, New Care Models Lead for NHS Enhanced Health in Care Homes.

Conclusion

My time working as a Dietitian within a Vanguard programme has provided me with so much more than I had anticipated. Not only have I had the opportunity to take on a role of increased responsibility within my Dietetic discipline but also within the greater health and social care system in our region. I have gained an insight into the process of care planning, provision and commissioning and have been involved in decision making affecting the future care of our care home residents. I have been fortunate to build relationships with and learn from experienced professionals in a range of different specialities and services. I would encourage any Dietitian to avail of an opportunity to work within such a unique, innovative and forward-thinking programme such as the NHS Vanguard programmes.

For more information on the Newcastle-Gateshead Enhanced Health in Care Homes Vanguard, visit: www.enhancedcare.org or www.newcastlegatesheadccg.nhs.uk/about-us/improving-healthcare/vanguard-briefing/.

To see tweets and pictures from our Care Homes Matter events, search #CareHomesMatter on Twitter.

To access the five-part ‘Enhanced Health in Care Homes Vanguard Series’ published in Complete Nutrition Magazine, visit: www.nutrition2me.com/publications/complete-nutrition

Following on from the Vanguard which concluded in March 2018, I am delighted to say that the Newcastle-Gateshead Clinical Commissioning Group decided to fund my post as a Dietitian & Clinical Educator in Care Homes for a further 12 months. During this time, I will be rolling out my Nutrition & Hydration Training Programme and Enhanced Dietetic Service to half of the Gateshead Care Home population. I will continue to collect data and evaluate the programme on a larger scale with the hope of its success resulting in a substantive post to offer this service on a continuing and equitable basis to all Gateshead Care Homes and their residents.

 

References 1. Bowman C, Meyer J (2017). Care home leadership: action is needed. Age and Ageing; 46 (4): 534–535. Accessed online: https://doi.org/10.1093/ageing/afx030 (June 2018). 2. Newcastle-Gateshead CCG (2016). Enhancing the health of care home residents: Gateshead’s Vanguard project. Accessed online: www.newcastlegatesheadccg.nhs.uk/about-us/improving-healthcare/vanguard-briefing/ (June 2018). 3. NHS England (2016). New Care Models: The framework for enhanced health in care homes. Accessed online: www.england.nhs.uk/wp-content/uploads/2016/09/ehch-framework-v2.pdf (June 2017).

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