Dietetics and Nutrition

Acute Hospitals

The Acute Dietitians provide support to patient admitted at Northampton General Hospital and Kettering General Hospital. We cover a wide range of specialties from surgery, medicine, trauma and orthopaedic, gynaecology, cardiology, respiratory and elderly medicine.

It is not unusual for patients to lose their appetite and eat less during their illness or when receiving treatment. When patients are admitted to hospital, we ensure that they are eating and drinking as best as they can.

All patients on admission are nutritionally screened using the Malnutrition Universal Screening Tool (MUST). This helps us to identify patients who are struggling with their oral intake and need to be referred to Dietitians for specialist advice.

All patients referred to the nutrition and dietetics service are nutritionally assessed, and individualised care plans are completed. More complex illnesses may require nutrition support by tube feeding, which the Dietitians’ will assist with.

Administration Team

Our administration team are key to all processes within our department and support everyone within the team. We have an administrator at both of our bases and a dedicated care home administrator.

They answer telephone calls, process referrals, and help with organisation in the department. They are essential to our day to day working.

Cancer Care

The Dietitians specialising in cancer care provide support to both inpatients and outpatients. Patients will have been referred to us by their Consultant or a Cancer Nurse Specialist during treatments, such as surgery, chemotherapy and radiotherapy.

A person’s diet can be affected by both the tumour site and the side effects of treatments, some of which can include:

• Unintentional weight loss

• Difficulties with swallowing

• Loss of appetite

• Taste changes

• Dry or sore mouth

• Nausea and vomiting

• Changes in bowel habits

We complete individual assessments to provide evidenced based tailored advice to those referred to us. We also offer support to family, friends and carers. We can offer written dietary advice and regular follow up appointments to support dietary intake throughout the cancer journey.

The Cancer Care Dietitians are:

• Macmillan Senior Specialist Head and Neck Dietitian

• Senior Specialist Oncology Upper GI Dietitian

• Specialist Oncology and Haematology Dietitian

• Macmillan Prehabilitation Dietitian

The Dietitians work in a variety of settings; including hospital wards, the chemotherapy suite, radiotherapy clinics. As well as offering telephone and face to face outpatient appointments.

We work in various teams which are made up of a wide range of healthcare professionals. We work closely together and strive to deliver excellent patient centred care.

Care Homes

The care home dietitians provide both an advisory and educational role for care home residents and staff:

• A telephone service is provided to care staff to discuss and devise an individualised nutritional treatment plan for residents with reviews as needed.

• Liaison with the GP and other Health professionals and if required a request for prescribed nutritional supplements which are regularly reviewed.

• Training for care staff is offered to increase knowledge and skills of nutrition and ensure that good nutritional care is embedded within the care homes. Online nutrition training is available for all care home staff, to access this please email dieteticsforcarehomes@nhft.nhs.uk

Referrals accepted for any care home resident that has been nutritionally screened with a MUST Score of 2 (High Risk) or above and is losing weight despite improvements to fortify food and fluid intake within the care home.

Care home staff can refer directly to Nutrition and Dietetics electronically via the NHFT website for Dietetic advice without the need for a GP/Health Professional referral 

Care home dietetics referral form

Community

We provide evidenced based dietary advice, to help manage or treat a wide variety of medical conditions. We work closely with patients to offer dietary advice which is practical and individualised. We can also support relatives, friends and carers.

We will often see patients in a wide variety of settings around Northamptonshire including outpatient clinics, patients own homes and community hospitals. We also offer appointments via telephone or video call.

As a team, we provide specialist dietary support in a variety of areas including;

• Neurological conditions such as Parkinson’s Disease and Dementia

• Gastrointestinal conditions such as Crohns disease, Coeliac Disease and Irritable Bowel Syndrome (IBS)

• Long term conditions such as respiratory diseases

We work closely with GPs, district nurses and other healthcare professionals to ensure patient centred care. We provide support and training for healthcare professionals.

Critical Care

There is a dedicated Specialist Dietitian for the Critical Care Units and they work as part of the multi-disciplinary team. Patients in the critical care setting are at high risk of malnutrition and have very complex nutritional needs. They often require tube feeding (enteral nutrition). Especially if they are put on a ventilator to help them breathe or put into an induced coma to aid their recovery. Feeding tubes are often placed so that the patient’s nutritional needs can be met. They may be fed intravenously if their gut is not functioning properly, this is called parenteral nutrition.

Home Enteral Feeding

The Home Enteral Feeding (HEF) team provide advice and support to both adults and children who are unable to meet their nutritional needs through eating and drinking by mouth. We work closely with Nutrition Nurses, Hospital Dietitians, Consultants, Specialist Homecare Nurses, a Homecare Delivery Company, GPs and School nurses.

We ensure that people with a feeding tube have their nutritional needs regularly assessed and are provided a personalised feeding plan. We offer advice and support on managing their feeding tubes and can give access to the specialised food and equipment. The Specialist Homecare Nurses provide expert advice on tube care, stoma care and training.

