our nutritional wellbeing today · and nutritional wellbeing needs wellbeing of people in their...

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Our nutritional wellbeing today – why we must improve

The next five years will offer significant challenges but there has never been a greater need and opportunity to improve nutritional wellbeing. Malnutrition literally means poor or bad nutrition and in the case of the majority of the people it most commonly refers to overweight and obesity leading to a premature deterioration in health, wellbeing and productivity due to associated diseases such as some cancers and type 2 diabetes. For older people however malnutrition mostly frequently refers to a lack of adequate nutrition leading to weight loss and ill health.

Malnutrition impacts across the entire life course and for example in Tayside:

Almost a quarter of Primary 1 children are overweight or obese and the proportion increases as deprivation increases.

Two thirds of adults aged 16 and over are overweight, including almost a third who are obese. Levels of overweight and obesity increased between 1995 and 2008, but have remained relatively stable since then.

One in 20 people have a diagnosis of diabetes. Most cases are type 2 diabetes and the number continues to increase steadily.

The number of people aged 65 and over is projected to rise by nearly 50% in the next 20 years. One in 10 people over 65 living in the community suffer from undernutrition and dehydration.

In light of reducing health and social care budgets and our ageing population, the next five years will undoubtedly offer significant challenges yet there has never been a better reason to address and improve the nutritional wellbeing of Tayside’s population. It makes economic sense.

Food, hydration and nutrition do not exist in isolation from other influences on health and wellbeing therefore a holistic approach to an individual’s needs is required, inclusive of teams and organisations providing integrated care, support and treatment. However we also know that a wide range of factors shape our nutritional wellbeing, including our genetic inheritance, place and position in society, behaviour patterns as well as the health and social care we receive. While health and social care has an important role to play, supporting us when we are ill and helping to improve our health and wellbeing, other factors have a greater influence on our health and nutritional wellbeing.

There is a clear commitment from the Scottish Government to improve nutrition across our society and this is demonstrated in a wide range of policy documents including those on maternal and infant nutrition, child healthy weight, adult weight management services, food, fluid and nutritional care standards and, the health promoting health service. We have the opportunity to make improving Tayside’s nutritional wellbeing really matter – improving lives and making better use of resources.

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The nutritional care system and our place within it

SCIENTIFIC & ACADEMIC COMMUNITY

Apply scientific knowledge,

methods & advanced technology to the prevention & treatment of malnutrition & nutrition related

disease. Provides advocacy for specific nutritional concerns

FOOD STANDARDS SCOTLAND

Responsible for protecting the public from risks to health that may arise through the consumption of

food.

TAYSIDE POPULATION

Make choices around their lives & nutritional wellbeing, & are affected, informed & influenced by their physical & social

environment. Supported by local authorities, NHS Tayside, Scottish Government, voluntary

& community sector & directly by Tayside Nutrition through its behaviour change &

service improvement programmes

NHS HEALTH SCOTLAND

Responsible for providing evidence of what works to

improve nutritional wellbeing & reduce nutrition related health inequalities &, facilitating knowledge exchange between public health practitioners e.g. Scottish Infant

Feeding Advisers, NHS Public Health Nutrition &, Adult/Child Healthy Weight Networks.

NHS HEALTH IMPROVEMENT SCOTLAND

Responsible for driving improvements that support the highest possible quality of care.

HEALTH FACILITIES SCOTLAND

Responsible for advice, guidance & support in relation to national facilities.

TAYSIDE NUTRITION MCN

Hosted within NHS Tayside’s Directorate of Public Health, registered health care professionals with an

expertise in nutrition work in partnership with personnel within & beyond NHS Tayside, volunteers

& the public to:

Improve the public’s health & wellbeing outcomes

Improve the nutritional wellbeing of population sub-groups through sustainable nutrition & dietetic pathways

Build capacity & capability of the health & social care system

Reduce nutrition related health inequalities

Through: Application of evidence into practice & improvement

methodologies

Reducing waste, unnecessary variation & harm

Influencing national & local health & social care policy

A collaborative and best value approach to primary and secondary prevention, treatment and care

Innovation and the application of technology

A placed based or whole systems approach that engages local communities, building on their assets and addressing the wider determinants of nutritional wellbeing including food access and food poverty

A life course approach, promoting equality, social justice and, a holistic and person centred view of an individual’s health and nutritional wellbeing needs

LOCAL AUTHORITIES

Responsible for improving the health & nutritional wellbeing of people in their area, addressing the full

range of factors determining good nutritional wellbeing & developing healthy & sustainable communities.

