The dietitians at North Bristol NHS Trust provide a neurology clinic at Southmead Hospital twice per month on Thursday mornings. 

Patients who attend this clinic are likely to have been diagnosed with one of the following neurological conditions:

• Parkinson’s Disease
• Huntington’s Disease
• Motor Neurone Disease
• Multiple Sclerosis
• Progressive Supranuclear Palsy (PSP)
• Duchenne’s Muscular Dystrophy

The dietitian’s role is to assess, educate and support. 
When you attend your appointment the specialist neurology dietitian will:

• Ask you about your medical condition, medications, investigations and symptoms
• Assess your weight and monitor weight changes
• Assess your current diet and fluid intake, ensuring that any nutritional deficiencies are identified
• Advise on methods of promoting/reducing weight or reducing symptoms
• Recommend nutritional supplementation as appropriate
• Provide information on alternative methods of feeding such as via a gastrostomy (PEG/RIG) tube
• Provide a link between you, your GP, allied health professional and consultant

Other conditions where you may be seen by a neurology dietitian include:

• Chronic Fatigue Syndrome
• Myalgic Encephalomyelitis

If you have one of these conditions and you feel you would benefit from seeing a dietitian, please ask your GP or Neurology consultant to refer to us.

Information on referring for clinicians. 

Useful links:

Chronic Fatigue Syndrome and Diet

Eating and Drinking with MS

Eating and Drinking with MND

Diet and Parkinsons Disease

At North Bristol Trust, the diabetic service consists of a multi-disciplinary team including two dietitians.

NBT diabetes dietitians see patients which require input from the entire diabetes team. If dietetic input is required, but input from the whole diabetic team is not necessary, consider community services.

If you are a clinician looking to refer a patient, please see indications for referral to North Bristol Trust’s Multi-disciplinary Diabetes Clinics.

For more info see the Diabetes & Endocrinology page.

Useful links:

Diabetes UK

Type 2 Diabetes and Diet

Type 1 Diabetes and Diet

Gestational Diabetes

13 Consultant Neurosurgeons cover all aspects of Neurosurgical practice.

The team also consists of 11 Specialist Registrars, 6-8 Senior House Officer Grade doctors, 9 Neurosurgical Nurse Practitioners and 2 Neuro-oncology Specialist Nurse Practitioners.

Dedicated trained nursing staff and invaluable Allied Health Professionals working alongside the team ensure that the care received by all Neurosurgical patients is of the highest standard.

At North Bristol Trust, we supervise Plymouth University dietetic students for A, B and C placements, as well as overseeing placements for MSc Dietetics students from Birmingham City University.

We aim to offer our students a varied experience when they are on placement with us. Areas which students typically gain experience in include:

• ICU
• Stroke and Neurosurgery (inpatient)
• Outpatient Bariatric Services
• Renal disease (inpatient and outpatient)
• Gastroenterology (inpatient and outpatient)
• Complex care (inpatient)
• Surgery (inpatient)
• Respiratory (inpatient)
• Burns & plastics (inpatient)
• Diabetes (outpatient)
• Metabolic disease (outpatient & learning)

We offer students a combination of home learning, face-to-face patient contact and virtual clinic experience. The home learning often comprises of case studies and tutorials to support learning in each speciality.

The dietetic team here comprises of approximately 30 dietitians. Each student will be assigned a key worker and mentor but will likely spend some time with most of the dietitians over the course of the placements.

Dietitians are uniquely qualified to translate scientific information about nutrition and food into practical dietary advice. As well as providing impartial advice about nutrition and health, dietitians also advise about food related problems and treat disease and ill health.

Many dietitians work in the National Health Service (NHS) and may work in one or more specialist areas e.g. diabetes, children's health, cancer, renal, public health. Others work with people in the community, sometimes visiting them in their own homes. They are a key part of the healthcare team and have an important role training other Allied Health Professional’s (AHP’s) and the public about nutritional issues.

