Supporting EuDAP & EU policy on health & well-being: dietitians as nutrition educators of health professionals Dr Anne Payne Associate Professor of Nutrition & Dietetics Plymouth University, UK

Overview/Introduction o What do health policies say about ‘Health Improvement’ and the education of Health Professionals? o Health 2020 (WHO 2013) o EU F&N Action Plan (WHO 2014) o EuDAP (EFAD 2015) o Strategic implications for dietetics o Dietitians as Leaders and Educators o Skill and competency development o Working example o Professional benefits

Health 2020: a European policy framework (WHO 2013)  Health 20:20 promotes change in health philosophy, from a focus on individual responsibility for lifestyle choice, to a ‘whole-of-government’ approach to ‘Health Improvement’  Changing health demographics, with an aging population & rising costs requires a new working culture  Focus is now on ‘health improvements’ with engagement of health professionals

Health Priority Areas 4 priority areas for action 1.Health improvement across the life-span through empowering people to take action 2.Tackling major health challenges (CVD, Cancer, Mental Health) 3.An enhanced public health approach … more flexible, multi-skilled and team-oriented workforce 1.Resilient communities and supportive health environments.

European Food and Nutrition Action Plan (WHO 2014) Strategies to improve dietary health require government-led action......a top down ‘whole-of-government’ approach Encourage the use of social media and new techniques to promote healthy food choices and healthier lifestyles Adopt tools and strategies to address the special nutrition needs of vulnerable groups including older people, for both those living in the community and those in care 5 key objectives

European Food and Nutrition Action Plan: 5 key objectives (WHO 2014) 1.Create healthy food and drink environments 2.Promote the gains of a healthy diet throughout the life-course, especially for the most vulnerable groups 3.Reinforce health systems to promote healthy diets 4.Support surveillance, monitoring, evaluation and Research 5.Strengthen governance, alliances and networks for a ‘health-in-all-policies’ approach

European Food and Nutrition Action Plan: Objectives 3 (WHO 2014) Reinforce health systems to promote healthy diets Improve capacity and training for primary health care professionals, including guidance on appropriate nutrition counselling and weight monitoring and management

European Food and Nutrition Action Plan: Objectives 3 (WHO 2014) Reinforce health systems to promote healthy diets Improve capacity and training for professionals in nutrition in order to secure a skilled public health workforce in addition to delivering high-quality nutrition services in health care settings. Member States, under WHO guidance, will provide public health and health care professionals with evidence-based information on nutrition in professional education systems and through best practice examples, guidance and guidelines.

European Dietetic Action Plan EuDAP ( ) Guiding principle Dietitians have a responsibility as a profession to support the improvement of nutritional health of the people of Europe through an evidence- based approach

EuDAP Objective 3 Use dietitians as educators and experts in community and clinical settings to advise the general population, other health professionals, authorities, media and industry

Strategic implications for Dietitians Nutrition now a responsibility of the wider health care team Changing focus of the Dietitians professional role: a greater emphasis on leadership and the education of other health professionals Need for the development of advanced skills and competencies in education and presentation skills

Dietitians as Leaders Engage with local and national government bodies to embed nutrition friendly policies Engage with mass media, industry and health insurance companies to disseminate evidence-based guidance Contribute to nutritional evidence via research and service evaluation

Dietitians as Educators Engage with health and social care managers to seek opportunities for nutrition education training sessions Encourage health and social care professional to adopt a ‘Make Every Contact Count’ (MECC) approach to health and well-being Engage in CPD to maintain an up-to-date (evidence based) knowledge and practice of dietetics

European Dietetic Advanced Competences (EDAC) July Educator Skills o 5.1 Demonstrates responsibility to contribute to the education and training of patients/clients, students, dietitians and other health professionals o 5.2 Demonstrates ability to prepare and present educational material through the critical evaluation and synthesis of relevant information to meet learning outcomes in appropriate settings and using effective media.

What Skills? Discussion point: What skills do we need to be good educators of other health professionals?

