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The four key areas identified by the British Dietetic Association (Wales Board) heading towards the 2021 National Assembly for Wales election are based around relevant aspects of the quadruple aim, which emerged from the Parliamentary Review of Health and Social Care – ‘A Revolution from Within – Transforming Health and Social Care in Wales’ and had cross-party support. These are: population-based health and wellbeing, quality of care, wellbeing of the workforce and value for money.

Dietitians can play an important role in achieving the overarching vision that everyone in Wales should have longer, healthier and happier lives and are able to remain active and independent, in their own homes, for as long as possible. The work of dietitians starts early – from pre-birth and continues right until the end of life. The work of dietitians is also integral in reaching the seven national wellbeing goals of Wales.

There are 300 dietitians and 60 dietetic support workers across Wales. Dietitians support people to make food choices throughout their lives that will maximise their health and wellbeing. They are recognised experts in evidence-based nutrition and offer reliable dietary advice and guidance. Dietitians are the only nutrition professionals to be regulated by law. Thus, people are assured of receiving the latest credible evidence-based information for prevention of ill health and optimisation of health and wellbeing across clinical conditions.

How can we make this happen?

1. People in Wales need to have access to a healthy and sustainable diet and food poverty should be eliminated

  • People need to be empowered to develop their knowledge and skills to buy, prepare and cook healthy, affordable, sustainable food for themselves and their families. This could be achieved by improving access to accredited nutrition and practical food skills courses. It is estimated that 80% of cases of heart disease, stroke and type 2 diabetes and 40% of cancer could be avoided if common risk factors were eliminated.
  • National nutrition standards need to be implemented and monitored to guarantee good quality food is provided in all settings including early years, schools, hospitals and care homes for older adults.
  • People need to have improved access to community-based interventions and community assets should be identified which could focus on food and physical activity such as gardening and food growing.
  • Food co-ops should be established in schools to improve access to good quality, affordable fruit and vegetables.
  • Nutrition and lifestyle training for all health and social care professionals, third sector organisations and the public should be facilitated by dietitians.
  • The use of price promotion and discounting practices need to change, with retailers shifting the balance towards the promotion of healthier products and alternatives.
  • The next Welsh Government should work with UK Government to further improve and enhance front of pack nutrition labelling on pre-packed products.

2. Children and young people in Wales will have access to good nutrition right from the start and throughout their life.

  • Healthy Start should be better promoted for eligible families and work with retailers to maximise the uptake of the scheme and opportunities to make the healthy choice the easy choice.

  • Access to community based healthy lifestyle programmes, such as Foodwise for Life, Get Cooking and Foodwise in Pregnancy should be widened. Schemes to support families to develop confident and positive parenting practices should be encouraged to include timely introduction of solid foods, overseen by registered dietitians to help sustain a change in behaviours for new families.

  • All Flying Start projects across Wales need to provide opportunities for families with infants and children to access evidence-based food and nutrition information.

  • The School Holiday Enrichment Programme (SHEP) Food and Fun should be expanded across the country, where trained staff deliver nutrition education and practical food skills activities for parents, children and young people.

  • The national curriculum should include practical food skills as core subject matter so that children and young people have the knowledge and skills to make healthy eating choices.

3. Everyone living with chronic conditions has access to dietetic expertise enabling them to manage their condition and maintain life-long independence

