WORKFORCE RISKS AND OPPORTUNITIES DIETITIANS EDUCATION COMMISSIONING RISKS SUMMARY FROM 2012

Transcription

1 WORKFORCE RISKS AND OPPORTUNITIES DIETITIANS EDUCATION COMMISSIONING RISKS SUMMARY FROM 2012 MARCH

2 Welcome to the 2012 CfWI workforce risks and opportunities: education commissioning risks summary (WRO ECRS 2012) for dietitians. The WRO ECRS 2012 reports cover all professions across health and social care, except the medical profession, which was covered in a report in 2011 ( Each report describes the key issues facing the different professions over the next three years, and aims to support local decisions on future education and training commissioning. The reports do not make specific recommendations for local commissioning decisions as these decisions are made through consultation between the education and training commissioner and employers. The reports will be submitted to the Department of Health in several tranches between November 2011 and the end of April This is a time of great change in the NHS. Employers are considering how best they can transform their services to maximise the quality of patient care, improve productivity and release the 20 billion savings to be reinvested in front line clinical care. This work could have a major impact on the future shape of the workforce and so needs to be considered alongside education and training commissioning decisions that are being made now. Financial allocations are a pivotal component of the overall education and training annual process across England. Presently the Department of Health secures funding to invest in the workforce through the Multi-Professional Education and Training (MPET) levy which is around 4.9bn for 2011/12. This funding is currently allocated to Strategic Health Authorities (SHA) largely based on historic patterns of training. The Department sets out key priorities and holds SHAs to account through a Service Level Agreement. SHAs develop plans for education commissions based on local workforce plans and then commission and fund training from education and clinical placement providers. Looking towards 2012/13, a flat cash settlement for MPET is likely. This allocation will have to accommodate a range of cost pressures which will include new costs, price increases and volume changes. In setting local investment priorities for the MPET allocation, SHAs are encouraged to consider the evidence presented within the WRO ECRS 2012 and the medical specialty training numbers reports. We hope you find the reports useful, and as always, appreciate your constructive feedback. Professor Moira Livingston Commissioning Director CfWI CfWI March

3 Purpose This information has been collated to inform decisions on education commissioning over the next three to five years. It considers the key factors influencing the estimation of future need of dietitians and gives an assessment of the current workforce supply. It includes regional perspectives, a summary analysis of risks in education commissioning, and examples of practice. translate the science of nutrition into practical information about food. They work with people to promote nutritional wellbeing, prevent food-related problems and treat disease. KEY FINDINGS Next steps The supply of dietitians is predicted to increase to approximately 6692 headcount (HC) by 2016 which is an increase of about 32 per cent from Training commissions in Scotland, which have historically supplied England, have recently been cut. England is also currently reducing its commissions. Part-time working among the predominantly female workforce means that training numbers need to reflect participation. Many staff are leaving the NHS aged between 40 and 50. A higher number of Return to Practice (RTP) requests have been received in the 2010/2011 academic year in comparison to previous years. There are a growing number of dietetic support workers 1 delivering nutritional care. In England there are 1243 registered dietitians outside the NHS. Continue to implement different models of quality, cost effective and efficient services through, for example, skill mix, extended roles and assistant practitioner posts, to support the delivery of care in the community, public health and health promotion. Continue to support the development of practice education in an increasing variety of settings, to enable students to spend time in community and other aspects of their work. Employers and professional bodies to gather intelligence on why qualified dietitians are choosing to work outside the NHS, as this could potentially create a in loss of skills and knowledge in the NHS. 1 Dietetic support workers (DSW) work with registered dietitians in either a community or hospital setting. Examples of work carried out by a DSW in a hospital include: assisting people requiring special diets to choose from the hospital menu; collecting information regarding patients' intake and weight; liaising with the dietitian regarding individuals progress.(bda 2011a) CfWI March

