Life Beyond the Waistline: The expanding role of an NHS dietitian

Life Beyond The Waistline

the expanding role of an NHS dietitian

Life Beyond the Waistline

The Expanding Role of an NHS Dietitian

Evelyn Newman

Copyright © 2024 by Evelyn Newman

All rights reserved. No part of this book may be reproduced or used in any manner without written permission of the copyright owner except for the use of quotations in a book review. For more information, contact: [email protected]

First paperback edition 2024

Book design by Publishing push

978-1-80541-419-3 (paperback)

978-1-80541-420-9 (ebook)

Overview

Evelyn is a multi-award-winning retired dietitian who has worked in a wide variety of roles and locations across the UK over four decades. She is well known to colleagues across the UK and has been a regular contributor to many national publications, on-line platforms and events. She has also volunteered for the British Dietetic Association (BDA) in a variety of roles since 1987. Her career path is unique to anyone in the profession and has taken her to work in places that no one could have imagined employing a dietitian when she started her student journey back in 1982. Her experience as a dietitian is certainly not the stereotypical characterisation that one might imagine and there is very little reference to people trying to lose weight – hence the title of the book. This is an autobiographical memoir, full of insights, stories, anecdotes and reflections of the many experiences her roles have offered and the people she has worked alongside in so many environments. Evelyn has seen many changes to dietetic practice, the profession and the NHS over the years but has always embraced and enjoyed these, readily taking on many new opportunities and challenges ahead of any other UK dietitian. Her positive outlook on life has helped in her personal and professional development, promoting the role of dietitians in many diverse settings, such as the prison service, football clubs, regional renal and burns units, the TUC and Whitehall. She has won several national awards and been selected to present her transformational work, sharing with colleagues in many international venues and events. The book takes readers on her journeys to New York state correctional facilities, a tour of Indian burns units, across to Europe, to Northern Ireland, Iceland and to the many towns and cities where she’s worked over the years. It is a story of perseverance, thankfulness, success and encouragement for others to be open to all possibilities.

Introduction

They say that you know you’re getting old when you start thinking about the old days. Well, I found myself doing just that a few years ago, even though, in my head, I’ll always think of myself as a young 36.

I initially started thinking about writing this book around the 70th anniversary of the NHS, having written an article reflecting on how my career had developed over the many years since leaving university. It was published in both the Scottish press and on a Scottish government blog site, which went out widely on Twitter, resulting in lots of really positive comments from a variety people both in and outside of work. Many NHS colleagues and acquaintances were surprised to hear how uniquely varied my roles had been and a few quipped that I should write a book about my experiences because they were so different to the public perception of what a dietitian did. The stereotype is, of course, of someone who either helps obese people to lose weight or is some kind of a muesli-munching veggie who frowns on anyone eating an unhealthy diet. Both generalisations are, thankfully, incorrect and in my case, they are way off the mark. I have been very fortunate to be able to steer a career course that bucked the trend of conventional dietetics, allowing me to move around the country, changing roles and areas of specialist interest. I have also been able to maximise the many unusual opportunities that came my way, taking me to places I would otherwise never have dreamed of getting to.

My upbringing in the Northeast of Scotland gave no indication of what I might go onto achieve, being the eldest of three siblings in a one-parent family, which was heavily reliant on state benefits. There was no expectation that I would do well at school, never mind go to university, but I have always had a strong sense of confidence in my own abilities and was determined to prove to any doubters that they were wrong. That has been a theme of my general approach throughout life and it has enabled me to never feel constrained by others’ limited opinions, any self-doubt or the general view of what might be possible. I have a strong work ethic and always believe that anything is possible if you put your mind to it, coupled with a bit of effort. When I hear people saying that something always has to be done a certain way, I see it almost as a challenge to question why that might be and look at how it might be transformed using a more innovative approach.

