The Role of Dietitians in Diabetes Care: BDA Diabetes Specialist Group Workforce Survey Summary of findings July 2016 Anita Beckwith Clinical Lead Dietitian (Diabetes), King’s College Hospital National DAFNE Educator, UK

90 Respondent Profile 85.6% Diabetes Departments Represented 5.6% 2.2% Consultant Paediatrician Clinical & Operational Lead for Nutrition & Dietetics Senior Specialist Dietitian Diabetes Stroke Dietitian Paediatric Diabetes Dietitian Team Leader 85.6% Diabetes Specialist Dietitian Specialist Dietitian Lead Diabetes Dietitian Dietitian 6.7% Highly Specialist Dietitian Advanced Practitioner Dietitian Associate Clinical Operational Lead Senior Research Associate Community Dietitian

Definitions Dietitian: “Degree qualified expert in nutrition and dietetics who practises evidence based medicine and is registered with the HCPC. Only nutrition professionals to be regulated by law.” Nutritionist: “A person who studies or is expert in nutrition.”

Surveyed Workforce by banding 554+ Total Staff Numbers (H/C)

Areas of care and patient types covered

Patient numbers and education programmes Others include: BERTIE KAREN SADIE ESTER Carb Counting 57,000 Highly specialised Paediatrics: As few as 120 patients As many as 57,000 diabetics in local area

DoH Criteria for Structured Education Philosophy A structured curriculum Trained educators Be quality assured Be audited

Emergency Treatment Costs Risk of DKA reduced by 61% Risk of severe hypoglycaemia reduced by 72% Costs of emergency treatments reduced by 64% Elliott et al., Diab Med in press

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Caseload “Need more dietetic staff” “Capacity does not meet demand” “Lack of funding and staff vacancies” “Capacity does not meet demand” “Struggling to cope… No time for service development and improvement” “Unable to provide one to one support” “Numbers and referrals increasing, also now receiving ‘prediabetes’ referrals” “Long overbooked clinics or long waiting lists” “Cover a massive geographical area… Only one specialist dietitian for high prevalence population” “Chronic staffing shortages”

Comments “We have always been under funded for diabetes dietitians in our area and therefore there are a lot of services that we do not provide due to lack of capacity.” “I am very lucky to have highly-trained and experienced, hard-working individuals in my team. I only have one day a week to manage a changing and challenging service which I find insufficient.” “We work very closely as a team helped by many of us (doctors, nurses and dietitian) sharing the same office.” “I work very closely with the DSNs, we have a very supportive encouraging team, many of the professional boundaries are now greyed but there remains a tremendous respect for each others work.”

Comments continued… “There is a chronic staff shortage… The gestational clinic and pump service is suffering due to lack of diabetes dietitians input. The NICE guidelines are not being met. This concerns me greatly.” “Diabetes Dietitian is always under valued by the service despite a great contribution to the management of diabetes. Most clinical guidelines hardly mention the word dietitian, instead using words such as ‘professional with nutrition expertise’ which makes it a vague about the need to hire dietitian.” “There resistance to improving IT and this hampers our ability to connect in a relevant way with older children. It also impacts negatively on time management.” “Group education is important to address ever increasing caseload of patients. Weight management must be seen as an important pathway for all obese or overweight patients.”