HEALTH & SOCIAL CARE PARTNERSHIPS

Responsible for ensuring that people get

the joined up & seamless food, fluid & nutritional care that they need to live safely & independently in their own homes for as

long as possible.

INDUSTRY

Influences the public’s nutritional wellbeing by providing people with

employment, goods, services & information.

VOLUNTARY & COMMUNITY SECTOR

Influences the public’s nutritional

wellbeing with volunteering opportunities, employment,

goods, services & information. Provides advocacy for specific

nutritional concerns.

SCOTTISH GOVERNMENT

Responsible for national strategy, legislation & policy on the public’s nutritional wellbeing & other decisions that influence the wider determinants.

NHS TAYSIDE

Responsible for providing food, fluid and nutritional care

throughout a patient’s journey, supporting people to

maintain or improve their nutritional wellbeing as well as, leading & delivering on

various public health nutrition interventions such as UNICEF

Baby Friendly, Health Promoting Health Service &

Healthy Working Lives.

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Our role Tayside Nutrition Network is lead by personnel from NHS Tayside’s Nutrition & Dietetic Service and the Public Health Directorate and consists of registered dietitians and health care professionals with an expertise in nutrition. The Nutrition & Dietetic Service is hosted within the Dundee Health & Social Care Partnership and has a responsibility for working with patients, health and social care personnel and the general public to

promote optimum nutrition and/or provide dietary interventions to prevent, alleviate or cure a medical condition. Tayside Nutrition Network has a skilled and committed workforce that has already made a significant impact on the health and social care system. We have worked to put prevention, reducing nutrition related inequalities and a population approach at the heart of the health and social care system, enabling NHS Tayside to better manage demand, improve efficiency and tackle funding pressures. Our priorities which are determined by Scottish Government policy and local health and social care priorities relate to the prevention and treatment of malnutrition i.e. obesity and undernutrition, improving maternal and infant nutrition and, a population approach to therapeutic nutrition. We also identified a number of game changers that offer unique opportunities for positive change and much faster progress on our nutrition priorities. These include a community based approach to childhood obesity prevention in partnership with Dundee City Council; evidence from return-on-investment dietetic interventions to support improvements to patient nutritional support and spending decisions; the opportunity to exploit social media and digital technology; and the contribution of employers to improving the nutritional wellbeing of their staff.

Tayside Nutrition Managed Clinical Network (Tayside Nutrition Network) exists to improve the nutritional wellbeing of Tayside’s population

and reduce nutrition related health inequalities. We do this through the application of research, advocacy, building partnerships, knowledge

and intelligence, and the delivery of public health nutrition and clinical dietetic services.

Optimising System Performance

Productive Partnerships

Principles

Process

Programme Management

Planned - Outcome Focused – Reported - Communicated - Risk Assessed

• Needs assessment

• Map & explore issues

• Co-design a future model

• Test & review ROI

• Spread & embed

• Review & refine

Stakeholders

present &

engaged from

start to finish,

function as

equals

throughout the

improvement

journey

Apply MCN &

public health

principles

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Tayside Nutrition optimises health and social care system performance through planned and delivered improvements by applying the four P’s (see diagram opposite) i.e. 1. Productive Partnerships – ensuring stakeholders are present and engaged from start to finish and function as equals throughout the im-

provement journey

2. Principles – working in accordance to Managed Clinical Network (MCN) and public health principles

3. Process – applying the following steps: a. Assessment of population needs i.e. source relevant health intelligence which best describes the characteristics of the target

population

b. Mapping and exploring the issue(s) e.g. validity of the data; clinical risk; evidence base; aspects of the local context; national comparisons of data; total cost

c. Co-designing a future model or pathway using innovation which aims to improve experience of care (including quality and satisfaction), improve the health of the population; and reduce the per capita cost of health care

d. Testing with improvement methodology and reviewing the return on investment

e. Spreading and embedding the change into mainstream services which may include reallocation of resource / disinvestment in obsolete processes / training / system change

f. Reviewing the position and refining the model / pathway as necessary

4. Programme management – ensuring the work is planned, outcomes focused, reported, communicated and, risk assessed

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Our vision for success by 2022

