Recruiting Community Nutrition Assistants

Community Nutrition Assistant (CNA) programme: Haringey

Background

Like many primary care trusts, Haringey Teaching Primary Care Trust (TPCT) is concerned about diet related illnesses including obesity and diabetes. Haringey also recognises that a significant number of community groups are isolated. It is difficult to reach them and give them accurate and relevant diet information, in particular information that is culturally appropriate.

Nationally the dietetic workforce is small compared to other health care professioinals. This shortage of skilled staff is compounded by the fact that dieticians generally start their careers in a clinical setting, not the community. Although Haringey has a huge amount of  multicultural wealth, it is on the outskirts of London with limited transport. This means the teaching hospitals in central London are the first choice for many dieticians to work in.

Key issues

Haringey TPCT did not have the capacity to meet the needs of the local community and hard-to-reach groups because:

• there were not enough dieticians to do the necessary dietetic work in the Haringey community
• dieticians could not get close enough to some of the communities to really understand their cultural needs 

Findings from research

Experience in other areas – such as Bolton, Newham, Luton and Dunstable – indicated that empowering community members to work with their own groups is effective.

Vision

The proposed way forward was to use a pilot programme to train people in the community to work with hard-to-reach groups. This would:

• reduce the workload on dieticians
• provide a cohort of people who knew the target groups well
• provide a skills escalator approach to encourage individuals from hard-to-reach backgrounds to enter into the NHS – including those who are socially isolated, lone parents and those from ethnic minority groups

The nutrition and dietetic service in Haringey needed more people to work in the community. So they decided to recruit and train community nutrition assistants (CNAs). To achieve their vision the team needed to:

• ensure suitable training was available
• identify suitable people to train
• gain the necessary funding
• provide opportunities to work in the community  

Setting up training

The previous CNA course was run through a National Open College network. Haringey followed this approach and became a member of the London Open College Network – now called the Open College Network (OCN) London Region.

The course was developed into three modules below. Both modules one and two were taken from the existing programme in Luton. Module three was developed as part of Haringey’s vision to develop a skills escalator for CNAs. All levels are developed at OCN level, equivalent to NVQ levels one and two.

• Module 1: Community Nutrition was delivered at levels 1 and 2. 
• Module 2: Developing Food Advisor skills was delivered at level 2.
• Module 3: Community Nutrition work placement was delivered at level 2.

Identifying and recruiting the right people to train

The team advertised in the local papers and through word of mouth. Many trainees were identified by existing organisations and groups such as Sure Start.

Resources needed

For the pilot, the team used a combination of funding from Sure Start, the 'Five a Day' programme (funded by lottery money) and the PCT.

Opportunities to work in the community

Those who went on to qualify as CNAs have  proved invaluable for working with different ethnic groups in the community, in particular those hard-to-reach groups. They have educated these groups about health and nutrition.

Examples of noteworthy work include:

• cook and eat sessions at St Ann’s Library for the Somali community
• making tropical smoothies for the Afro-Carribbean community at Wood Green Library during Black History Month
• producing healthy packed lunches at Broadwater Farm for the Turkish community
• healthy eating events for the Healthy Schools Partnership

During the Somali cook and eat session people were shown how to adapt the large amounts of salt and fat they usually cooked with. Many commented that they did not realise food could taste so good without large quantities of fat and salt.

Key learning from project: training course

• While most of those recruited had very good English some had difficulty with the course and dropped out after level one
• some of the students could not keep up with the volume of homework
• more time and people resource was needed to support the students who often needed 1-1 supervision
• overall the learning was that this cannot be run simply as a training course, this is a community based learning opportunity. The needs of those learning included confidence building, hours to suit working mothers.

Recruitment

Many of the people that came forward were already known to the community through Sure Start. Or in some cases they were already working in a related field who wanted to develop these skills.

Completion of the modules

• Overall 13 started on module one.
• Eleven then went on to begin module two and eight completed it.
• Three of the remaining eight felt they had sufficient knowledge for their current role and did not go on to module three.
• One person felt unable to go on to module three because of working full-time. 

Work experience

CNA are not employed full-time but are paid on a sessional basis through the bank system. Haringey TPCT's continued professional development programme keeps their skills up-to-date. They each have a 'knowledge and skills framework' to ensure they maintain their competences. 

Career development

Several participants have gone on to study further. The training has also helped some get other employment, such as running a mother and toddler group for Sure Start, and delivering healthy eating talks for a 'Fit for life' group.

Impact on end users

An impact assessment has not yet been done on end users. But there has been positive feedback from the organisations that have used CNA including children’s centres, schools and voluntary groups.

This article was published in July 2007 and was written by Isabelle Iny.