Memorandum by the Nutrition Professions
Confederation (WP 62)
SUMMARY
The Nutrition Professions Confederation is concerned
about the lack of defined standards for training in nutrition
in many of the health professions, and hence wide variety in the
competence of those who need to deliver nutritional advice or
care in their professional practice. There is a need for a coordinated
and coherent approach to incorporating nutrition and dietetics
within health delivery. This might be achieved by development
of a National Service Framework for Nutrition which would take
responsibility for setting standards, curriculum development,
improving delivery of nutrition and dietetics services in public
health, primary, secondary, and tertiary care, and for integrating
science and research into clinical practice.
1. We are a confederation of professionals
from the disciplines of medicine and nutrition science dedicated
to the nutritional health of people, both in the community and
as patients in the healthcare system.
We represent the following organisations:
Intercollegiate Group on Nutrition
A grouping of 14 Medical Royal Colleges with
representatives from the British Dietetic Association, British
Dental Association, Faculty of Public Health, British Pharmaceutical
Nutrition Group, and the Chief Nursing Officer—the remit
is to improve the knowledge and skills of doctors in the principles
and practice of nutrition, and hence provide improved nutritional
care in hospitals and in the community.
Nutrition Society
The Nutrition Society is the learned and professional
association which represents the science and practice of nutrition
in the UK. Its aim is to advance the scientific study of nutrition
and its application to the maintenance of human and animal health.
British Dietetic Association
A professional organisation with the aim to
advance the science and practice of dietetics, promote training
and education in dietetic practice and support individual dietitians
in their professional practice.
Association of Professors of Human Nutrition
The Association of Professors of Human Nutrition
is an association of Professors and academics of distinction,
who are committed to exercise leadership and to safeguard and
enhance the integrity and quality of the academic discipline of
human nutrition.
2. We agree with the Government's position
that nutrition is a major determinant of the health of people
and populations and welcome the prominence of these considerations
in the formulation of government policy.
3. In the context of current evidence, future
research and evolving government policy it is pertinent to consider
the readiness of the health sector in effecting and implementing
government policy in this area.
4. Services for the delivery of health,
including public health, are provided by a variety of health professions
who may have only modest, if any, nutritional training and work
in a non-integrated way in the NHS for the benefit of the individuals
and the population. Further, those who are currently engaged in
delivering services in nutrition are not always trained to explicitly
recognised standards, other than in the case of Registered Dietitians
and Public Health Nutritionists.
5. We believe that this lack of an interprofessional
competency framework limits the great potential for health improvement,
both preventive and therapeutic, that exists within the UK.
6. Health services at primary, secondary
and tertiary care level will all be involved in the implementation
of policy and this may be illustrated by the consideration of
the experience of a patient and or the public in the context of
a nutritionally related issue, such as obesity or undernutrition.
7. Vulnerable groups in the UK population
such as the old, the very young, those on low income and ethnic
groups are of particular concern.
8. There is potential not only for health
gain but also for economic savings—considerable evidence
exists that better nutrition before or during illness improves
outcome and reduces hospital stay.
9. These two factors, inadequately defined
standards across the health professions, and a range of greatly
varying competences for those who need to access nutrition in
their professional practice, limits the great potential offered
by nutrition for health improvement and for economic savings.
10. We have identified several opportunities
for incorporating nutrition components within the training of
health professions both at undergraduate and postgraduate levels,
and within service delivery.
11. We envisage a co-ordinated, integrated
and coherent approach to incorporating nutrition and dietetics
within health delivery.
12. We recognise three major domains underpinning
effective health delivery—training, practice and research.
Nutrition and dietetic practice should be integrated within a
coherent framework in each of these. In order to do this, the
different nutrition professions engaging with the development
of these various activities should do so in a coherent way. We
have come together in order to promote this coherence and consistency.
13. All health professionals should be able
to demonstrate safety and competence to practise, including in
nutrition, at an appropriate level for their practice. Currently
several political and professional initiatives offer singular
opportunities to coordinate and integrate the place of nutrition
and dietetics in professional training and health delivery.
14. We consider that this will be best achieved
by a development along the lines of a National Service Framework
for Nutrition. This would inevitably be cross-cutting with other
Service Frameworks, and would enhance the delivery and success
within these other areas of consideration. We identify below initial
steps that we believe will help achieve this:
— curriculum development;
— services in public health nutrition,
primary, secondary and tertiary care; and
15. SETTING STANDARDS
The Healthcare Commission document "Standards
for Better Health" sets out a generic framework of performance
indicators to which different professions are aligning their statements
of professional standards through concordats. We would develop
a set of nutrition standards congruent with this core activity,
applicable for nutrition across a range of professions.
With a focus on the patient's clinical journey,
we will develop scenarios to help identify the personnel, skills
and competencies required to ensure a seamless provision of nutrition
and dietetic related care across the primary, secondary and, where
necessary, tertiary care.
16. CURRICULUM
DEVELOPMENT
We have already identified in the Core Curriculum
for Health Professionals a minimum set of nutrition and dietetic
knowledge that all health professionals should appreciate by the
time they graduate. Within postgraduate general medical training
the curriculum for the new F1/F2 training years has been released
for consultation and we will be offering constructive proposals
for incorporating nutrition without overburdening an already crowded
curriculum. Nutrition is well suited to providing a horizontal
conceptual underpinning in support of a systems-based, vertically
integrated framework.
17. PUBLIC HEALTH
NUTRITION
Developing and endorsing healthy eating practices
and diets throughout the community, using healthy settings approaches
in strategic partnerships with other agencies charged with promoting
public health for all sectors of the population.
18. PRIMARY CARE
The RCGP is in the process of developing a curriculum
for general practice within the new primary care context. We will
engage with this process to ensure a coherent presence for nutrition
within this, and build on it in relation to other health professions
in the primary care team. The development of GP specialists might
also offer opportunities for development of the necessary nutritional
skills.
19. SECONDARY
CARE
We will work with the medical Royal Colleges,
both individually and through the Academy, with the PMETB, and
with other professional bodies to develop nutrition-related standards
that could be applied in developing specialist and sub-specialist
training in nutrition for other health professionals, to complement
those of registered dietitians. These standards would cover the
essential knowledge, skills and competencies required by health
professionals operating within secondary care, who profess a particular
interest in nutrition.
20. SCIENCE AND
RESEARCH
We represent the principal academic and learned
bodies concerned with the science of nutrition, both basic and
clinical, and its application in human health. We will ensure
that our structures and procedures will be open and transparent,
and meet the highest standards of professional practice. We are
already far along this road, but it is not yet possible, outside
the hospital system, for the public to identify easily amongst
individuals who offer professional nutrition and dietetic advice,
those who have undergone an appropriate structured training of
sufficient quality and duration together with professional supervision.
21. CONCLUSION
Given the very wide sweep of nutrition, the
challenge of developing a co-ordinated approach to the delivery
of service to the public is considerable. Nevertheless, there
is a clear need for better and more effective co-ordination, and
for regulated mechanisms through which the public can be assured
of the professional competence of those in practice. Our ultimate
ambition is that The Nutrition Professions Confederation will
provide this assurance and thereby enable the public to identify
with confidence the nature and level of service which they might
expect from different groups of health practitioners.
January 2005
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