4 CONSIDERATIONS FOR FUTURE REQUIREMENTS Policy drivers Table 1 summarises the key policy drivers and the relevant references. Table 1: Policy drivers affecting the workforce dietitians Key drivers 1. Workforce expansion to deliver new service delivery models use patient specific direction 3(PSD) or patient group direction 4(PGD) to supply a range of renal, obesity, pancreatic and diabetes drugs. also play a key role in advising other professionals on appropriate prescription in relation to changing nutritional status in a wide variety of conditions, in acute and community settings. 2. Clinical leadership to meet future challenges Good clinical leadership is vital to leading service improvement right across the NHS. This drives demand for a high quality dietetic service and expertise at the higher tiers of services and increases demand for dietetic leadership with training and supervision at the lower tier services. Relevant policy Allied health professions prescribing and medicines supply mechanisms scoping project report (Department of Health (DH), 2009a). Next Stage Review of the NHS (DH, 2008a). Clinical Leadership Competency Framework (NHS Institute for Improvement and Innovation, 2011). Healthy lives, healthy people White Paper: Our strategy for public health in England (DH, 2010a). The Public Health Responsibility Deal (DH, 2011a). 3. Flexible, productive and responsive workforce A flexible and responsive workforce is needed to drive up quality and improve productivity, with nationally transferable skills and competences. This will ensure that all skills are utilised effectively and efficiently across services. Modernising Allied Health Professions Careers: Competence-based Career Framework (MAHPC) (DH, 2008b). Modernising Allied Health Professions Careers (MAHPC), phase 2 (DH, 2011b). Preceptorship framework for newly qualified nurses, midwives and allied health professionals (DH, 2010b). Strategic health authority (SHA) perspective SHAs work in partnership with employers (service providers), service commissioners, education providers and each other to assess workforce requirements. This then informs education commissioning plans in each region. SHAs work with local employers to inform CfWI March

5 their decision making. This is a requirement of service level agreements between SHAs and the DH for the investment of education and training funds. The CfWI has therefore engaged primarily with SHAs as the agreed route to ensuring the views of employers are considered, as part of this work. Following NHS reform, it is likely that the CfWI will engage with employer-led Local Education and Training Boards to gain this perspective. Although financial pressures and a degree of oversupply (for example in London) are playing a part in the national trend to reduce commissions, some regions anticipate a future increase in demand. Drivers for this include preventive health initiatives, obesity and cancer. Management and supporting people, especially the older population with long-term conditions, such as diabetes, dementia and those surviving strokes. Profession s view 2 Recent feedback from the British Dietetic Association (BDA) indicates there are substantial cross border flows of qualified staff between the four countries of the UK. In the 2010/11 academic year there were 521 commissions across the UK 84 per cent of the population live in England, but only 73 per cent of the dietitians in training are commissioned and trained in England (BDA 2011b). Table 2 indicates the workforce requirements for a population of 10,000 people with diabetes (BDA, 2006): Table 2: Workforce requirements for a population of 10,000 people with diabetes dietitians Diabetic condition Support staff full time equivalent (FTE) Type 1 Diabetes Type 2 Diabetes Paediatric diabetes Registered dietitians (FTE) Source: A Workforce and Training Framework for the Delivery of Diet and Lifestyle Care Pathways, for Long Term Conditions (BDA, 2006) The BDA estimated that a 10-bed stroke unit would require 0.3 full time equivalent (FTE) dietitians and 0.3 FTE clinical dietetic support workers. A community service providing this level of care would also require 0.3 FTE dietitians, but less time from support workers as a result of an increased emphasis on specific activities due to a different level of nutritional dependency (BDA, 2007). This level of commissioning indicates that England is reliant on trainees transferring from other countries of the UK. If commissioning levels were to change in other countries of the UK, this would directly affect the number of trainees coming into England. 2 The CfWI engaged with representatives from each profession to inform this report. This workforce summary will use the term representative to credit information presented by these representatives. Although in some cases the source is not explicitly named, this information may be available on a case-by-case basis. Please contact the CfWI if more information is required. CfWI March