We are regarded as the ‘go to’ experts for advice on improving nutritional wellbeing and return-on-investment in public health nutrition and clinical dietetic interventions and, we support all our partners as local contributors in improving the public’s nutritional wellbeing. Early intervention and prevention of malnutrition (obesity and undernutrition) is recognised as integral to delivering health and social care’s quality and efficiency challenges. The wider NHS and local authority services including education and social care are fully engaged in improving nutritional wellbeing. We are able to demonstrate that we are efficient, economic and effective in all that we do, with a growing reputation as a leading nutrition partnership. Prevention of malnutrition (obesity and undernutrition) is core to NHS Tayside’s agenda, on which we are a trusted adviser. Nutrition related health and wellbeing outcomes are improving and the gap between the most affluent and the most vulnerable is reducing. Our nutrition and dietetic personnel are working with experts across Scotland, to provide authoritative and practical expert advice to Scottish Government, NHS Scotland, NHS Health Scotland, Food Standards Scotland, Scottish Public Health Network, Health Facilities Scotland, Professional Bodies such as the British Dietetic Association, and third sector organisations, based on the evidence and our expertise and experience. More people recognise the impact of optimal nutrition to their health and wellbeing. More people are supported as close to home as possible using technology where appropriate. More vulnerable people can access affordable healthy food and drink. More people are improving their diets. Tayside exhibits a healthier and more sustainable food culture. Capacity and capability is increasing through a partnership approach. More people advocate on behalf of optimal nutrition. There is an increased level of knowledge and skills amongst those providing practical information and signposting.

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New opportunities in the wider system While longer term societal drivers of change represent the principal challenge facing the public’s nutritional health and wellbeing, there are opportunities which have arisen that are beginning to have an impact.

Sets out the vision and ambition for health and social care services in Scotland for the next 10 to 15 years.

Under the Public Bodies (Joint Working) (Scotland) Act 2014, in 2016 NHS Tayside and the three local authorities became jointly responsible for the health and care needs of adults and older people, ensuring those who use services get the right care and support whatever their needs, at any point in their care journey. Health and social integration also means a greater emphasis on enabling people to stay in their homes, or another homely setting, where possible, sharing their lives with their family and friends, doing the things that give life meaning and value.

The Children and Young People (Scotland) Act 2014 has facilitated a shift in public services towards the early years of a child’s life, and towards early intervention. Whenever a family of a young person needs help, the legislation encourages preventative measures.

SUPPORTING CHILDREN & YOUNG PEOPLE

HEALTH & SOCIAL INTEGRATION

NATIONAL CLINICAL STRATEGY

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A framework challenging the inequalities older people face as they age and to celebrate older people in

Scotland.

A three-year programme that aims to maximise the contribution of allied health professionals to the health and wellbeing of the population of Scotland.

The Scottish Government wants to revolutionise the way patients’ needs are addressed by hospital-based, but not necessarily hospital-delivered, services to deliver care closer to the patient’s home, providing more person centred care, utilise new and emerging technologies, whilst maximising the role of clinicians across primary, secondary and community based services.

Sets out NHS Scotland’s approach to ensuring all members of multidisciplinary teams (not just doctors) make best use of all the resources available to us in the delivery of world-class healthcare.

REALISTIC MEDICINE

MODERN OUTPATIENT PROGRAMME

ACTIVE & INDEPENDENT LIVING PROGRAMME

A FAIRER SCOTLAND FOR OLDER PEOPLE

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Public expectations are changing dramatically due to developments in digital and data technologies and rapid changes in the way people access information. There is enthusiasm for nutrition related digital technology across all ages, such as our gluten-free food scheme micro site and Florence (a home mobile health monitoring system) used in adult weight management service.

Under the Community Empowerment (Scotland) Act 2015, community planning partnerships are required to prepare and publish a local outcomes improvement plan which sets out the local outcomes to be prioritised for improvement.

A radical programme of service redesign and reform to improve health and wellbeing for the people and communities of Tayside. Aims to drive longer term service change and support staff to ensure we continue to provide the best and safest care and treatment we can for patients, their families and the public.

A transformational plan for children and young people, their parents, carers and families of Scotland who require support from allied health professionals.