I am so grateful to the NHS for the many years of employment, variety and opportunity to work with so many groups of staff and members of the public, across so many different care settings. The role of a dietitian has evolved far beyond my expectations and earlier experiences as it has adapted to numerous clinical, professional and service developments. Perhaps my recollections will prompt some to reminisce about their own working life and maybe even enthuse others to take up the baton of innovation and release even greater transformational potential for their future roles and careers. As I settle into an exciting new phase of life in retirement, and the undoubted opportunities that will bring, I hope that you enjoy my story. And if you were part of that story, thank you.

Contents

Overview

Introduction

Chapter 1 — Student life

Chapter 2 — Putting it into practice

Chapter 3 — The early years

Chapter 4 — Burning challenges.

Chapter 5 — Moving on

Chapter 6 — Onwards and upwards

Chapter 7 — Life in the Southeast.

Chapter 8 — Life behind bars

Chapter 9 — The cabinet office leadership programme

Chapter 10 — Volunteering with the BDA

Chapter 11 — Affiliation with the TUC

Chapter 12 — A national role

Chapter 13 — The Highlands

Chapter 14 — New beginnings

Chapter 15 — The digital coming of age

Chapter 16 — COVID

Chapter 17— Retirement

Chapter 18 — Reflections

Acknowledgements

Glossary of terms

References

Chapter 1 — Student life

I can clearly remember being interviewed for a place at Robert Gordon’s Institute of Technology (now Robert Gordon’s University — RGU) by the head of school, Dr David Livingstone. I had no idea what to expect from my first-ever interview but to say the experience was informal is an understatement. He was sat back with his feet up on the desk and hands folded over his stomach. I discovered later that he thought this would help to keep students relaxed and that the meeting was more about getting to know us and how well we might fit into life as a student dietitian. My handwritten application was lying on the desk next to him. In those days, we actually had to declare our weight and height, to ensure that no one was accepted onto the course if they potentially had an eating disorder or were very overweight. There was a very clear expectation of how a dietitian should look and it was generally believed that no patient or colleagues could take an obese or anorexic dietitian seriously. Why that should ever have even featured in a decision about anyone’s career path is bizarre. I doubt whether the same bias existed for medical students or nurses who didn’t look after their health by smoking or drinking too much alcohol.

My one and only careers interview in 6th year had been a revelation to me. I had no real idea what I wanted to do after leaving school, so, when I was asked about the subjects I was studying, the advisor started flicking through a variety of reference magazines and that’s where the degree course for nutrition and dietetics appeared. I wasn’t sure what I’d be able to do as a dietitian; did it mean just telling people how to lose weight? That was the stereotypical view of the job, which was still a very new profession at the time. Then again, that was part of the appeal, I suppose — being different — but in the end, I thought that anything to do with food would have lots of potential and it turned out that I was right. I never regretted applying for the course or the career path that unfolded in the years ahead.

I waited several weeks before receiving the offer of a place at RGU, conditional on gaining a C or above in Higher biology. I had been brought up in a single-parent household, in council accommodation, heavily reliant on the various social security benefits of the day. Money was always very tight and I was fortunate to have a steady part-time job in a local chemist’s shop. However, I was determined to break out of the cycle of poverty, dependence on handouts and hand-me-downs so I put every effort into my studies. After a nail-biting wait for the postman to bring my results in August 1982, a registered letter arrived — no email or text alerts back then! I was thrilled to have the much needed C, which proved all the extra studying had been worth it. I was excited and couldn’t wait to get started the much needed degree, which would eventually lead me to so many new places, unbelievable opportunities and a secure future career in the NHS.

