Aims and objectives:
The objectives of the service change is to expand the growing public health remit within the Community Nutrition and Dietetic Service, to tackle diet related health inequalities by reducing obesity and improving diet and nutrition in deprived communities. This is in line with the Coronary Heart Disease and Diabetes National Service Frameworks and the NHS Cancer Plan.
The service change involves the development of new roles called Community Food Workers. They are drawn from the local community, and on recruitment, undertake an accredited training package in Nutrition Skills, led by members of the Dietetic Service.
Community Food Workers understand the day-to-day experiences of the people they work with, as they live in the same communities. They are able to communicate health messages in appropriate, accessible ways - and help people to develop the practical skills they require in shopping, budgeting and cooking - to be able to make informed choices to eat more healthily on a budget. This is directly comparable to the new "health trainer" roles recommended in the recently published Public Health White Paper - Choosing Health: making Healthy Choices Easier.
Support for the change:
This is an example of how the NHS workforce is being modernised and the new roles will be embedded as part of the "Agenda for Change" review. Good communication within the existing dietetic service and partnership working with the City Council, community and voluntary groups has helped gain acceptance and understanding of these new roles. Strategic influencing has been supported by the healthy living centre via a presentation to the PCT annual general meeting. In addition, the project took part in a visit from Business in the Community reporting back to the Prince of Wales.
Patient and public influence:
Local people were consulted during the initial stages of setting up the project, when needs assessment work was undertaken. This involved visiting existing groups within the community, as well as key people within the community such as teachers, youth workers, community workers, wardens in warden aided complexes for older people, tenants and residents groups and local health workers. In this way a programme of work was developed which meets the needs of the community. Project users are consulted on an ongoing basis, and the project responds and adapts its programme according to local need. This has allowed the department to develop a service, which helps to meet the needs of more deprived communities, and tackle health inequalities, which exist within these communities.
Impact on the workforce:
The changes have created a new role of Community Food Worker with Nottingham City Primary Care Trust. This has created a new opportunity for individuals with an interest and skill in working in food related health promotion to gain the opportunity for employment within the NHS. The post holders receive a package of accredited training by the NHS on recruitment - so this has a direct affect on increasing the qualifications of the workforce.
It has also created a more effective use of a Dietician’s role, where they can train and support others to do food related health promotion.
Measuring the results:
As the project is part of a Healthy Living Centre it is subject to rigorous monitoring. Data is collected on a quarterly basis to establish the extent to which we are reaching the local community, against the targets established in the bid. This includes information about the number of people we reach, their age, sex, ethnicity and if they are disabled. We also collect information about the type of groups we run and the venues where the groups happen.
In addition we have developed an evaluation strategy, which explore the changes in knowledge, attitude and behaviour of those attending the sessions. Community Food Workers keep reflective diaries, and evaluation sheets are sent to key workers in the area who are involved closely with the service users, such as youth workers and teachers.
Improved performance:
So far, monitoring and evaluation data has been collected for 12 months, so an initial picture of the success of the project is beginning to form.
3 people have been successfully recruited from the local community as Community Food Workers, and all three have successfully completed an Open College Network training package at level 1, 2 and 3.
2411 local people have been involved in the project. 74 "Cook and Eat" groups, where food is prepared with a group, have run. Work has been done with 10 local Infant and Nursery schools.
All sessions have been well attended, and initial evaluations have shown an increase in knowledge and cooking skills in those attending, and changes in food related behaviour.
Reflecting diversity:
Embedded in the whole approach using Community Food Workers is that to meet the needs of people in deprived communities, we need a new approach to working which allow the advice and information provided to be communicated in an accessible and appropriate way. It is also a community-based model, where the work is delivered within the community itself, within venues where local people already meet, rather than expecting people to come to us.
Sharing the learning:
The project has only been running for 18 months, so we are just at the beginning of the process of sharing our success. This started on 30th November 2004, when a poster was presented at the East Midlands Public Health Network Emphasis Food event. Entering for this award is key way we hope to start sharing the work more widely, and through attending the NHS in Trent Building on Success event in March 2005.
Outstanding features:
Developing new posts, which involve employing local people who live within the deprived communities we are working, in order to break down the barriers, which can exist between professionals and the people we most need to reach. Using a very practical, fun and informal approach, with plenty of opportunities to prepare and taste healthier foods - and going to where people are in the community, and delivering sessions where people are, rather than expecting them to come to us.
