Mandakini Patel
As part of our Trust a Dietitian campaign, we are keen to highlight the variety of places dietitians work and where they make a real difference. Here we are featuring a Q and A with Mandakini Patel, Clinical & Professional Lead for Nutrition & Dietetics, at the North Middlesex University Hospital NHS Trust, who along with her Physiotherapy and occupational therapy colleagues, and with tremendous support from her dietetic staff, introduced a 7 day working dietetic service from October 2013. North Middlesex Hospital is the first dietetic department in London to provide a 7 day service.
How does 7 day working function?
We found that the way we have introduced 7 day working was the best and most efficient way to capture new patients for the trust without having huge resource implications, which includes cover during week-days. Majority of patients come via A&E, and are then transferred to the acute assessment unit or acute medical ward, thereafter to other wards.
From the outset we agreed on acute medical and paediatric unit staffing, which means we save by not needing more staff, as long as services are not extended. Staff who work on Saturdays, Sunday’s and all Bank holidays, work on site from 9am until 2pm.
Which staff are involved in 7 day working?
The staff involved in 7 day working include all adult and paediatric dietitians, including those in managerial roles. This is all Bands. Dietitians are autonomous practitioners and able to work on their own; all staff are instructed to work within their scope of practice, whatever their Band. In the event of emergencies all staff are encouraged to contact me. This has not happened to date and we have been operating for 1.5 years now.
Why did 7 day working come about?
Overall, and based on patient needs, there was an obvious requirement for a week-end service. This included patients that were being discharged over weekends but not referred to us, and then re admitted, unsafe discharges, lost opportunities for early interventions for some conditions etc. This was further flagged up in audits which highlighted the need to see more patients overall such as our yearly hospital MUST audit and enteral feeding audit. Additionally, local commissioners were asking for 7 day working. It also fitted in with Care Quality Commission requirements and London Quality Standards (2013).
How do you know that 7 day working is, well, working?
The evaluation so far has highlighted that there is less pressure on the front of house and patients are receiving earlier and timelier interventions. Also, as a service, we are experiencing fewer late Friday issues, as these can now be addressed the next day, Saturday or Sunday. Overall, it is felt across the team that productivity levels have increased and we are delivering an enhanced service, which is a better for patient care.
Were there any challenges the service had to overcome to bring in 7 day working?
A small number of members of the team would have preferred not to work over the weekend, but when put in context of patient care, that this was about the future of our profession, the importance of nutrition as part of the patient treatment plan, raising the profile of nutrition, teamwork within the department, and flexibility in the rota system, this was resolved and all team members are involved in 7 day working. Our Head of Therapies also had to secure funding to ensure we had one dietitian working each day on Saturdays and Sundays. Since the introduction of 7 day working, the Trust is now looking at extending the service possibly to other areas.
Anything else you would like to say about 7 day working?
The need for nutrition does not end at 5.00 pm on Friday and restart at 9.00am on Monday. Nutrition is an essential part of the overall treatment for holistic patient care, in order to get the very best possible result for patients. I believe that as a dietitian my role and my expertise are needed to work with patients every single day of the week, regardless of the name of the day! This is an opportunity to raise our profile and demonstrate that nutrition is as important as other treatments for achieving good patient care. This is why I came to work in the NHS and at the end of the day, Dietitians are the experts when it comes to food and nutrition, patients’ outcomes and patient safety, I say Trust a Dietitian!