I moved through to Aberdeen a couple of days before the start of the course, having rented a room, with one of my friends, in a family house just off Queen’s Cross in the west end. Fiona moved out after a year, but I remained with The Peats for the rest of my university studies, only moving out during summer holidays. I continued to keep in touch with my (now late) landlady long afterwards and always felt very fortunate for having had such a nice, warm welcoming place to live and study throughout my time in Aberdeen. The first week of student life was a whirl of form-filling, working out our timetables and trying to navigate where everything was. I met Jan, who has remained my closest friend for all these years, and because our surnames were closest alphabetically, we found ourselves next to each other for most of the practical work sessions. Matriculation cards were produced and student grants were paid to us as individual cheques (no internet banking in those days). All university tuition was free (as it still remains in Scotland) and grants were paid on a means-tested basis. Because of my family circumstances, I received the full grant each term and had more money than I could have ever imagined in my bank. I started to eat much better and enjoyed joining friends for meals out. We started the first day with a list of items that we were expected to buy before lessons started for real the following week: Two white coats — 1 for catering and one for lab work — a large Good Housekeeping cookbook for our soon-to-be infamous cooking sessions, a set of quality kitchen knives, which I still use today, and a variety of textbooks. New clothes soon became a priority as I outgrew everything after the first term, having gained much needed weight and height with a much better personal diet. After three years and a lot of disciplined study, I qualified with a BSc degree in nutrition and dietetics back in 1985. However, it wasn’t always plain sailing and I very nearly didn’t make it past my first year.

Funnily enough, it was nothing to do with my academic ability. I worked really hard to even be pretty average in subjects as diverse as biochemistry, physics, psychology and microbiology. My Achilles heel was much more practical — catering — and, more particularly, in cooking family meals! The trouble was that cooking for the apparent ‘families’ we were catering for, we were using food and kitchen equipment that bore no resemblance to any that had ever appeared in my home growing up. When I started at RGU, I was quite underweight and anaemic because of years of relying on government benefits and of eating a very limited poorly balanced diet. Janet Lowell, our catering lecturer, took me aside towards the end of first year to gently explain that I was in danger of not progressing to second year if my performance didn’t improve.

This wasn’t a surprise to me, or my fellow students, who regularly fell about laughing at my lack of knowledge of raw ingredients and the many mishaps in my food preparation. Each week, it wasn’t so much a question of whether I would make a mistake, it was how big and hilarious it would be. I wasn’t trying to be funny or deliberately stupid; I just genuinely didn’t know what I was doing. Even today, Jan still tells the story of how I managed to turn a recipe for six portions of cold cucumber soup (you see what I mean about family cooking?) into an individual portion complete with a hint of carbon... You guessed it; I left it cooking on the gas stove (I’d never used one before) on too high a heat and neglected to notice that it was slowly evaporating and sticking to the bottom of the pan.

I had managed to get myself distracted with even more confusion about the main course I was assigned to prepare — Turkish three bean salad. The only experience I’d previously had with beans was the popular 57 variety, served with sausages and mash at home. Not only did I have to work out which beans were which, I was panicking because the salad dressing contained fresh herbs, of which I had no previous experience. There was an array of green stalks laid out with other ingredients for the class to select for preparing the different meals we were all assigned to make. When I asked Janet for help identifying some mint, she pointed to a bunch on the table and left me to it. When she returned twenty minutes later, she was clearly confused as I proudly showed off my hard work. She asked where the mint was and it quickly became clear that the leaves, which I’d stripped off and thrown in the waste bin, should have been chopped up and mixed into the salad dressing. Instead, there were small, carefully chopped pieces of mint stalks mixed throughout the dish, making it pretty much inedible! I felt so disappointed in myself— it had been really hard work to cut it up! Suddenly, we were alerted to the distinctive smell of burning coming from the stove…

Through tears of laughter, Jan and Lesley, in the neighbouring cooking stations, called others over to see the catering carnage. Even Janet was finding it hard not to join in. I can only imagine the amusement in the staff room later when she shared yet another afternoon of my catering disasters with her colleagues. It wasn’t just ingredients that I struggled with either; I had never used some of the equipment before. At home, I had been the one coming home from school and cooking tea but mainly used the oven, grill and ever-present chip pan, full of lard, in our kitchen. We had no fridge freezer, never mind fancy modern gadgets. So, one day, when I arrived for class to see that I would have to use a food processor, my anxiety levels reached new heights but I was still determined to try and get it right. I was tasked with making mayonnaise from scratch, which involved slowly and carefully adding ingredients to prevent the mixture from separating. Janet approached my workstation with a now familiar expression of curious hopelessness. I couldn’t understand why I didn’t seem to be getting anywhere, watching the egg yolks whirling round. Why was my mayonnaise not developing? She stepped closer with a hint of a smile quivering at the side of her mouth. Lifting the clear stopper out of the opening in the blender where ingredients should be added, she pointedly handed it to me. Immediately, I realised that I had been adding my mixture into the stopper, which is why the mayonnaise wasn’t materialising — what a basic error! As Janet walked off shaking her head, laughter from my classmates erupted around the room once again.