6 The BDA representative highlighted that there is a very high proportion of women in the workforce (96 per cent). This has an effect on the FTE requirements due to maternity leave, career breaks, job-sharing and part-time working. Demographics Dietetic services cover all age ranges. Recent emphasis on care in care homes and care at home has increased cases of malnutrition in the older population. This change is due to more older people receiving treatment outside a hospital setting, without the correct levels of nutritional supervision (BDA, 2011b). More than three million people in the UK could be at risk of malnutrition with approximately 93 per cent living in the community setting, 5 per cent in residential care and 2 per cent in hospital (BDA, 2011c). In recent years obesity has increased across all ages in England. If this trend continues, the BDA suggests that demand for dietitians will continue to increase both in public health and prevention services and in treatment services for adults. Additional drivers Public health campaigns such as Change for Life (DH, 2009b), Healthy Schools Programme (DH, 1999) and Be Active, Be Healthy (DH, 2009c) have led to an increased awareness of healthy lifestyles and nutrition. As a direct result, the work of public health dietitians has increased and evolved. If prevention measures are successful, this could lead to a reduced need for dietitians in the medium to long term. The proposed changes to public health leadership and the commissioning of public health programmes will have an impact on the profession. in public health work at all levels from public health strategy to nutrition and health improvement and health promotion. The need for nutritional expertise at strategic level and in programmes to tackle the challenges of community malnutrition, obesity and other conditions with a lifestyle component will not diminish (BDA, 2011d). The Malnutrition in Hospitals (Age, UK 2010) report provides a seven-step guide to tackle malnourishment in hospitals. The campaign has resulted in 82 per cent of NHS hospital trusts across England engaging with the Hungry to be heard campaign. 55 per cent of these trusts have taken some direct action to improve their mealtimes, to stop people in later life becoming malnourished in hospital. The Government responded to the campaign by publishing a nutrition action plan on how to collectively address nutritional care within hospitals, care homes and the community. Age UK reports that despite all this, malnutrition in hospital is still a big problem for people in later life, due to a lack of consistency across hospitals. The report states that while some hospitals have taken great steps to improve their mealtimes, others have not (Age UK 2010). This focus on malnutrition in hospitals may result in an increase demand for dietitians. CfWI March

7 The increasing incidence and prevalence of long-term conditions, especially those with a lifestyle component, will also increase demand for dietetic expertise to lead the delivery of programmes to empower people to self-manage their conditions (BDA, 2011d). Changes in activity People present to dietetic services with multiple morbidities and greater complexity across most care pathways. These complexities increase demand for dietetic expertise in the higher tier services as well as for dietetic leadership with training and supervision in the lower tier services. There are a growing number of support workers delivering nutritional care: both generic support workers and those who are specifically identified as part of the dietetic workforce. will also train and support other qualified staff to deliver nutritional care as part of a shared and common competency approach to multidisciplinary working. CURRENT AND FORECAST SUPPLY Existing workforce Supply As of 1 March 2011, there were 7299 dietitians on the Health Professions Council (HPC) register. The HPC cannot confirm how many dietitians work in private practice as individuals registered can provide a home address and/or a work address, so it is not always possible to tell where an individual is working (HPC, 2011). Based on information provided by its members, the BDA estimates that 30 per cent of the7299 dietitians work in private practice, food industry or academia (education and research) (BDA, 2011b). Freelance dietitians regularly help schools and other institutions to meet nutritional standards. Freelance dietitians also work in the food industry, advising on nutrition marketing strategies, recipe development, food and labelling regulations, research and public health policy (Freelance, 2011). Table 3 shows the makeup of the workforce for dietitians, according to the NHS Information Centre for Health and Social Care (NHS IC) Census CfWI March

