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Issue No. 64 March 2012

B A P E NAdvancing Clinical Nutrition

Registered Charity 1023927





PLUS: What’s New, Diary Dates, Core Group Updates.. .

BAPEN at DDFWhy you simply

must go!See page 8

Meet the 2012 BAPENExecutive Team

DR TIM BOWLINGHonorary Chairman

Dr Tim Bowling, Honorary Chairman, invites you to the DigestiveDisorders Federation Conference in Liverpool in June 2012.

One of the challenges that we all face is furthering our professionaldevelopment in the face of limited resources. While our Trusts wish to

have employees at the top of their game, it can be difficult for Trusts to assist us to improve ourskill-set. This is particularly the case in the current difficult economic climate. It can be easier forus to undertake e-learning, and this can be very effective; indeed BAPEN has its own e-learningmodules. However, CPD is much more than acquiring knowledge sitting alone at a computerterminal. We are all in vocational occupations. Much of what we do and learn is experiential, i.e.learned and improved by practical experiences. While much can be learnt in-house (especially formore junior colleagues), there is a great deal that cannot. Some of this can be delivered in aconference setting, with lectures and case discussions with expert panels, etc., but much can alsobe acquired from talking to colleagues and networking with new ones. Such aspects of CPD canonly be acquired off-site, and the value of doing so cannot, in my view, be over-stated. Attendingconferences though requires study leave time (or sacrificing annual leave), negotiating withcolleagues and bosses to be allowed away and finance for registration, travel and accommodation.As a result we are all very selective about which meetings we will honour with our presence.

This is why I want to tell you about a very important meeting coming up in June that shoulddeliver a great deal. It is the inaugural Digestive Disorders Federation (DDF) Conference inLiverpool from 17th-20th June. This is the combined conferences of BAPEN, the British Society ofGastroenterology (BSG), the British Association for the Study of the Liver (BASL) and theAssociation of Upper GI Surgeons (AUGIS). Not only are the individual groups holding their ownconferences, but there will be many shared symposia on topics on which common ground isshared. For example, intestinal failure (BAPEN and BSG); fibre and food intolerances (BAPEN andBSG); perioperative nutritional support (BAPEN and AUGIS) and nutrition in liver disease (BAPENand BASL) – to name just a few.

It is expected that there will be 3000-4000 delegates and the meeting will attract a largeinternational contingent. The advantage of many different symposia running together is thatBAPEN sessions should attract an audience that would not normally come to BAPEN meetings.Likewise, those attending primarily because of BAPEN’s involvement, will be able to sample areasrelevant to the other stakeholder groups. Another great advantage of a high profile event is thecalibre of the speakers, presentations and original abstracts, which I can assure you will be veryhigh indeed. On top of the intellectual activities there will be, as always, plenty of opportunitiesto let your hair down and enjoy the social life of DDF and of Liverpool with colleagues and friends,both old and new.

“What’s the catch? ” I hear you ask. Actually there genuinely isn’t one. The delegate costs, ifyou are a member of one of the four stakeholder groups, are very low indeed. If you are a dietitian,nurse, pharmacist or other allied health professional and are a BAPEN member, the daily rate is£55 instead of £220 if you are not a member, or £190 for the full conference versus £500 (doctorspay a bit more). If you are a patient, it is only £20 per day. The reason delegate costs have beenable to be kept low (and a lot less than our normal conferences) is because of the anticipatednumber of attendees driving down overheads and running costs per head.

So, I would like to encourage you all to consider this. DDF will be a very big and a very importantmeeting, with a very full and varied programme, which I challenge anyone not to be able to findsomething of value. If you are not already a member of BAPEN, i.e. you are reading this over theshoulder of someone who is, please join (www.bapen.org.uk/join.html) and get a dramaticallyreduced registration (www.ddf2012.org.uk). This is one of those few situations nowadays that is a“win, win”.See you in Liverpool.

1

Welcome

British Association forParenteral and EnteralNutrition

BAPEN is a Registered Charity No:1023927

A multi-professional association andregistered charity established in 1992. Itsmembership is drawn from doctors,dietitians, nutritionists, nurses, patients,pharmacists, and from the health policy,industry, public health and research sectors.

Principal Functions:• Enhance understanding and

management of malnutrition. • Establish a clinical governance

framework to underpin the nutritionmanagement of all patients.

• Enhance knowledge and skills inclinical nutrition through educationand training.

• Communicate the benefits of clinicaland cost-effective optimal nutritionalcare to all healthcare professionals,policy makers and the public.