Despite it being a steep learning curve for me, the year really expanded my knowledge and catering repertoire and allowed me to try out so many new dishes and ingredients that I might never otherwise have come across.

Thankfully, I managed to scrape through catering with the lowest pass mark and started to look forward to my next year. However, readers may not be surprised to know that I have never since felt the need to make cold cucumber soup, homemade mayonnaise or Turkish three bean salad...

The course was pretty much full time over 5 days a week back then. We studied sociology, psychology, nutrition science, microbiology, physiology, biochemistry, statistics and physics and I had to work really hard to keep on top of all the new information and assignments. I became very adept at taking copious real-time notes, and today, I can still look ahead at presentations while simultaneously writing in my notepad.

We were a close network of 40 students, coming from a variety of backgrounds and nations: Poom was from Thailand, Kitty came from Hong Kong and kept many people entertained with palm reading; there were two students from Kenya who sadly didn’t make it into second year; Alison from Armagh in N. Ireland; a variety of people from England; while the rest of us were Scots, including two others from my hometown.

Thankfully, I made it through our many first-year exams and was glad to finally finish my studies of both physics and statistics — the latter being an open-book test, which I just scraped through with the help of other students’ notes. 1982 was also the year when I became a student member of the British Dietetic Association (BDA) and enjoyed receiving the monthly printed magazine and associated information that was posted to us. Students weren’t allowed to receive the regular jobs list that was sent to full members, so we had to wait to learn more about vacancies from dietitians on placement in later years. I also became elected as a class representative for my year, which was probably where my later love of industrial relations came from.

Looking for work in the summer of 1983 and the following Easter holidays, I became a temporary hospital cleaner. This allowed me to remain financially independent while living in Aberdeen, working in two local elderly care settings — Woodend and Morningfield Hospitals. It gave me a real insight into the hard work that hospital cleaners have to do and a lifelong appreciation for their contribution to the smooth running of all health and social care settings. I had a few challenges using the large, powerful floor buffers, as I was still quite underweight. On one occasion, another cleaner managed to avert a nasty accident when the cable for the machine became wrapped round the buffing pad. It pulled me close to the machine as the cable had been held round my waist and I was struggling to move. She leaned down behind me and switched it off at the wall, giving me a few minutes to slowly extricate myself and calm down before carrying on where I left off. Little did I know how relevant this work, and insights from it, would be many years later when I was interviewed for and appointed to the role of head of nutrition and cleaning for England and Wales!

In September 1983, second year started optimistically but still included catering; this time, though, it was done on a large scale. Our lecturer was a rotund, ginger-bearded ex-RAF chef with many years of experience of bulk catering. The sessions were designed to help us appreciate the challenges of cooking for large numbers, scaling up the weight of ingredients and the size of the equipment. For the most part, I managed better because I was working as part of a small team or in pairs and other students knew much more about ingredients than me, helping to disguise my ignorance of many.

The format of our biochemistry lectures changed in 2nd year as we were joined by pharmacy students for lessons in the city-centre lecture theatres. Chris Fenn became our food science lecturer and made the lessons really interactive, fun and interesting. We continued studying physiology, microbiology, psychology and sociology but studying was more manageable as we had all developed a good routine and encouraged each other lots. All of my classmates were a really nice group of colleagues to be with and if we bumped into each other over the years at various events, we still greeted each other with great friendship and enjoy memories from those times.

Lab work was at the RGU building in the centre of Aberdeen, and the smell of various chemicals lingered in clothes and hair long after we left for the day. At the time, I was very committed to anti-vivisection and approached Dr Livingstone to ask if I could opt out of any actual dissections. He found it somewhat amusing but agreed and I was allowed to observe Jan and Lesley carry out theirs instead.