  • Dietitians can teach and support people throughout their life course, alongside their carers to self-manage their long-term conditions and diet related co-morbidities. This would lead to fewer GP appointments and hospital admissions.
    Effective prevention programmes by dietitians in primary care are key to modify behaviour and lifestyles. Many people can be effectively treated by dietitians in primary care such as people with obesity, people with diabetes and people with Irritable Bowel Syndrome (IBS).
    • Primary care dietetic services can support patients with IBS, a chronic and debilitating functional gastro-intestinal disorder that affects up to 20% of the population at an estimated cost of £45.6m per annum. In Betsi Cadwaladr University Health Board East area primary care dietetic led clinics for patients with IBS have demonstrated a 24% reduction in the need to refer on to secondary care as well as improved quality of life and reduced symptoms for 87% of patients.
    • Rolling out Diabetes Prevention Programme in Wales. Evidence driven dietetic led programmes reversing the trends in Type 2 diabetes through weight management should be encouraged. Afan Valley had a cluster level programme to support people with Pre-Diabetes as weight management is key in its treatment and preventing it progressing into type 2 Diabetes. This dietetic led brief intervention programme showed 62% of people with pre diabetes returned their blood glucose levels to their normal range increasing quality adjusted life years (QALY) at reduced cost.
  • Dietitians should be commissioned to work with others, promoting optimum nutrition and care for older people in the community, reducing the risk of malnutrition and unplanned hospital admission. Twent-eight per cent of patients admitted to hospital in Wales are malnourished and the annual cost of malnutrition in Wales is estimated to be more that £1.4 billion per annum.

4. Dietitians need to be recognised as the professional nutrition experts

  • Dietetic capacity needs to be increased with additional training places in Wales to support patients and the public to make informed choices, promoting healthy behaviour thus reducing inequalities in health.
  • More dietitians should have access to prescribing training and education, which would enable patients to access the medicines they need without delay and further appointments with the GP.

For further information about our calls to action and to learn more about the impact of dietetic services, please contact Sandra Tyrrell, Policy Officer, British Dietetic Association. 

Cymraeg

Mae’r pedwar maes allweddol a nodwyd gan Gymdeithas Ddeieteg Prydain (Bwrdd Cymru) wrth edrych tuag at etholiad Cynulliad Cenedlaethol Cymru 2021 yn seiliedig ar agweddau perthnasol y nod pedair ochrog, a ddaeth i’r amlwg o’r Adolygiad Seneddol o Iechyd a Gofal Cymdeithasol - ‘Chwyldro o’r Tu Mewn’ - Trawsnewid Iechyd a Gofal Cymdeithasol yng Nghymru’ a dderbyniodd gefnogaeth drawsbleidiol. Y rhain yw: iechyd a lles ar sail poblogaeth, ansawdd gofal, lles y gweithlu a gwerth am arian.

Gall dietegwyr chwarae rhan bwysig wrth gyflawni’r weledigaeth gyffredinol y dylai pawb yng Nghymru gael bywydau hirach, iachach a hapusach a’u bod yn gallu parhau i fod yn egnïol ac yn annibynnol, yn eu cartrefi eu hunain, cyhyd ag y bo modd. Mae gwaith dietegwyr yn cychwyn yn gynnar - o’r cyfnod cyn-geni ac yn parhau hyd ddiwedd oes. Mae gwaith dietegwyr hefyd yn rhan annatod o gyrraedd saith nod lles cenedlaethol Cymru.

Mae 300 o ddietegwyr a 60 o weithwyr cymorth dietegol ledled Cymru. Mae dietegwyr yn cefnogi pobl i wneud dewisiadau bwyd trwy gydol eu hoes a fydd yn cynyddu eu hiechyd a’u lles i’r eithaf. Maent yn arbenigwyr cydnabyddedig mewn maeth ar sail tystiolaeth ac yn cynnig cyngor ac arweiniad dietegol dibynadwy. Dietegwyr yw’r unig weithwyr proffesiynol maeth i gael eu rheoleiddio gan y gyfraith. Felly, mae pobl yn sicr o dderbyn y wybodaeth ddiweddaraf sy’n seiliedig ar dystiolaeth ar gyfer atal afiechyd ac optimeiddio iechyd a lles ar draws cyflyrau clinigol.

Sut allwn ni wneud hyn ddigwydd?