8 Under and over Total Education commissioning risks summary Table 3: Current qualified NHS workforce - dietitians Staff type HC FTE FTE/HC Consultant therapist Manager Therapist Qualified staff 4112* *Headcount totals may not equal the sum of components. Source: NHS IC Non-Medical Census (NHS IC, 2011a) Age profile Figure 1 shows that the age profile for dietitians working in the NHS peaks between 25 and 34 (NHS IC, 2011a). The workforce is relatively young, with no indication of a large number of people approaching retirement. Figure 1: HC and FTE age profile by five-year age band, April 2011 dietitians Age profile (HC and contracted FTE) - dietitians Contracted FTE Headcount Source: NHS IC Monthly Workforce Extract, April 2011 Age bracket (years) Note that the Under 25 age bracket only contains those between the ages of 21 and 24, whereas the other groups are in 5-year bands, therefore the relative numbers for that age band in figure 1 will be smaller. Few dietitians work beyond 65 years of age with the typical retirement age being 60. Staff recorded as retiring between the ages of 40 and 50 may not actually be retiring but moving into the private practice. The BDA representative has stated that private practice tends to recruit more experienced staff. The BDA representative stated that the profession is experiencing a higher number of RTP requests in 2010/2011. In the last three academic years, six to eight RTP requests were CfWI March

9 received. To date, 15 RTP requests have been received in 2010/2011. If this trend were to continue, commissioners may need to reassess their plans in future years. Current vacancies and employment The three-month vacancy rate for dietitians in March 2010 was recorded as 0.5 per cent, equating to 16 FTE (NHS IC, 2010). The BDA workforce survey, which covers the six-month period from 1 October 2010 to 31 March 2011in 2010, shows that there were 82 vacant posts which still had funding but were in the recruitment process or frozen (BDA, 2010). The BDA workforce survey also illustrates that, although some services lost funding for existing posts, some also received funding for new posts (BDA, 2010). Reports also suggest that some services are undergoing service redesign which some see as a response to the current financial situation and others in response to changing need. The BDA representative has stated that 80 to 90 per cent of graduates were employed within 12 months of graduating in 2010 with about 10 per cent going into academia or changing careers. Students More dietetic courses are run in England than the rest of the UK. In total there are 22 courses across the UK, 13 in England, two in Wales, two in Northern Ireland and five in Scotland. CfWI modelling assumes that 97.5 per cent of commissions per year are to the four-year course and the remainder is to the three-year courses. The BDA representative confirmed that attrition is at 7 per cent. The BDA representative has stated that there has been no difficulty recruiting students to dietitian courses. CfWI March

10 2002/ / / / / / / / / /12 Commissions Education commissioning risks summary Figure 2: Total national commissions of training places, planned and actual 3 dietitians Planned and actual commissions of pre-registration courses, England (2002/03 to 2011/12) - dietitians Planned Actual Year Source: Multi Professional Education and Training (MPET) 02B - Non Medical Education and Training (NMET) Commissions, 2002/03 to2011/12 Figure 2 shows that the number of actual commissions peaked in the academic year 2006/07 and has slightly reduced since, but that commissions are still significantly above 2002/03 levels. Recruitment The BDA representative indicated that no undergraduate courses have entered clearing recently and there were no concerns around the quality of applicants. The representative also noted that there is healthy interest in the population in nutrition and healthy lifestyles. 3 The 2011/12 planned commissions should be regarded as indicative. CfWI March

11 Geographical distribution Figure 3: Map showing NHS staff, planned and actual commissions in relation to weighted capitation by SHA dietitians Source: NHS IC Census 2011 (headcount); DH NMET Monitoring Quarter 4, 2010/11 (commissions); DH 2011d (weighted capitation). Figure 3 shows the headcount of dietitians in each SHA in September 2010 (NHS IC, 2011a), the actual commissions for training in dietetics in the academic year 2010/11 and planned commissions 2011/12 (DH, 2011c), and weighted capitation (DH, 2011d). According to weighted capitation, the London SHA appears to be over-capitated with over 23 per cent of commissions compared with weighted capitation level of 14 per cent. CfWI March

