Health CommitteeWritten evidence from Association for Nutrition (ETWP 18)


1.1 Association for Nutrition (AfN) is the professional body for qualified nutritionists. We protect and benefit the public by promoting nutrition and public health and championing high standards of practice in the nutrition profession. We maintain a competency-based register of individuals who are qualified and competent in nutritional science and practice and agree to uphold professional and ethical standards through a code of conduct. Only individuals who meet the highest standards in evidence based science and professional practice can join and remain on the Register.

1.2 Registered Nutritionists occupy important positions, often with strategic input, in policy and service functions throughout the NHS, private healthcare, academia and the food sectors (retailing, service, manufacturing and aspects of agriculture).

1.3 The Association also accredits 35 Bachelors and Masters courses in nutrition and promotes high standards of competence, skill and ethical conduct. Each year approximately 450 students qualified in the science of nutrition with a strong all round skill set and a firm understanding of and commitment to professional responsibility and accountability graduate from AfN accredited courses.

1.4 In addition, the AfN is in the final stages of a major project funded by the Department of Health under the Third Sector Investment Programme entitled Improving Capacity, Confidence and Competence in Nutrition across the Workforce, producing a blueprint for supporting the health workforce below professional level and health professionals, (GPs pharmacists, school nurses, health visitors, etc), who provide nutrition advice to individuals and populations where nutrition may not be a central part of their role, but an important element of it. A major focus of this project is exploring how to reduce nutrition-related inequalities by improving the capacity, confidence and competence of the frontline nutrition workforce.

1.5 Our strategic aim is to ensure consistent, accurate and evidence based nutrition practice across the healthcare team, from professional to frontline worker, to improve nutrition-related health outcomes for public, patients and service users. We welcome the opportunity to provide evidence to the Health Select Committee on healthcare education, training and workforce planning, and our evidence centres on two areas. First, the role of professional bodies in securing employer and professional input into the standard setting and quality assurance of high-quality degree and postgraduate professional training and second, the need for a single point of influence to address perceived weaknesses in current statutorily regulated professions. We will also provide comment on the work we are undertaking to integrate and quality assure nutrition skill across the frontline workforce and to provide career support and progression for workers at levels 3 & 4* across the health and social care sectors.

Our Evidence

2.1 We support the Government’s intention to encourage greater multi-professional leadership in the health-care professions. There must be greater recognition of the skills of all healthcare professionals in achieving better health outcomes; not just the skills of those professionals who have statutory protection through government regulation. Registered Nutritionists, qualified and competent in nutrition science and practice, work as part of a team of healthcare professionals and have an equal commitment to improving health outcomes, often at a strategic or population level, for public, patients and service users.

2.2 High standards and relevant curricula in the education and training of Registered Nutritionists are achieved through a combination of risk-based voluntary regulation and by encouraging and sharing best practice. Employers and nutrition practitioners, together with academics and lay professionals set standards for the education and training of Registered Nutritionists at graduate and postgraduate level for entry into the profession. Degree standards are monitored by our course Accreditation Committee through an annual and five-yearly review cycle, led by employers, nutrition practitioners, academics and lay professionals to ensure decisions are made in the public, rather than the profession’s interest. We are confident Registered Nutritionists are both competent and capable members of the healthcare team, with the right mix of skills and abilities to test, communicate and advance nutrition science and practice.

2.3 However, research undertaken by us suggests the current training and support for frontline nutrition workers at levels 3 & 4* and other healthcare professionals in the provision of nutrition advice is inadequate. (For example, in a recent survey 47% of GPs said they did not have the necessary training to provide nutritional messages.) In addition, career development and/or opportunities for progression within the nutrition workforce below professional level are limited. Our concern is to ensure all members of the healthcare team have access to, and can communicate correctly, evidence based nutrition advice to the public and service users.

2.4 Funded by the Department of Health, we are developing a single, coherent platform for all healthcare workers to demonstrate their competence in nutrition and to improve their capacity and confidence in providing consistent and accurate nutrition advice to service users and the public. Our objective is to encourage high and consistent standards of education and training (including continuing professional development) alongside robust support, recognition and progression mechanisms to ensure the nutrition workforce is sufficiently developed and skilled to deliver the government’s targets to reduce nutrition related health inequalities.

2.5 We have developed and tested a comprehensive quality assurance framework entitled the “Workforce Competence Model in Nutrition” to benchmark nutritional skills and knowledge with the aim of improving the competence of the target workforce. The model features a set of core competences at differing levels, based on National Occupational Standards, which benchmark nutritional knowledge and skills and transferrable attributes fundamental to the frontline nutrition workforce. The model has been tested and validated at multiple workshops across England including Community Food Workers, Health Trainers and Nursery Nurses and their managers. Initial results from the workshops suggest the need to invest in lower level training and education to improve competence, morale, workforce support and retention. Our research with frontline nutrition workers indicate there are significant gaps in current training, with nutritional advice often conflicting between professional and workforce groups, and the need for workers to increase capacity to progress horizontally and/or vertically into nutrition related roles within the health and social care sector.

2.6 Our research highlights gaps in the education, training and continuing professional development of current statutorily regulated health professions (GPs, dentists, nurses, pharmacists, health visitors, etc). A single point of influence, whereby weaknesses identified in the skill and competence of fellow health professionals can be addressed quickly and cost effectively would be in the public and service users interest. This may be one function the Committee may wish to see incorporated into the functions of Health Education England.

2.7 We support the intention of the NHS Educational Outcomes Framework to invest in education and training to ensure that appropriate values, behaviours, attitudes and team-working are developed. Domains 4 and 6 are particularly important to support the Government’s public health agenda.

2.8 We disagree with the limited definition of Competence in the NHS Educational Outcomes Framework, “Competences focus only on the function itself, and not on the personal attributes of the individual performing the function.” Our research, using the very helpful definition of competence published by Skills for Health, demonstrates that competence must acknowledge transferrable skills, some of which rely on personal attributes.

December 2011

Prepared 22nd May 2012