Dietitians have the only legally recognised graduate qualification in nutrition and dietetics that is registered with the Health Professions Council (HPC). This is a national regulatory body, which was created following the Health Professions Order, 2001. Dietitians are one of 13 healthcare professions regulated by the HPC, which ensures rigorously maintained standards of training, professional skills, behaviour and client safety. The title Dietitian/Dietician can only be used if the individual is appropriately qualified and registered with the HPC. Verification can be achieved by checking the Dietitians Register on the HPC website www.hpc-uk.org.

How does a dietitian differ from a nutritionist?

The title ‘nutritionist’ is not protected. Some may have attended degree level courses in nutrition, and upon qualification, many register as nutritionists (RNutr) or as public health nutritionists (RPHNutr) with The Nutrition Society. However, there are many who will not have a recognised qualification. Nutritionists work in government, industry, sports, education, media and for charities, supporting the collection and communication of information about food and health. Some nutritionists provide general guidance about eating to support good health, however, as they are not regulated by a governing body, information given does not have to comply with scientifically based evidence.

Want to become a dietitian?

There are two types of programme available to qualify as a dietitian:

• Full-time undergraduate BSc (Hons) programme - these are either three or four years in length.

• Full-time postgraduate programme - these are two years in length and can either lead to a Postgraduate Diploma (PgDip) in dietetics or a Masters (MSc) qualification in dietetics.

Find out more on The Association of UK Dietitians website.

Shadowing a dietitian

At North Bristol NHS Trust, we don’t routinely offer opportunities to shadow dietitians. Instead, we run virtual allied health professional events. This will give you the opportunity to find out more about what working as a dietitian in a hospital is like.

To find out more about when our next event is, follow us on Twitter @nbt_dietitians or email dieteticenquiries@nbt.nhs.uk

Dietitians at North Bristol NHS Trust (NBT) provide both an inpatient and outpatient service.

Inpatient services

Our inpatient team is made up of dietitians who work within North Bristol NHS Trust providing a dietetic service to all wards.

The service is available between 8:30am - 4:30pm Monday to Friday.

• If you are an inpatient and your care team thinks you would benefit from seeing a dietitian, they will refer you directly.
• If you are an NBT health care professional and want to refer an inpatient to the nutrition and dietetic service, please do so via ICE.

Malnutrition is common in hospital patients and it’s important that it’s identified and treated early to reduce recovery time and complications. Each patient should be screened for malnutrition risk on admission to hospital and weekly throughout their stay. At NBT, we use the BAPEN Malnutrition Universal Screening Tool (MUST).

We use a range of assessment techniques to devise and review nutritional plans for patients. The aims of treatment are to improve nutritional status or symptoms to aid recovery.

Outpatient Services

Outpatient clinics are run at Southmead Hospital Bristol and Cossham Hospital where adult patients can be treated for conditions under a range of different specialties including:

• Gastroenterology
• Neurology
• Diabetes
• Bristol Bariatric Service
• Inherited Metabolic Conditions
• Renal
• Diet and Cancer

For more information click on the relevant specialty above to find out more.

If you are a clinician and want to refer a patient to a specialist outpatient clinic please view Nutrition & Dietetics – For Clinicians.

Community Services

• Patients who continue to need support to increase nutritional intake following discharge from hospital will be referred to the Community Nutrition and Dietetic team if appropriate. Read more information about their services.
• Patients who are being fed through a feeding tube (enteral feeding) will be referred to the Home Management Service (HMS). HMS will make arrangements to deliver feed products at home and to monitor progress. This service covers all of Bristol, South Gloucestershire and North Somerset.
• If a patient requires specialist dietetic input, the ward dietitian will arrange follow up through the GP or book directly into clinic.
• If you have never seen a dietitian and think that you need to, you can ask your GP, practice nurse or hospital consultant to refer you depending on the nature of your condition.
• If you have seen a dietitian at North Bristol Trust in the past, you can telephone the dietetics department directly and ask if you would need a referral.

Patient Handover for Clinicians

Inpatient handovers

If you are a dietitian and your patient has been transferred to NBT, please ring the department on 0117 4145428 to hand over.

Please note that University Hospitals Bristol also provide inpatient care to patients in the Bristol area.

Community handovers

If a patient has been discharged to the Bristol community, please contact the community team to handover.