12 The BDA reports that training courses are spread around the UK and their understanding is that students move and do not always stay in the region where they trained. Not all SHAs undertake commissioning of dietitians. The South Central SHA does not commission training in dietetics as historically this has been done on their behalf by South East Coast SHA although the arrangement is historic rather than formalised. The Yorkshire and the Humber SHA commissions training on behalf of the North East SHA. This is due to the fact that the North East SHA is relatively small as a region so does not generate sufficient numbers for full training courses in smaller professions or specialist areas. Furthermore, the nearest dietetics undergraduate courses to the North East SHA are in Leeds and Edinburgh. The North West SHA is maintaining commissioning at the same level. As it is bordered by Scotland and Wales, consideration of the UK pool has helped inform this decision. Supply projections There is currently a lack of basic and accurate information necessary to inform comprehensive workforce supply modelling. Wherever data is available it is not sufficiently robust or detailed to be suitable for modelling purposes. Figure 4a shows that the NHS dietetic workforce has expanded by 21 per cent in the last five years. CfWI modelling estimates that the supply of dietitians available to the NHS and other services in England, will increase to approximately 6692 HC (5733 FTE) by 2016, this is an increase of 26 per cent for FTE by The forecasts are based on the HPC register for England which includes those in the NHS and private practice. There are approximately 1240 registered dietitians outside the NHS, which include non practitioners and those working within dietetics scope of practice without direct frontline contact, for example: those that have retired but remain on the HPC register those in management posts both in the NHS and private organisations some of those that provide education to undergraduate courses those working with other professional bodies those working in advisory and research roles. CfWI March

13 Full time equivalent Headcount Education commissioning risks summary Figure 4a: Historical and projected workforce supply by HC dietitians Summary of the available workforce headcount - dietitians 8,000 7,000 6,000 5,000 High and low scenarios of supply forecast Historic NHS headcount 4,000 3,000 2,000 1,000 Forecast of those registered and available to practice (HC) including non practitioners and those working without direct patient contact Weighted change in demand based on population growth and age based activity 0 Year Source: Historical supply data is from the NHS IC (2011). Forecasts are based on HPC data and workforce assumptions. Figure 4b: Historical and projected workforce supply by FTE dietitians Summary of the available workforce full time equivalent - dietitians Other demand drivers exist, but they have not been shown on this graph 7,000 High and low scenarios of supply forecast 6,000 5,000 Historic NHS FTE 4,000 3,000 2,000 1,000 Forecast of those registered and available to practice (FTE) including non practitioners and those working without direct patient contact Weighted change in demand based on population growth and age based activity 0 Year Other demand drivers exist, but they have not been shown on this graph Source: Historical supply data is from the NHS IC (2011). Forecasts are based on HPC data and workforce assumptions. CfWI modelling 4 from 2010 onwards is based on current commissions, assumptions reached by analysing past trends, and engaging with the profession to identify other indications. The most likely scenario (black line) indicating the estimate of future supply uses the agreed baseline assumptions in Table 4. The darker shaded area on the right of the graph shows the 4 Further details of the modelling used in the CfWI workforce risks and opportunities education commissioning risks summaries from 2012 (WRO ECRS 2012) can be found in the WRO ECRS technical report. CfWI March

14 forecast range of dietitians and is based on the low and high scenario assumptions in Table 4. Table 4: Summary of assumptions used in the supply forecast dietitians Variable Low scenario Baseline High scenario Training pipeline 2.5% take3 years 92.5% take 4 years 5% take 5 years 2.5% take3 years 97.5% take 4 years 2.5% take3 years 97.5% take 4 years Trainee commissions Commissions 5% lower As current No change Training attrition 9% from % from % from 2010 Trainees registration on graduation 89% with HPC 90% with HPC 91% with HPC International recruits 0 per year 0 per year 0 per year FTE/HC ratio Current minus 1% As current Current plus 1% Retirements Retirement trends shifted 2 years earlier, and 50% greater Retirement profile as Retirement trends shifted 2 years later It is assumed that new graduates start work within the same year, and that there are no international recruits or leavers. The lower line (long dashes) indicates the estimated future demand for dietetic staff (5547HC, 4752 FTE in 2016). The modelling uses the workforce headcount in 2010 (all registered professionals NHS and non-nhs) as a baseline and calculates the future weighted change in demand due to population growth and age based activity. This model assumes that service activity continues to be delivered in the same way as now. We accept service reconfiguration and skill mix are likely to alter future demand and so future modelling can be adapted, as we know more about these changes. Interplay with related groups In June 2010 the Association for Nutritionists (AfN) was created. It holds a competencybased register of nutritionists, the UK Voluntary Register of Nutritionists (UKVRN). Table 5 shows the makeup of the workforce for nutritionists, according to the UKVRN, as at 31 March 2011 (AfN, 2011). The numbers shown below also include members of the workforce that are already registered as dietitians. CfWI March