• Fund a multi-professional researchprogramme to enhance understandingof malnutrition and its treatment.

In Touch – The Newsletter of the BritishAssociation for Parenteral and EnteralNutrition

Cost per issue: £2.00 to non members

Printed version: ISSN 1479-3806. On-line version:ISSN 1479-3814. All contents and correspondence are published atthe discretion of the editors and do not necessarilyreflect the opinions of BAPEN. The editors reservethe right to amend or reject all material received. Noreproduction of material published within thenewsletter is permitted without written permissionfrom the editors. BAPEN accepts no liability arisingout of or in connection with the newsletter.

Contents...

Welcome 1

What’s New 2

BAPEN Executive Team 5

BAPEN at DDF Conference 8

Core Group Updates 11

Diary Dates 13

BAPEN Contacts 15

A message from BAPEN’s Chairman...







BAPEN In Touch No.64 March 2012

B AP E

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Advancing Clinical Nutrition


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What’s New

BAPEN In Touch No.64 March 2012 2

• NEWS • NEWS • NEWS • NEWS • NEWS • NEWS •Keeping you up-to-date with the latest news, views, reviews & developments

There have been a number of documents andinitiatives over the past few years that havehighlighted the importance of patient experienceand the need to focus on improving this experiencewhere possible. Such proposals have underlined thesignificance of the entire patient experience withinthe NHS, ensuring people are treated withcompassion, dignity and respect within a clean,safe and well-managed environment.

To deliver the best possible experience forpatients who use NHS services, high quality careshould be clinically effective and safe. This qualitystandard and accompanying clinical guidance aimto ensure that patients have an excellentexperience of care from the NHS.

The new quality standard for improving thequality of patient experience includes ensuringthat patients are given the opportunity todiscuss their health beliefs, concerns andpreferences in order to individualise their care. Italso states that patients have their physicalneeds (such as nutrition, hydration, personalhygiene and pain relief) and psychological

concerns (such as fear and anxiety) assessed. Inaddition the standard states that patients aremade aware that they have the right to choose,accept or decline treatment and these decisionsare respected and supported.

NICE has also published accompanyingclinical guidance on patient experience in adultNHS services. This guidance promotes person-centred care that takes into account a patient'sneeds, concerns and preferences. It acknowledgesthe value patients place on healthcareprofessionals acknowledging their individualityand the unique way in which each personexperiences a condition and its impact on theirlife. The guidance therefore makes a number ofrecommendations on knowing the patient as anindividual, essential requirements of care, andenabling the patient to actively participate intheir care.

The quality standard and guidance are availableon the NICE website: http://www.nice.org.uk/guidance/qualitystandards/patientexperience/home.jsp and http://www.nice.org.uk/cg138

New Support for Malnutrition Report

The report, launched in February, highlightsthat too many families are struggling to copewith the lack of nutrition advice and supportcurrently available, and are sometimes left toface the serious consequences of malnutrition.

Malnutrition, however, is largelypreventable and Carers UK is calling for actionto improve nutritional support offered to carersand the people they care for. Support for CarersUK’s call for action has come from the chiefexecutives of the British Dietetic Associationand BAPEN, Baroness Greengross and CareServices Minister Paul Burstow MP.

Dr Tim Bowling, Chair of BAPEN, said:"BAPEN fully supports Carers UK call for threespecific actions that will support carers torecognise the risk of malnutrition early and toensure appropriate advice and nutrition care

planning are available where required. Carersmust be supported to provide good nutritionalcare for their relatives and action is urgentlyneeded to promote nutritional screening incommunity settings with access toappropriately trained healthcare professionals.

A joint national nutrition strategy isrequired and BAPEN is committed to co-authoring such a strategy with the Departmentof Health and a coalition of national partnersworking in the field of malnutrition. We lookforward to working with Carers UK to tacklethese problems effectively and put an end toavoidable malnutrition."

The full research report can be read at:http://www.carersuk.org/professionals/resources/research-library/item/2461-malnutrition-and-caring-the-hidden-cost-for-families

‘Malnutrition and caring: The hidden cost for families’, a report from Carers UKin conjunction with Nutricia, has won support from parliamentarians andnutrition professionals.

NICE Publishes New Quality Standard and Guidanceon Patient Experience in NHS ServicesNICE has published a new quality standard and guidance on patient experience in adultNHS services.

