Nutrition Advice

A Day in the Life of ......

Nicola Strawther, Chief Dietetic and Catering Technician at Nottingham University Hospital NHS Trust (NUH)

This role in the trust comes under the dietetic arm of therapy services; however it also comes under the estates and facilities division working for the catering service. The role is varied and broad and covers operational aspects as well as being a strategic position. Working for both dietetics and catering demonstrates a clear power of 3 ethos as recommend by the HCA of catering, dietetics and clinic teams working together. At NUH we like to call this the Power of 4 with the patient being the 4^th element.

I am now in my 22^nd year of working for the NHS, 17 of those at NUH with the last 10 years spent in this role. I have always been proud and felt fortunate to be in this position that allows me to work in an area that I am passionate about.

No day is the same, operational work with the catering team can include menu and recipe development, completing the allergen and nutritional information, staff training. An example is we have just launched a new renal menu for the children’s hospital. For me this involves many conversations with the ward dietitian to gather information on what the patients would like on the new menu along with the specific renal requirements that we have to follow. The nutritional requirements for renal are extremely important and complex so being stringent when reviewing nutritional information and dish suitability from our existing portfolio is a lengthy procedure but also crucial, from this I can then look at any dishes we could adapt to make more renal friendly. We also have to take into account the service design with it being a cook freeze operation, this element is important as we need to ensure the recipes work in this system and that the end result is of high quality for our patients. I devise a draft menu ready to share with the catering team and clinical team. This is where working together is critical to the service and patients; there are so many factors to consider ensuring the end result is nutritionally sound, with good quality dishes that also meet the needs of the financial budget, but most importantly we want the patients to enjoy the food when they are with us whilst also supporting there nutritional recovery and requirements. It is key that we work with our supplies as they support us in accessing products and keeping us informed of new trends and products. Local produce and sustainability is a huge part of our catering service at NUH. Several drafts of the menu later and we then work with a printing company to design the menu for our patients. The work doesn’t stop there though, we have to ensure the electronic systems are set up and ready, there is staff training to complete, production plans are created for the chefs to start cooking the food, and allergen information is completed. NUH is a large trust and communication is paramount in the operation, it is crucial that we as a catering team work together as this allows me to then translate the work into the clinical areas working with the clinical team and the patients to ensure all needs are accounted for.  I have a responsibility to promote improvement through food and beverage services that are cost effective, good quality, safe, nutritionally adequate and appropriately patient focused.

Day to day I also support with any patients who may have complex or multiple allergies, where they may have allergies outside the 14 that we have listed by law, or they are very complex so require extra help in finding safe suitable foods whilst they are in our hospitals. In some cases we have to create bespoke meals, I am able to support the chefs by advising what would be suitable, again being a large organisation the communication is critical so we don’t cause any delays to patient’s receiving meals that are safe for them to eat whilst also aiding there recovery.

Strategically my role is also responsible in helping to ensure the trust in delivering its nutrition strategy. As part of a multi-disciplinary team I am actively involved and influential in working in service specifications that ensure best practice in planning, ordering and delivery systems, whilst undertaking and leading on specific projects. The strategy clearly shows how we as a trust will meet the nutrition and hydration requirements for our patients. I am part of two of the work streams that report into the nutrition strategy. These work streams cover wide ranging areas, from nutritional requirements of menus, to safe service of meals at ward level and the patient meal time experience. There are patient safety measures such as IDDSI and food allergens which have to be embedded across the trust with training and information being made readily available and designed specifically for different areas and staff groups. We measure ourselves against the national standards for nutrition and hydration to ensure we are compliant and where we can improve. We also ensure meal services are observed and audited and food quality is measured, we have strong patient partnership links and patients work with us across all the work streams and are at the core of our decision making.

My role also covers the important area of health and wellbeing for our retail catering facilities. As part of this team we work with our external provider to ensure healthier options are available in the retail facilities and vending areas. The health and wellbeing of our staff, visitors and patients is important but again complex due to the nature of the business with the NHS always open.

As part of a service level agreement I also work for Nottinghamshire Health Care NHS Trust at one of their hospital sites. Operationally this is very different as it is a cook serve service for patients that are often there for long stays. My job at this site is a mirror image of my role at NUH but adapted to meet the specific needs of the hospital.

In our response to COVID I have also been working with a private hospital that has supported the NHS with a particular patient group. The nutritional needs for the patient group are crucial in there recovery so I have been able to support the clinical and catering teams in menu design and food suitability for these patient’s.

For me one of my favourite achievements, I say favourite rather than best, as I hope I do my best every day. My favourite achievement is a “grow your own” garden project. This has a personal meaning for me as the area is outside oncology wards. Working with the clinical team I was successful in gaining some charitable funds to improve the outdoor balcony area. With help from the charity, the council and local businesses we were able to transform the space into a grow your own area. The space is used by patients and staff and for patients it brings so many therapeutic benefits. Staff find it a peaceful area to spend time in during their breaks. The produce grown was used in recipe development and for patients to take away with them.