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.
What does ASCEND aim to achieve?
Illustration | Song bird
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.
What does ASCEND aim to achieve?
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.