Create a direct link tothe 'MUST' Calculatoronto your desktop!If you are a regular user of the ‘MUST’Calculator, or would like to have a directlink to it for ward staff to use, then thisnew facility is for you. However, talk toyour Trust IT department first and see ifthe link can be added onto desktops onwards and any computers in yourdepartment. When you visit the ‘MUST’Calculator page (http://www.bapen.org.uk/must-calculator.html) on the BAPENsite, you will now see a little BAPEN logositting next to the site URL in yourbrowser. If you click on it you can dragand drop it straight onto your desktopscreen. A box will appear on yourdesktop which then acts as a direct linkto the ‘MUST’ Calculator page –meaning no more surfing through theBAPEN site pages to get straight towhat you need. Why not see if this canbe done where you work.

3

What’s New


• Mortality for patients admitted with UChas halved over the 3 rounds of the audit

• Readmission rates have lowered• The percentage of patients being seen by

an inflammatory bowel disease (IBD) nursespecialist during their admission hasdoubled since the first round.

There is however still room for improvement,particularly in the following areas:• More patients need to be tested for infections,

including Clostridium Difficile (CDiff) • All patients should be given heparin where

appropriate to prevent blood clots• More patients should see a specialist IBD nurse

during their stay in hospital, who can adviseand screen patients if anti-inflammatorytreatment (Anti-TNF) is prescribed

• All CD patients should see a dietitian toprevent malnutrition

• Patients should receive more help to giveup smoking and stay stopped to preventthe risk of worse outcomes.

Inflammatory bowel disease is increasing and nowaffects one in 200 people in the UK, with profoundlife changing effects. The total cost of IBD to theNHS was estimated at £720 million in 2006.

The UK IBD Audit (2010) is commissionedby the Healthcare Quality ImprovementPartnership (HQIP) as part of the NationalClinical Audit and Patient OutcomesProgramme (NCAPOP) with additional fundingfrom Healthcare Improvement Scotland. Theaudit is co-ordinated by the ClinicalEffectiveness and Evaluation unit (CEEu) of theRoyal College of Physicians of London onbehalf of a collaborative partnership betweengastroenterologists (the British Society ofGastroenterology), colorectal surgeons (theAssociation of Coloproctology of Great Britainand Ireland), patients (Crohn’s and Colitis UK),physicians (the Royal College of Physicians ofLondon) and paediatric gastroenterologists (TheBritish Society of Paediatric Gastroenterology,Hepatology and Nutrition).

The 2010 audit covered over 3,000 patientsadmitted with each condition. Whencomparing results from hospitals whoparticipated in the previous two audits, 2,000admissions each for UC and CD were directlycomparable and their data is used here:Ulcerative colitis key findings: • The amount of people dying from UC has

reduced by half since 2006 (1.7% to 0.8%)• The percentage of people admitted to hospital

in the two years before the audited admissionhas reduced from 51% to 34%, most likely asa result of more responsive outpatient services

• Stool samples are now being sentsignificantly more frequently for bothStandard Stool Cultures (SSC), (66% to 81%)and Clostridium Difficile Toxin (CDT), (54% to75%) for UC patients admitted with diarrhoea

• There has been a significant reduction inthe number of stool samples positive forCDT (4.2% to 1.6%) for patients admittedwith diarrhoea in 2010.

• Prophylactic Heparin is being prescribedmore frequently (54% to 87%). 2%(66/3049) of patients had a blood clotduring their admission in the third round

• The prescription of bone protection for patientsdischarged on steroids has increased (41% to70%) as recommended in the BSG Guidelinesfor the management of IBD in adults.

Crohn’s disease key findings:• The use of Anti-TNF therapy for patients

admitted with CD has doubled over 3rounds but use remains at a relatively lowlevel overall (3.9% to 8%)

• For CD there has not been the sameincrease as observed for UC in the rates ofstool samples sent for Standard StoolCultures and Clostridium Difficile Toxin inpatients admitted with diarrhoea, in factthe rates increased between rounds 1 and 2and decreased in round 3

• 34.7% of patients with IBD were taking 5-ASA (anti-inflammatory) drugs, but theseare only effective in UC, not CD

• 63.3% of patients in 2010 (1978/3122)were not taking any form of immuno-suppressive drugs on admission, so aremissing an important form of treatment

• Significantly more patients are being weighedduring their admission (51.4% to 74.7%)

• The number of patients seen by a dietitianduring their admission has continued torise across rounds but remains at a low rateoverall (35.8% to 39.7%)

• Just under a third of patients with CDadmitted to hospital are smokers. This hasnot changed over the 3 rounds of the IBDAudit (31.5% to 31%).Dr Ian Arnott, Consultant Gastroenterologist,

Western General Hospital and UK IBD AuditClinical Lead, said: “The third round of the UK IBDaudit has demonstrated very significantimprovement in the care of IBD patients. Theaudit is widely supported by clinicians fromaround the UK and clinical teams have workedhard to realise these gains. Further rounds of theaudit are needed to encourage and promotefurther improvement in the quality of care forpatients with IBD.”