15 Table 5: Current registered nutritionist workforce Staff type HC Associate Nutritionist 296 Associate Public Health Nutritionist 168 Registered Nutritionist 322 Registered Public Health Nutritionist 252 Total 1,038 Source: UKVRN March 2011 (AfN, 2011). This register is voluntary therefore numbers shown are not representative of the total nutritionist workforce. The AfN also accredits university undergraduate and postgraduate courses, with some 30 courses already accredited (AfN, 2011). Some new graduates in nutrition work in the NHS as dietetic assistants or healthcare assistants. This is a way to develop competency in the application of nutrition to professional practice. Such graduates may go on to study dietetics at postgraduate level (NHS Careers, 2011). The latest BDA workforce survey shows that in 2010 investment in new posts was greatest in services related to nutrition support and obesity, closely followed by paediatrics and general hospital positions. Other services supported by dietetics include cystic fibrosis, prescribing of oral nutritional supplements (ONS) and gastroenterology surgery (BDA, 2010). Dietetics UK states that the main factors affecting malnutrition in older people are listed as: oral: swallowing problems from a stroke, Parkinson's disease or other neurological disorder, and worsening dentition and periodontal disease manual dexterity: loss of use of hands from a stroke, Parkinson's disease or other neurological disorder, frail skin on hands, and osteo- and rheumatoid arthritis socio-economic: institutionalisation, isolation, bereavement and poverty malabsorption: more prone to infection and thus bacterial overgrowth, and after surgery diminished sensory ability general health. These factors indicate the range of professions and specialties that dietitians work alongside. Malnutrition is one of the many conditions treated by dietitians. The profession also works with nearly all specialties of doctors, nurses including specialist nursing, primary care, and community nurses, pharmacy, other AHP groups, as well as with other professionals within public health and catering services. CfWI March

16 CONCLUSION The supply of dietitians is predicted to increase by about 13 per cent from 2011 to However, not all SHAs in England commission training in dietetics and those that do are reducing commissions Training commissions in Scotland, which have historically supplied England, have recently been cut. There are no major issues with attracting students into the profession, and course attrition is low compared to other AHP professions. Assistant practitioners and nutritionists can provide support and work alongside dietitians; these supporting roles could be taken into consideration in workforce planning. The dietetic workforce is relatively young and therefore there are not significant numbers of people approaching retirement. However, many staff leave the NHS aged between 40 and 50. There could be a risk to future levels of qualified dietitians in the NHS, if the level of staff moving into private practice increases. Early leavers need to be carefully monitored to assess the probability of this risk. CfWI March

17 ANNEX EXAMPLES OF PRACTICE Malnutrition Kensington and Chelsea Central London Community Health Care NHS Trust borough project is led by a Public Health Dietitian, working with older people. In partnership with day centres across the borough the team have implemented Food and Nutrition Policies. These policies provide a platform for each centre to communicate their commitment to nutrition standards for service users. Policies include introduction of nutrient based menus that meet the Caroline Walker Trust (CWT) nutrient guidelines for Older People, Malnutrition Universal Screening Tool (MUST) training for all staff, assessment of the eating environment and hydration guidelines. Policies are implemented and managed by a Nutrition Action Committee formed of representatives from staff, service users and management. A Community Meals screening study was conducted in 2010 to assess the vulnerability of service users and associated risk of malnutrition. Nutrition screening was carried out to assess the nutritional risk of all eligible community meal users (using the Malnutrition Universal Screening Tool with 106 eligible community meal users). 20% of community meal users screened were identified as at risk of malnutrition (MUST score = 1 or above) and 9.4 per cent of these users were identified as at high risk of malnutrition (MUST score of two or above). 32 per cent were overweight or obese. The rate of malnutrition in community meal users in Kensington and Chelsea is almost double the national average of 14 per cent of older people living in the community in the UK. As a result of this study, all new community meal users are referred to the Nutrition and Dietetics Service for nutritional assessment (BDA 2011c). Obesity Leicestershire dietitian-led LEAP groups deliver 12 weeks of intensive weight management support. Clinical and quality of life (including anxiety and depression) measurements are collected. On average patients lose significant amounts of weight and waist circumference; 4.4kg and 4.2cm respectively. Depression and weight related quality of life scores also improve significantly (BDA 2011e). Public Health South Devon PCT have a community dietitian who is involved in a range of practical work to increase the awareness of the link between nutrition and health including work on school meals, work with Surestart, Homestart, Teignbeat (a local heartbeat type award) and group education for type 2 diabetes. The dietitian has also been involved in writing and developing the local obesity strategy (BDA, 2008). CfWI March