1. Mae angen i bobl yng Nghymru gael mynediad at ddeiet iach a chynaliadwy a dylid dileu tlodi bwyd

  • Mae angen grymuso pobl i ddatblygu eu gwybodaeth a’u sgiliau i brynu, paratoi a choginio bwyd iach, fforddiadwy, cynaliadwy iddynt eu hunain a’u teuluoedd. Gellid cyflawni hyn trwy wella mynediad at faeth achrededig a chyrsiau sgiliau bwyd ymarferol. Amcangyfrifir y gellid osgoi 80% o achosion o glefyd y galon, strôc a diabetes math 2 a 40% o ganser pe bai ffactorau risg cyffredin yn cael eu dileu.
  • Mae angen gweithredu a monitro safonau maeth cenedlaethol i sicrhau bod bwyd o ansawdd da yn cael ei ddarparu ym mhob lleoliad gan gynnwys y blynyddoedd cynnar, ysgolion, ysbytai a chartrefi gofal i bobl hyn.
  • Mae angen i bobl gael gwell mynediad at ymyriadau yn y gymuned a dylid nodi asedau cymunedol ag allai ganolbwyntio ar fwyd a gweithgaredd corfforol fel garddio a thyfu bwyd.
  • Dylid sefydlu cydweithfeydd bwyd mewn ysgolion i wella mynediad at ffrwythau a llysiau fforddiadwy o ansawdd da.
  • Dylai dietegwyr hwyluso hyfforddiant maeth a ffordd o fyw ar gyfer yr holl weithwyr proffesiynol iechyd a gofal cymdeithasol, sefydliadau’r trydydd sector a’r cyhoedd.
  • Mae angen newid y defnydd o arferion hyrwyddo prisiau a disgowntio, gyda manwerthwyr yn symud y cydbwysedd tuag at hyrwyddo cynhyrchion iachach a dewisiadau amgen.
  • Dylai Llywodraeth nesaf Cymru weithio gyda Llywodraeth y DU i wella labelu maethiad blaen pecyn ar gynhyrchion wedi’u pacio ymlaen llaw.

2. Bydd plant a phobl ifanc yng Nghymru yn gallu cael gafael ar faeth da o’r dechrau a thrwy gydol eu hoes.

  • Dylid hyrwyddo Cychwyn Iach yn well ar gyfer teuluoedd cymwys a gweithio gyda manwerthwyr i sicrhau bod y cynllun yn cael ei ddefnyddio i’r eithaf a chyfleoedd i wneud y dewis iach yn ddewis hawdd.
  • Dylid ehangu mynediad i raglenni ffordd iach o fyw yn y gymuned, fel Bwyd Doeth am Oes, Dewch i Goginio a Bwyd Doeth yn ystod Beichiogrwydd. Dylid annog cynlluniau i gynorthwyo teuluoedd i ddatblygu arferion rhianta hyderus a chadarnhaol i gynnwys cyflwyno bwydydd solet yn amserol, dan oruchwyliaeth dietegwyr cofrestredig i helpu i gynnal newid mewn ymddygiad ar gyfer teuluoedd newydd.
  • Mae angen i bob prosiect Dechrau’n Deg ledled Cymru ddarparu cyfleoedd i deuluoedd â babanod a phlant gael gafael ar wybodaeth am fwyd a maeth ar sail tystiolaeth.
  • Dylid ehangu Bwyd a Hwyl y Rhaglen Cyfoethogi Gwyliau Ysgol (SHEP) ledled y wlad, lle mae staff hyfforddedig yn cyflwyno addysg maeth a gweithgareddau sgiliau bwyd ymarferol i rieni, plant a phobl ifanc.
  • Dylai’r cwricwlwm cenedlaethol gynnwys sgiliau bwyd ymarferol fel pwnc craidd fel bod gan blant a phobl ifanc y wybodaeth a’r sgiliau i wneud dewisiadau bwyta’n iach.