What Skills?? EFAD Advanced Educator Skills A knowledge and critical understanding of effective educational methods and pedagogy Use of educational techniques to empower Facilitates mentoring and coaching to promote a positive learning environment Able to critically appraise current evidence and synthesize an informed strategy, to teach best practice Creates a culture where critical feedback is received positively and mistakes are regarded as learning opportunities Supports the development of supervision skills in others

Skill Development Discussion point: How can we develop advanced skills & competencies?

Skill development MethodPro’s and Con’s…… Identify local opportunities to gain relevant experience in multi-professional education & presentations Engage in formal and informal CPD opportunities ▫ E-learning ▫ Evidence Based Practice (EBP) training Post-graduate Education No-financial cost/builds confidence/networking opportunity/ but adds significantly to workload Small episodes of CPD are affordable and readily absorbed into workload, but no formal recognition of learning Supports career progression but expensive and a considerable personal commitment

EU policy and EuDAP : an example Health 20:20 (WHO,2013) Five-year Forward Review (UK Dept Health, 2014) promotes service redesign Health Education SW commissions CPD for community Health Professionals Plymouth University now delivering multi- professional CPD modules Maintaining a Healthy Weight (NICE guideline 2015) UK Health & Care professionals encouraged to adopt a MECC approach to promote Health Improvement European Food and Nutrition Action Plan EuDAP Objective 3: use Dietetians as Educators Dietetic educators train other health professional on public health nutrition

UK policy on public health (2014) says……… ‘NHS health professional needs to be more engaged with patients on a day-to-day basis, taking a proactive approach to promote wellbeing and prevent ill-health’ It identifies a ‘health and well-being gap’ that needs to be seriously addressed, by preventative health measures

NICE guidelines on weight control (2015) say……… Who should take action All those who provide information to help different population groups maintain a healthy weight or prevent excess weight gain. This includes practitioners providing information or advice to children and adults in primary care, community based settings, early years settings, schools and workplaces.

Making Every Contact Count (MECC) (Varley & Murfin, 2012) A ‘toolkit’ to support health and care professionals to deliver healthy messages within the community care setting They systematically ask individuals about their lifestyle and changes they wish to make may involve either the giving of relevant information, signposting or onward referral of individuals to the support they need

What could MECC achieve? An example (Varley & Murfin, 2012) : Across NHS Midland and East (UK) there are 288,000 staff who collectively have millions of contacts with the public every year If each staff member delivers MECC just 10 times each year there will be 2.88 million new opportunities to change lifestyle behaviour every year If one in 20 of these people go on to make a positive change to their behaviour a total of 144,000 people would be improving their health and wellbeing.

Benefits to other Health Professionals......e.g.... Better knowledge and understanding of the relationship between nutrition and health Relevant CPD opportunities A more holistic relationship with their patients/clients Better informed of how to signpost patients/clients to nutrition & dietetic professionals for support

What are the benefits of a MECC approach to the Dietetic Profession?

Benefits to Dietetic Profession..? Opportunity for greater client/patient nutritional support from both a preventative and therapeutic perspective Raised profile of dietitian’s as experts in nutritional and dietetic care Raised awareness among clients/patients and other health professionals of links between nutrition and health Opportunity for dietitians to extend scope of profession to better embrace leadership

Summary WHO has taken a leading role in re- designing primary healthcare to meet the needs of an aging European population If effective, this approach will be rolled- out more widely The profile of ‘nutrition’ has been raised, giving Dietitians a remit as ‘educators’ of other health professionals This has the potential to have a huge cost-effective impact on Health

References o Department of Health (2014) Five Year Forward Review. NHS, London, UK. o EFAD (2015) European Dietetic Action Plan EUDAP ( ) o NICE (2015) Maintaining a healthy weight and preventing excess weight gain among adults and children. NICE guideline (ng7) UK: Accessed 12/10/15 o Varley E & Murfin M (2012) An implementation Guide and Toolkit for Making Every Contact Count: Using every opportunity to achieve health and wellbeing. East Midlands Trainer Hub. NHS Derbyshire County, UK. o WHO Europe (2013) Health 2020: a European policy framework supporting action across government and society for health and well-being o WHO Europe (2014) European Food and Nutrition Action Plan