READY TO ACT

NHS TAYSIDE TRANSFORMATION

PROGRAMME

LOCAL OUTCOME IMPROVEMENT PLANS

PUBLIC EXPECTATIONS, TECHNOLOGY &

SCIENTIFIC ADVANCES

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The next five years – how Tayside Nutrition Network will play its part We have made a good start to deliver improvements and our skilled and committed staff will continue to work with others to focus our combined activity around the greatest causes of malnutrition and nutrition related disease, to secure the greatest health gains for the population of Tayside and, to reduce nutrition related health inequalities. We will continue to make sure that our unique services are of a high quality and are delivered efficiently and effectively. Success will only be achieved if we all make healthier decisions about our lives and if partners play their part too by making healthy choice the easy choice. Therefore our approach for the next five years is based on utilising the specialist skills of our staff so we can provide services that support others to deliver on this agenda as well as provide necessary access to specialist nutrition and dietetic care. Scottish Government We will work closely with the Scottish Government to develop its food, nutrition and obesity policies and, to maximise the effectiveness of their implementation.

A foundation for the whole system, for public services, third sector, community organisations and

others, to work better together to improve Scotland’s health, and to empower people and

communities. It is a starting point for new preventative approaches, and a new awareness around

wellbeing, that will develop and strengthen in the coming years.

Priority 6 - A Scotland where we eat well, have a healthy weight and are physically active.

SCOTLAND’S PUBLIC HEALTH PRIORITIES

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Health & Social Care Partnerships We will support health & social care partnerships, including the voluntary sector, in delivering their statutory duty to improve the health of their local people and deliver value for money, by sharing our knowledge, data, evidence and expertise through a range of tools and examples of interventions that work. NHS Tayside We will work with NHS Tayside and partners across the health and social care system to reduce avoidable malnutrition and nutrition related diseases. We will support NHS Tayside to deliver on its transformation programme and, reduce waste, unwarranted variation and harm associated with food, fluid and nutritional care systems and processes. The Public We will build productive partnerships that help all of us take healthier decisions, reaching out to vulnerable individuals, families and communities, and working with local authorities, the third sector and commercial organisations to help make the healthy choice the easy choice. We will highlight the potential health, economic and social benefits of nutritional wellbeing and the impact of the environment to the public. We will maintain the rigorous standards of the NHS Tayside Food, Fluid and Nutritional Care and Infant Feeding Policies so that they remain the best in Scotland. We will continue to develop new standards where the evidence supports their introduction. We will build on our successful service improvement plans, continuing to apply Managed Clinical Network principles and, focusing on increasing capacity via the use of new technologies. We will continue to engage with stakeholders, provide information in a variety of ways and improve understanding of how individuals, families and communities can improve their nutritional wellbeing. Developing the nutritional care system (see driver diagram) We will promote the development of different workforces, including our own staff, ensuring they are fit to meet future challenges and opportunities in connection with nutrition.

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We will take forward our plans to create an exemplar nutrition and dietetic service that demonstrates a shared leadership approach to improving nutritional wellbeing across Tayside’s populations and patient groups. We will continue to develop a population approach to nutrition, strengthening the impact of our expert dietitians and nutritionists. We will further develop our knowledge and intelligence infrastructure, including population health and nutritional wellbeing profiles, intelligence networks, alongside the analytical and advisory support that provides the data needed for safe and effective care, and supports decision making. We will maintain our commitment to applying the evidence bae on which public health nutrition and clinical dietetic practices are based and, strengthen our obligation to scientific research and sharing of best practice.

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People resources for 2019/20

To deliver on policy implementation and services NHS Tayside employs the following public health nutrition and clinical dietetic personnel: Health - Children & Young People

PUBLIC HEALTH DIRECTORATE, NHS TAYSIDE

Dietetic Consultant in Public Health Nutrition

Infant Nutrition Coordinator

Tayside Nutrition Programme Manager

Public Health Nutrition Adviser

Breastfeeding Support Workers

Tayside Nutrition Administrator NUTRITION & DIETETIC SERVICE Dundee Health & Social Care Partnership (H&SCP)

Service Leads:

o Community Food & Health (and Dundee H&SCP) o Nutritional Support (and Acute Services) o Therapeutic Nutrition (and Angus H&SCP) o Weight Management & Diabetes (and Perth & Kinross H&SCP)

Nutrition & Dietetic Leads:

o Adult Weight Management o Older People o CBIR/Stroke/Neurosciences o Child & Adolescent Mental Health o Children & Young People - Clinical o Coeliac Disease o Complex Nutritional Care o Cystic Fibrosis - Adults o Diabetes o Learning Disabilities o Mental Health o Oncology - Adults o Oral Nutrition Support - Adults o Paediatric Overweight Service Tayside o Public Health - Children & Young People o Renal o Specialist – Children & Young People

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