3.Dylai pawb sy’n byw gyda chyflyrau cronig gael mynediad at arbenigedd dietegol sy’n eu galluogi i reoli eu cyflwr a chynnal annibyniaeth gydol oes

  • Gall dietegwyr ddysgu a chefnogi pobl trwy gydol eu cwrs bywyd, ochr yn ochr â’u gofalwyr i hunanreoli eu cyflyrau tymor hir a’u cyd-afiachusrwydd sy’n gysylltiedig â diet. Byddai hyn yn arwain at lai o apwyntiadau meddygon teulu a mynediadau i’r ysbyty.
  • Mae rhaglenni atal effeithiol gan ddietegwyr mewn gofal sylfaenol yn allweddol i addasu ymddygiad a ffyrdd o fyw. Gall llawer o bobl gael eu trin yn effeithiol gan ddietegwyr mewn gofal sylfaenol fel pobl â gordewdra, pobl â diabetes a phobl â Syndrom Coluddyn Llidus (IBS).
    • Gall gwasanaethau dietetig gofal sylfaenol gefnogi cleifion ag IBS, anhwylder gastroberfeddol swyddogaethol cronig a gwanychol sy’n effeithio ar hyd at 20% o’r boblogaeth ar gost amcangyfrifedig o £45.6m y flwyddyn. Yn Bwrdd Iechyd Prifysgol Betsi Cadwaladr, yn ardal y Dwyrain, mae clinigau dan ofal dietegol ar gyfer cleifion ag IBS wedi dangos gostyngiad o 24% yn yr angen i gyfeirio at ofal eilaidd yn ogystal â gwell ansawdd bywyd a llai o symptomau i 87% o gleifion
    • Cyflwyno Rhaglen Atal Diabetes yng Nghymru. Dylid annog rhaglenni dietegol sy’n gwrthdroi’r tueddiadau mewn diabetes math 2 trwy reoli pwysau. Roedd gan Cwm Afan raglen lefel clwstwr i gefnogi pobl â Chyn-Diabetes gan fod rheoli pwysau yn allweddol yn ei driniaeth a’i atal rhag symud ymlaen i Diabetes math 2. Dangosodd y rhaglen ymyrraeth fer hon ag arweiniwyd gan ddeieteg fod 62% o bobl â chyn diabetes wedi dychwelyd eu lefelau glwcos yn y gwaed i’w hystod arferol gan gynyddu blynyddoedd bywyd edi’u haddasu o ansawdd (QALY) am gost is.
  • Dylid comisiynu dietegwyr i weithio gydag eraill, gan hyrwyddo’r maeth a’r gofal gorau posibl i bobl hyn yn y gymuned, gan leihau’r risg o ddiffyg maeth a mynediad i’r ysbyty heb ei gynllunio.Mae 28% o’r cleifion sy’n cael eu derbyn i’r ysbyty yng Nghymru yn dioddef o ddiffyg maeth ac amcangyfrifir bod cost flynyddol diffyg maeth yng Nghymru yn fwy na £1.4 biliwn y flwyddyn.

4. Mae angen cydnabod dietegwyr fel yr arbenigwyr maeth proffesiynol

  • Mae angen cynyddu gallu dietegol gyda lleoedd hyfforddi ychwanegol yng Nghymru i gynorthwyo cleifion a’r cyhoedd i wneud dewisiadau gwybodus, gan hyrwyddo ymddygiad iach a thrwy hynny leihau anghydraddoldebau iechyd.
  • Dylai mwy o ddietegwyr gael mynediad at hyfforddiant ac addysg ragnodi, a fyddai’n galluogi cleifion i gael gafael ar y meddyginiaethau sydd eu hangen arnynt yn ddi-oed a lleihau apwyntiadau pellach gyda’r meddyg teulu.

Am ragor o wybodaeth ynglyn â’n gofynion maniffesto ac er mwyn dysgu mwy am effaith gwasanaethau dietegol, cysylltwch â Sandra Tyrrell, Swyddog Polisi, Chymdeithas Ddieteg Prydain.