Mental Health

The specialist mental health Dietitian works as part of a multi-disciplinary team at the community mental health hospitals in the county. Dietetic input can include raising awareness of malnutrition, nutrition support and promotion of healthy eating and weight management advice.

Paediatrics

The Paediatric Specialist Dietitians provide support for children age 0-18 years old for both inpatients and outpatients across Northamptonshire. The service we provide is evidenced based. We see children in a variety of settings such as community clinics, their own home, schools, hospital and respite care. We work on a one-to-one basis or with groups, in liaison with parents, carers, health professionals and other agencies . In many conditions we work closely with a variety of healthcare professionals to provide the best possible care.

Timely referrals, assessment and intervention from a Paediatric Specialist Dietitian can:

• Ensure appropriate prescribing of specialist paediatric products to support GP practice and provide cost effective quality patient care.

• Enable care closer to home by supporting children, young people and their families who are tube fed in the community to avoid hospital admission.

• Improve symptoms and quality of life in conditions where diet plays a significant role in treatment such as coeliac disease, allergies, cystic fibrosis .

Renal (Kidney Care)

We are a team of Specialist Renal Dietitians who work alongside the renal consultants and nurses. We see patients in clinics on dialysis and as inpatients. We provide individualised dietary advice and support to patients, families, and carers of those with kidney disease.

Patients may be advised to alter their diet to help protect remaining kidney function and to prevent problems that may occur with chronic kidney disease. These can include: changes in blood mineral levels of potassium and phosphate, blood pressure, fluid balance and changes to appetite and muscle mass.

A Specialist Renal Dietitian can:

• Discuss suitable foods to eat and limit at different stages of kidney disease.

• Provide information about foods containing salt, potassium, phosphate, protein, energy and fluid that can all be affected by kidney disease.

• Provide advice on reducing your risk of developing renal bone disease through diet and guidance on when to take phosphate binders.

• Provide nutritional support advice if a patient is struggling with their appetite.

Who should be referred to a renal dietitian?

In-patients with:

- Potassium levels of more than 6mmol/l or rising, requiring a low potassium diet

- Potassium levels less than 3.5mmol/l, requiring high potassium diet

- Chronic kidney disease (CKD) and poor appetite or weight loss

Out-patients with:

- Recent diagnose of CKD 4 or CKD 5.

- Patients who are starting any type of dialysis (Haemodialysis or Peritoneal Dialysis).

- CKD patients with poor appetite or weight loss

Stroke at Northampton General Hospital

The Dietitians specialising in stroke care provide support to inpatients during their stroke journey. A person’s eating and drinking might be affected for a variety of reasons following a stroke including: their ability to swallow, issues with their vision and cognition, or difficulty feeding themselves due to muscle weakness.

Sometimes a feeding tube may be required to help a person meet their nutritional and hydration requirements. This is because they are unable to swallow or eat and drink enough. A Stroke Dietitian will make a personalised feeding plan which consists of a liquid feed given via the feeding tube. This is sometimes the only source of nutrition if a person cannot swallow.

Other times, a person may be able to eat and drink small amounts alongside the feeding tube. In this case, the feeding tube is used as a top-up to meet their nutritional needs overall. The Stroke Dietitian will review regularly to tailor the feeding plan as a person’s eating and drinking habits change.

If a person is almost eating and drinking enough to meet their nutritional needs, a Stroke Dietitian can offer food first advice and oral nutritional supplements. These include build up drinks and desserts to optimise their nutritional intake.

The Stroke Dietitians work closely as part of a larger team, including Consultants, Speech & Language Therapists, Specialist Nurses and other Allied Healthcare Professionals. We work together to provide best patient care.

Weight Management

We provide a tier 3 weight management service for adults and children who are registered with a Northamptonshire GP. For Adults, the first appointment is usually an online group session (via Teams), followed by a series of 1:1 consultation with the dietitian. Children’s appointments are all on a 1:1 basis with the dietitian.

We see children who have a BMI centile of 98 or greater or BMI centile of 91 with co-morbidities. We see adults who have a Body Mass Index (BMI) of 40 or more or a BMI over 35 with comorbidities for example diabetes. Although we will discuss healthier food choices, our main focus is how to successfully change eating habits and lifestyle behaviours.

Patients who meet the agreed criteria can be eligible for bariatric surgery in a specialist hospital centre. The patients GP will need to refer to this service.

Our service does NOT offer medication for weight loss, including the newer GLP-1 injections and tablets.

Please note, there is on average a 12 month wait to access the specialist Tier 3 weight management service. Please contact us if you have been referred and no longer wish to remain on the wait list. Whether you decide to pursue our service or not, in the meantime you may wish to access Tier 2 services, with various offerings across the county:

• Healthy weight - West Northamptonshire Council  www.westnorthants.gov.uk/keeping-healthy/healthy-weight
• Weight management - North Northamptonshire Council www.northnorthants.gov.uk/keeping-healthy/weight-management