About ASCEND

ASCEND—Assessing Paediatric Caseload Complexity and Enteral Nutrition Demand—is developing evidence-based recommendations for safer staffing, caseloads and workloads in community paediatric dietetic services supporting children and young people receiving home enteral tube feeding (HETF).

The project was commissioned by the BDA Paediatric Specialist Group (PSG) and Dietitians Interested in Special Children (DISC), with funding from the British Dietetic Association (BDA).

ASCEND is currently open to eligible contributors across the United Kingdom, including Northern Ireland. We hope to include colleagues in the Republic of Ireland shortly, once the BDA has confirmed that all applicable requirements have been met.

Why is ASCEND needed?

Home enteral tube feeding enables many children and young people with complex health needs to receive essential nutrition and hydration at home. Safe and effective support depends on dietetic services having sufficient capacity to provide timely, individualised care and respond when clinical, nutritional or wider circumstances change.

The work extends well beyond direct clinical appointments. It includes monitoring growth and nutritional adequacy, adapting feeding plans, supporting transitions, educating families and caregivers, and coordinating with health, education and social care professionals. Travel, multidisciplinary liaison, safeguarding, governance, administration, training and service development are also essential, but may not be fully represented by conventional measures of clinical activity.

Services report increasing caseloads and patient complexity without consistent growth in workforce capacity. This can affect the timeliness and consistency of support for children and families while placing sustained pressure on the professionals delivering their care.

What will the project do?

ASCEND is inviting dietitians, dietetic support workers and service representatives from across England, Scotland, Wales, Northern Ireland and the Republic of Ireland to contribute through two linked surveys:

• the Individual Clinician Survey, completed by dietitians and dietetic support workers;
• and the Team Survey, completed once by an appropriately knowledgeable representative of each service.

Together, the surveys will gather information about workforce capacity, caseloads, patient complexity, clinical activity, service delivery, workload pressures and experiences of safety and sustainability. Patient complexity will be considered using the Universal Dietetic Patient Complexity Tool (UDPCT V11) alongside other characteristics of the caseload and service that influence the staffing required to deliver safe and effective care.

Combining service-level information with the experiences of individual members of the workforce will provide a more complete picture of how services operate, the work required to support their patients and where pressures or gaps may arise.

The BDA Safe Staffing and Safe Workload Guidance (2024) provides an overarching framework for assessing dietetic staffing and workload. ASCEND will build on this foundation by gathering the specialist evidence needed to apply its principles to community paediatric HETF services.

ASCEND will develop practical, evidence-based recommendations to support:

• safer staffing, caseload and workload decisions;
• sustainable workforce and service planning;
• informed discussions with managers, commissioners and service leaders;
• recognition of patient complexity and the full range of work undertaken;
• greater consistency and equity of access to specialist support;
• and safe, timely, coordinated and family-centred care.

Services whose staffing reflects the needs and complexity of their caseloads are better placed to monitor patients, adapt feeding plans, coordinate care and respond when circumstances change. This supports the safety, consistency and quality of care while helping families manage enteral feeding confidently at home.

The songbird represents the value of every contribution: individual voices, heard together, can create a stronger and more meaningful evidence base. Through that shared evidence, ASCEND aims to support safer services, more sustainable workloads and workforce planning, reduce avoidable pressures, and strengthen professional wellbeing—ultimately supporting better care and experiences for children, young people and their families.

FAQs

How did ASCEND come about?

You have told us for several years via the BDA Paediatric Specialist Group (PSG) and Dietitians Interested in Special Children Group (DISC), that providing a safe service is a major concern. The inability to work in a clinically safe way, and the effect of working long term with sustained pressure and clinical risk cannot be underestimated for the profession, with subsequent impact on children, young people and their families.

We are aware that better care for children and young people from birth and the neonatal period is improving, leading to more children surviving with complex conditions. In addition, the NHS 10-year plan drive to move care from hospital to community is meaning more children, quite rightly to be cared for in their own home and to be able to access a normal childhood as much as possible.

What will be the outcome of the project?

ASCEND will enable us to produce recommendations on safer staffing levels for dietetic services working in paediatric home enteral feeding, so you are able to evidence information to provide a safely staffed paediatric enteral feeding service.

What would I need to do?

Your data will be collected via a website. There are two surveys:

1. A team survey
2. An individual survey for staff within the team

Please complete the surveys as fully as possible.

What data do I need?

Team survey

You will be asked about:

• Geographic coverage and population served (without naming your organisation or service)
• HETF staffing numbers, roles, pay bands and vacancies
• Active HETF caseloads, age profiles and feeding routes
• Referrals, discharges, reviews, waiting lists and service demand
• Care pathways, governance and additional support services
• Clinics, home visits, remote care and other care settings
• Coordination with external teams, agencies, homecare providers and suppliers
• Any records showing changes in caseload, complexity, staffing or demand

Individual survey

You will be asked about:

• Your job plan, contracted hours and FTE
• Time allocated to paediatric HETF work
• Your attributable HETF caseload
• A representative diary, calendar or activity record
• Patient contacts, liaison activities and travel
• Additional paid or unpaid hours worked
• How your HETF time is distributed across activities
• Home/remote working and supervision arrangements
• Patient complexity using the BDA Universal Dietetic Patient Complexity Tool

My role includes more than home enteral feeding. Should I include that work?

No. Please include only work relating to children and young people with feeding tubes living at home.

Do not include:

General community work such as clinics, allergy, faltering growth or feeding clinics
Acute NG tube use (for example during RSV admissions)

Tube feeding on a neonatal unit or paediatric ward

Can I save my progress?

Yes. You can save your responses and return later – please click here for guidance. We recommend completing the surveys in stages.

Who can take part?

The survey is currently open to participants across the UK (England, Scotland, Wales and Northern Ireland).

We hope to extend participation to colleagues in the Republic of Ireland shortly, pending resolution of some data protection requirements. Colleagues elsewhere are unfortunately not eligible at this stage.

How long will the surveys to complete?

If you have all the information available to you the surveys are likely to take 45 – 60 mins each to complete. 

How long is the survey open for?

Project ASCEND runs until 30^th November 2026, so there is plenty of time to prepare and participate.

Please get involved

We need the widest possible participation from community paediatric dietitians and dietetic support workers involved in home enteral tube feeding. Our aim is to receive one Team Survey from every eligible service, together with an Individual Clinician Survey from every eligible dietitian and dietetic support worker who wishes to contribute.

It is particularly important that we hear from services experiencing substantial workload or staffing pressures. We recognise that these teams may have the least time available to participate, but without their contributions, the evidence may not fully reflect where support and investment are most needed. The surveys can therefore be completed in stages, with guidance and direct support available.

Broad participation will help ASCEND develop credible recommendations for safer staffing, sustainable workloads, caseload and service planning. The resulting recommendations will be made available to DISC and PSG members and can support informed discussions with managers, service leaders and commissioners about workforce requirements and the resources needed to provide safe, high-quality care.

Project champions

We have a number of volunteers who are acting as out project champions who will be contacting teams within their area to encourage participation. We thank them for their enthusiasm and help with this project. They are all listed on this page.

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