Written evidence submitted by the British Dietetic Association (RTR0043)

Context

The British Dietetic Association (BDA) is the professional association and trade union for dietitians and strives to improve the health of the nation by supporting our members to promote good food and nutrition. Dietitians and the wider dietetic workforce believe in the importance of health to the success and development of our communities.

The BDA is committed to securing the future of dietitians, to strategically develop the dietetic profession and to understand the shape of the current workforce. The BDA conducted an NHS and HSCNI Dietetic Workforce Survey in 2020 [i] which focused on the changes occurring within these services, future challenges to the dietetic workforce and the ways in which services are trying to manage these. Amongst its findings it identified that:

15% of the workforce capacity is at risk due to maternity leave, retirement and vacancies.

65% of services did not feel they had adequate staffing levels for demand going into the COVID-19 pandemic.

97% of services took on practice-based learners and, in the face of current pressures, 78% did not believe they could take on more.

To underpin this work a quick survey of BDA members was conducted in January 2022 to provide a snapshot of those issues identified in the call for evidence, namely- initial and ongoing training of staff in the health and social care sectors to increase supply, principal factors driving staff to leave the health and social care sectors and employment models necessary to attract the right staff numbers and skills.

A summary of responses is provided below. The question numbers referenced are those used in the original BDA survey. Further summary data is available upon request and subject to license and appropriate data permission being sought in accordance with UKGDPR.

Key findings [ii]:

–	1–	2–	3–	4–	5–	6–	TOTAL–	SCORE–
– Pay	33.39% 183	23.54% 129	15.33% 84	11.68% 64	10.04% 55	6.02% 33	548	4.41
– Conditions of service	11.86% 65	19.89% 109	21.90% 120	13.14% 72	21.72% 119	11.50% 63	548	3.53
– Staff shortages/Resilience	41.80% 232	27.75% 154	18.20% 101	8.29% 46	3.24% 18	0.72% 4	555	4.94
– Access to CPD	1.81% 10	3.27% 18	7.08% 39	15.61% 86	17.60% 97	54.63% 301	551	1.92
– Effects of the Covid-19 pandemic on personal mental and physical health	7.78% 43	15.55% 86	23.51% 130	25.32% 140	20.43% 113	7.41% 41	553	3.43
– Effects of the Covid-19 pandemic on working conditions within the organisation	4.46% 25	11.07% 62	14.46% 81	26.25% 147	25.54% 143	18.21% 102	560	2.88

–

1–

2–

3–

4–

5–

6–

TOTAL–

SCORE–

–

Pay

33.39%

183

23.54%

129

15.33%

11.68%

10.04%

6.02%

548

4.41

–

Conditions of service

11.86%

19.89%

109

21.90%

120

13.14%

21.72%

119

11.50%

548

3.53

–

Staff shortages/Resilience

41.80%

232

27.75%

154

18.20%

101

8.29%

3.24%

0.72%

555

4.94

–

Access to CPD

1.81%

3.27%

7.08%

15.61%

17.60%

54.63%

301

551

1.92

–

Effects of the Covid-19 pandemic on personal mental and physical health

7.78%

15.55%

23.51%

130

25.32%

140

20.43%

113

7.41%

553

3.43

–

Effects of the Covid-19 pandemic on working conditions within the organisation

4.46%

11.07%

14.46%

26.25%

147

25.54%

143

18.21%

102

560

2.88

Fig 1: Data breakdown of Q4 (above)

Our quick survey demonstrated overall strong feelings amongst our membership in relation to gaps in the existing workforce, issues regarding training provision and protected learning time, as well as the culture of funding and forward planning within the NHS.

Q3 What changes could be made to the initial and ongoing training of staff in the health and social care sectors in order to help increase the number of staff working in these sectors?

Sample of BDA Members answers:

‘More funds provided for ongoing training, currently we often have to pay part or all of the training/conference costs and almost always all of the travel and accommodation’.

‘Clear routes into clinical positions, clear career progression maps to show that you have a way to learn, improve and progress in your field rather than stagnate in one banding for 20 years’.

‘Increase apprenticeships and access to advanced clinical practice training’.

‘Increased and in-depth training opportunities. Financial support for training, career development, and CPD. Apprenticeship programmes’.

‘Excellent leadership from senior staff in training students’.

‘All existing staff to be trained in how to support students, no matter how senior or what speciality/sector they work in. Staff supervising students to be rewarded for their time and commitment with a one-off bonus’.

‘Undergraduate training: Reinstate the bursary so no tuition fees or paying off tuition fees for people who work for NHS after one year’.

‘Give clinical staff set study leave pro rata e.g., one week per year per person as standard. Funding at managers discretion but time allowed as standard. This should be in addition to statuary trust training. It would be amazing to have a week to read/train/develop once a year and this would be an investment in staff’.

Q5 What other factors do you feel are driving staff to leave the health and social care sectors, and what could be done to address them?

Sample of BDA Members answers:

‘Lack of resources, short staff, waiting list pressures’.

‘Staff are tired of continuously "firefighting" the clinical referrals, other professional roles & responsibilities e.g., statistic collection, administration & development of service, CPD, audit & research, statutory & mandatory training & expectations of the Government, hospital & public’.

‘A lack progression through the Trust and staff shortages’.

‘Difficult to find the right work-life balance, pressures, feeling that other public service workers (particularly high up) continue to give themselves pay rises whilst workers merely get a pay rise that equates the inflation’.

‘Dietetics often undervalued and funding is not given for posts when services are developed. There is always an expectation to then pick up these areas’.

‘Not feeling like you are able to deliver meaningful and effective care e.g., Dietetic advice being limited by hospital menu provisions’.

‘Lack of appreciation of the work that is expected in the conditions that are only getting worse with staff shortages. Puts extra pressure on physical and mental health that cannot continue long term’.

Q6 Are there specific roles, and/or geographical locations, where recruitment and retention are a particular problem and what could be done to address this?

Sample of BDA Members answers:

‘Working remotely- increase the use of phone clinics, online training (both facilitated and independent)’.

The housing market, travel infrastructure & the large volume of people & cars of the South East of England means that the resources required i.e., cost & time of living & travelling is higher than in other parts of the country.

In more isolated areas colleagues need to take on board a massive responsibility of managing full services by themselves, with no support.

Not enough staff to do the work in community nutrition support that is needed to make a true difference to patients (where we could hopefully reduce the number of people becoming patients in the first place) - it is so disheartening to see the same situation time and time again where we can only have limited impact.

Dietetics generally is an at-risk profession but paediatrics and diabetes are particularly difficult to recruit to. The North East of England is not appealing to lots of people and perhaps bringing back relocation expenses would help with this.

James Sandy

Policy Officer

January 2022

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[ii] 92.8% of respondents were employed within the NHS, 84% in England, 4% in Wales, 7% in Scotland and 5% in Northern Ireland. The survey received 806 responses.