Crohn’s and Colitis – Care improving but servicesfall short in key areasThe third round of the UK Inflammatory Bowel Disease Audit, carried out in 2010, showsthat care for patients with ulcerative colitis (UC) and Crohn’s disease (CD) has improvedacross a wide range of measures since the previous two rounds in 2006 and 2008.

Following Support ofDignity Action Day TheNACC Announce a NewPublication that will ensureDignity through Mealtimes

Produced in collaboration with the EnglishCommunity Care Association (ECCA), thepublication embeds nutritional wellbeing with bestpractice. It is a valuable resource document, packedwith information, guidance and practical tools, andfocuses on the importance of mealtimes as part ofthe care service, as well as nutritional content.

The NACC supports the aims of Dignity ActionDay to ensure that people in care are alwaystreated as individuals, and are given choice,control and a sense of purpose in their daily lives.It recognises that mealtimes are significantoccasions for those receiving care, both physicallyand emotionally, and the manner in which theyare organised and delivered is vital in ensuringthat dignity is upheld.

Martin Green, Chief Executive, ECCA,comments: “Everyone has a role to play inensuring that mealtimes are enjoyableexperiences for those in receipt of care services.The social aspect is as important as the nutritionalcontent, and they should not be task orientated.Only by the mealtime being person centred candignity be ensured. If it is enjoyable then,ultimately, the nutritional care will be excellent. Anenjoyable meal recognises what people want, andhow, where and with whom they want it.”

Karen Oliver, Chair, NACC concludes: “TheCare Quality Commission’s (CQC) EssentialStandards of Quality and Safety are clear. Dignityis a core component of any provision of care andinspectors will certainly expect providers of healthand social care to demonstrate their compliance.Our publication offers care professionals apractical resource that will help them meet thesestandards and ensure that mealtimes succeed inproviding both nutritional wellbeing and dignity.”

For further information: www.thenacc.co.uk

Dignity Action Day (held this year on 1stFebruary 2012) spotlights the importanceof continually upholding the dignity ofpeople receiving care. The new publicationfrom the National Association of CareCatering (NACC) – How to Comply withCQC’s Outcome 5: Nutritional Needs –offers all community and residential socialcare providers the tools and know-how toensure dignity through mealtimes.

BAPEN Nutricia Research Fellowship Award

2008BBAAPPEENN NNuuttrriicciiaa

GGoooodd PPrraaccttiiccee AAwwaarrddss 2012

Gold£2000Silver

£1000Bronze

£500

5

BAPEN Executive

Meet the 2012 BAPEN Executive Team

Introducing…Dr Tim Bowling – BAPEN Chair

Tim has been a member of BAPEN Exec for anumber of years in the positions of HonorarySecretary and Chair Elect. Tim is a Consultant inGastroenterology and Clinical Nutrition atNottingham University Hospitals. He runs theclinical nutrition service and a nine-beddedintestinal failure unit and spends much of histime looking after acute type 1 and 2 intestinalfailure patients, originating both from his localsurgical wards and from further afield. He alsoruns the home TPN service. His academic interestsall lie within nutrition support and concentrate onthe physiological responses to enteral feeding. Hehas published over 60 papers, has edited books onnutrition in cancer and on nutritional support andlectures widely. Work is well underway to deliverBAPEN’s 2012 objectives, which include thedevelopment of the new BAPEN website, clinicalguidance for frontline teams and deliveringimproved membership benefits in addition to thepolitical work that is ongoing.

Ailsa Brotherton – BAPENHonorary Secretary

Ailsa joined BAPEN Exec at the AGM in 2010. Shewas Head of Acute Dietetics at the LancashireTeaching Hospital NHS Trust before taking up thepost of Senior Research Fellow at the Universityof Central Lancashire. She has recentlyundertaken a secondment to the Department ofHealth's QIPP Safe Care workstream which hasdelivered a national improvement programmewith a focus on nutrition and hydration. Inaddition to the secretarial role, Ailsa is a memberof BAPEN’s Quality Group and is involved indeveloping national nutrition policy andappropriate system levers. Ailsa is also Editor ofthe Journal of Human Nutrition and Dietetics.