18 REFERENCES Age UK (2007) Hungry to be Heard [online] Available at: [Accessed February 2012] Age UK (2010) Still Hungry to be Heard 2010 [online] Available at: [Accessed February 2012] Association for Nutrition (2011) Reports and Accounts 2010/2011 [online] Available at: VIZ_ pdf [Accessed February 2012] British Dietetic Association (2006) A Workforce and Training Framework for the Delivery of Diet and Lifestyle Care Pathways, for Long Term Conditions, published June 2006 [online] Available at: [Accessed February 2012] British Dietetic Association (2007) The Value of Nutrition and Dietetics for Stroke Survivors, published December 2007 [online] Available at: [Accessed February 2012] British Dietetic Association (2008) working to improve public health through nutrition [online] Available at: [Accessed February 2012] British Dietetic Association (2010) Workforce Survey 2010, unpublished British Dietetic Association (2011a) What is a dietetic support worker. [online] Available at: [Accessed February 2012] British Dietetic Association (2011b) Centre for Workforce Intelligence - Workforce Summaries and Recommendations project [ ] (Personal Communication, 31 July 2011) British Dietetic Association (2011c) Malnutrition the skeleton in the bed. [online] Available at: [Accessed February 2012] British Dietetic Association (2011d) The British Dietetic Association response to Healthy Lives, Healthy People, published March 2011 [online] Available at: [Accessed February 2012] CfWI March

19 British Dietetic Association (2011e) Obesity a weighty issue [online] Available at: [Accessed February 2012] Centre for Workforce Intelligence (2011) Allied Health Professionals, Workforce risks and opportunities [online] Available at: [Accessed February 2012] Department of Health, (1999) Healthy Schools Programme [Online] Available at: [Accessed February 2012] Department of Health (2008a) The Next Stage Review. [online] Available at: digitalasset/dh_ pdf [Accessed February 2012] Department of Health (2008b) Modernising Allied Health Professions Careers: Competencebased Career Framework. [online] Available at: digitalasset/dh_ pdf [Accessed February 2012] Department of Health (2008c), Self referral Pilots to musculoskeletal physiotherapy and the implications for improving access to other AHP services. [online] Available at: dance/dh_ [Accessed February 2012] Department of Health (2009a) Allied health professions prescribing and medicines supply mechanisms scoping project report [online] Available at: /dh_ pdf [Accessed February 2012] Department of Health (2009b) Change 4Life [online] Available at: [Accessed February 2012] Department of Health (2009c) Be Active, Be Healthy [online] Available at: /dh_ pdf [Accessed February 2012] Department of Health (2010a) Healthy Lives Healthy People White Paper: Our strategy for public health in England. [online] Available at: /dh_ pdf [Accessed February 2012] Department of Health (2010b) Preceptorship Framework, for newly registered nurses, midwives and allied health professionals [online] Available at: CfWI March