If the patient has been discharged to the Bristol community and is receiving enteral nutrition, please contact the Home Management Service to handover.

Neuro-Rehabilitation Consultant
Dr Angus Graham
Telephone: 0117 9562697
Fax: 0117 9569941
Email:angus.graham@nbt.nhs.uk

Outpatient services

Outpatient services for Neuro-Rehabilitation include clinics in:

• General neurological rehabilitation
• Spasticity
• Head injury
• Intra-thecal Baclofen

Clinics will be delivered at Neurosciences Outpatients, Level 1, Brunel building, Southmead Hospital, as well as satellite clinics at:

• BraMS Unit
• West of England MS Therapy Centre, Bradley Stoke
• Portishead Marina Health Centre
• Knowle Clinic, Broadfield Road, Knowle

Inpatient Management

Frenchay Brain Injury Rehabilitation Centre is a regional/supra-regional unit for the management of patients with neuro-physical and/or neuro-behavioural consequences following acquired brain injury who need intensive in-patient neurological rehabilitation. Frenchay Brain Injury Rehabilitation Centre remains at the Frenchay Hospital Site.

www.brainandspine.org.uk The Brain & Spine Foundation website contains information resources for people with neurological conditions.

www.bps.org.uk Free leaflets aimed at the general public. More topics will appear over the next few months, so please revisit the site.

www.encephalitis.info The Encephalitis Society website provides evidence based information on all aspects of the condition in printed, electronic, video and audio formats .

www.epilepsy.org.uk Epilepsy Action was set up in 1950, and since then the Association has changed dramatically, but their aim is still the same - to raise awareness of epilepsy.

www.headway.org.uk Headway, the charity that works to improve life after brain injury.

www.neurosymptoms.org NeuroSymptoms is a website about symptoms that are neurological (such as weakness, numbness or blackouts), real (and not imagined), but not due to neurological disease. The website is written by a neurologist with a special interest in these problems and aims to give you a better understanding of these symptoms. It has no advertising and does not make any money for the author.

Attention and Concentration: this refers to an individual's ability to focus, sustain and switch their attentional resources appropriately.

Verbal Intelligence: this refers to an individual's level of acquired intelligence. This acquired knowledge is typically developed through schooling and other forms of education. It is often considered a marker for an individual's 'premorbid' level of functioning as it represents, on average, what someone was able to accumulate when they were able to apply their cognitive resources prior to any brain damage.

Visuospatial/Non-verbal reasoning and problem solving: this refers to the more visual and fluid aspects of intellectual ability. Performance here is far less dependent upon an individuals formal level of education or knowledge of the English language. Performance on these tests represents what is often considered to be a 'culture-fair' indicator of intellectual ability. Typically , as these tests attempt to avoid reliance on English language abilities, they are presented within a visual and spatial format.

Working Memory and mental flexibility: this refers to those abilities that relate to the temporary storage, organisation and utilisation of information in one's mind. This information is used to guide and evaluate ongoing behaviour and decision making.

Anterograde Memory: this refers to those abilities that are necessary for the acquisition, storage and retrieval of newly learned information. This ability can be divided in terms of the nature of the to-be-remembered material, i.e. material presented within the auditory versus visual modality.

Language function: this refers, in the neuropsychological setting, mainly to verbal fluency, both phonemic and semantic and visual confrontation naming. In addition to these formal measures of language functioning qualitative assessment of language function is also undertaken. A complete and detailed assessment of language abilities is usually undertaken by a Speech and Language Therapist.

Processing Speed: this refers to the speed with which cognitive abilities can be utilised in relation to specific task demands.

Executive function: this is a broad concept that incorporates many facets. Some of these can be tapped, to some extent, through formal cognitive assessment, but many aspects of this domain are only really apparent through the skilful evaluation of an individual using multiple sources of evidence. This domain refers to the highest level of cognitive function and is typically thought to be important in such things as planning, organisation, time management, adaptability to changing task demands, social appropriateness of behaviour, etc. In essence executive function refers to the ability of an individual to appropriately make use of their abilities in applying themselves to achieve a goal in a culturally appropriate way.