20 cuments/digitalasset/dh_ pdf [Accessed February 2012] Department of Health (2011a) The Public Health Responsibility Deal. [online] Available at: /dh_ pdf [Accessed February 2012] Department of Health (2011b) Modernising Allied Health Professions Careers, Phase 2 [online] Available at: /dh_ pdf [Accessed February 2012] Department of Health (2011c) Non-medical education and training (NMET) monitoring Quarter 4; Re: Quarterly Commissions data. [ ] (Personal communication, 27 June 2011). Department of Health (2011d) Weighted capitation formula. [online] Available at: _ [Accessed February 2012]. Department of Health (2009e) Implementing the Next Stage Review visions: the quality and productivity challenge. Letter- David Nicholson. 10 August. [online] Available at: /dh_ pdf [Accessed February 2012]. Dietetics.co.uk (2011) Undernutrition in Elderly (2009) [online] Available at: [Accessed February 2012] Freelance (2011) Welcome to freelance dietitians [online] Available at: [Accessed February 2012] Health Professions Council (2011) Number of dieticians and start date of statutory regulation, FOI Disclosure Log 1/3/11. [online] Available at: [Accessed February 2012] National Institute for Health and Clinical Guidance, (2006) Obesity, guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children [online] Available at: [Accessed February 2012] NHS Careers (2011) Nutritionist [online] Available at: [Accessed February 2012] NHS Information Centre (2011a) Non-Medical Staff Census as of 30 September [online] Available at: [Accessed February 2012]. CfWI March

21 NHS Information Centre (2011b) Vacancies Survey March [online] Available at: [Accessed February 2012]. NHS Institute for Improvement and Innovation (2011) The Clinical Leadership Competency Framework. [online] Available at: mpetency_framework_(low_res).pdf [Accessed February 2012]. Office for National Statistics (2010) 2008-based Subnational Population Projections by sex and quinary age; England and Government Office Regions. [online] Available at: [Accessed February 2012]. CfWI March

22 DISCLAIMER The Centre for Workforce Intelligence (CfWI) is an independent agency working on specific projects for the Department of Health and is an operating unit within Mouchel Management Consulting Ltd. This report is prepared solely for the Department of Health by Mouchel Management Consulting Ltd, in its role as operator of the CfWI, for the purpose identified in the report. It may not be used or relied on by any other person, or by the Department of Health in relation to any other matters not covered specifically by the scope of this report. Mouchel Management Consulting Ltd. has exercised reasonable skill, care and diligence in the compilation of the report and Mouchel Management Consulting Ltd.'s only liability shall be to the Department of Health and only to the extent that it has failed to exercise reasonable skill, care and diligence. Any publication or public dissemination of this report, including the publication of the report on the CfWI website or otherwise, is for information purposes only and cannot be relied upon by any other person. In producing the report, Mouchel Management Consulting Ltd. obtains and uses information and data from third party sources and cannot guarantee the accuracy of such data. The report also contains projections, which are subjective in nature and constitute Mouchel Management Consulting Ltd s opinion as to likely future trends or events based on i) the information known to Mouchel Management Consulting Ltd. at the time the report was prepared; and ii) the data that it has collected from third parties. Other than exercising reasonable skill, care and diligence in the preparation of this report, Mouchel Management Consulting Ltd. does not provide any other warranty whatsoever in relation to the report, whether express or implied, including in relation to the accuracy of any third party data used by Mouchel Management Consulting Ltd. in the report and in relation to the accuracy, completeness or fitness for any particular purposes of any projections contained within the report. Mouchel Management Consulting Ltd. shall not be liable to any person in contract, tort (including negligence), or otherwise for any damage or loss whatsoever which may arise either directly or indirectly, including in relation to any errors in forecasts, speculations or analyses, or in relation to the use of third party information or data in this report. For the avoidance of doubt, nothing in this disclaimer shall be construed so as to exclude Mouchel Management Consulting Ltd.'s liability for fraud or fraudulent misrepresentation. CfWI March

23 The Centre for Workforce Intelligence produces quality intelligence to inform better workforce planning that improves people s lives CONTACT E [email protected] T +44(0) Mouchel Management Consulting Ltd Registered in England No at Export House, Cawsey Way, Woking, Surrey GU21 6QX