Dr Simon Gabe – BAPENHonorary Treasurer

Simon is BAPEN’s Honorary Treasurer andCaldicott Guardian. He was a regionalrepresentative for BAPEN in 1999 and Chair of theRegional Representatives from 2003-6. In 2005,he became an Executive Officer, until 2008 whenhe started as Treasurer.

Simon is a Consultant Gastroenterologist atSt Mark's Hospital in Harrow. He co-Chairs thenationally commissioned Intestinal Failure Serviceat St Mark’s, one of two centres in the UK fundedto provide this service. Dr Gabe has a wide clinicalexperience in dealing with complex inflammatorybowel disease, especially with fistula developmentas well as intestinal failure, clinical nutrition,home parenteral nutrition and consideration ofintestinal transplantation. Simon also co-Chairsthe National Adult Small Intestinal Transplant(NASIT) forum and is an Editor of Proceedings ofthe Nutrition Society Journal.

Dr Tim Bowling

Dr Ail

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Dr Simon Gabe


BAPEN Executive

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With the new BAPEN Executive Team now in place, it’s now only apt that we introduce each

BAPEN Executive and what role they have in moving BAPEN forward throughout 2012.

Dr Nicola Simmonds –Treasurer Elect

Nicki has worked as a ConsultantGastroenterologist with an interest in Nutrition atthe Luton & Dunstable Hospital since 1996. Untilrecently, she led the Nutrition Support Team(which won the NHS Team of the Year award in2000) and chaired the Nutrition SteeringCommittee in Luton, dealing with all aspects ofnutrition care in the hospital. She has had aninterest in training junior doctors in nutrition andin ethics in relation to nutrition and has spokenon the subject at the BSG and Leeds course inClinical Nutrition.

Nicki was introduced to BAPEN when it wasfounded in 1992 and, in recent years, has been amember of the Education and Training Committee,Honorary Secretary of BAPEN Medical, has writtenthe educational modules for junior doctors thatare currently available on the BAPEN website(http://www.bapen.org.uk/elearning/), and beeninvolved in the BAPEN quality group and writingthe commissioning toolkit. Nicki is currentlyTreasurer Elect of BAPEN due to step into the roleof Treasurer at this year’s AGM and is also leadingthe development of the new BAPEN website onbehalf of BAPEN Exec.

Andrea Cartwright – HonoraryOfficer: Membership

Andrea is taking a lead role for membership onBAPEN Exec in 2012 and is a Nutrition NurseSpecialist at Basildon and Thurrock UniversityHospitals NHS Foundation Trust. She has a BSc(Hons) in Nutrition Support, is a registeredSpecialist Practitioner in Adult Care and a NurseIndependent and Supplementary Prescriber.Andrea was Chair of the National NursesNutrition Group (NNNG) 2006 – 2009 and hasrepresented the NNNG on BAPEN Council since2001 as both NNNG Secretary and Chair. Andreahas been involved in many national workingparties, most notably the NICE nutrition supportguidelines (2006), and The Royal College ofPhysicians Feeding Oral Dilemmas (2010). If youhave any requests for particular membershipbenefits or ideas for the BAPEN membership drivethen please contact Andrea via the BAPEN Office([email protected]).

Dr Sheldon Cooper – HonoraryOfficer: Education and Training

Sheldon is a Consultant Gastroenterologist andNutrition Lead at the Dudley Group NHS FoundationTrust in the West Midlands. During specialist trainingin the West Midlands he completed a Mastersdegree in Nutritional Medicine at the University ofSurrey. Subsequently, he has undertaken an MDexamining the aetiology of oesophagealadenocarcinoma, currently being written up.

Sheldon took over the Dudley Home ParenteralNutrition service in 2009 when first appointed, andhas now developed this into an Intestinal FailureUnit, currently looking after 35 to 40 HPN patientsin the West Midlands. He also holds an honorarycontract as a visiting consultant with one of thenational intestinal failure units in Salford. Otherclinical interests include inflammatory bowel disease– Sheldon co-leads a wireless capsule endoscopyand double-balloon enteroscopy service – inaddition to intestinal failure and clinical nutrition.

In 2009, he became a member of the BAPENMedical Committee (now ex-officio) and in 2010joined the BAPEN Education and Training (E&T)Committee, becoming chair later that year. BAPENMedical responsibilities include organising thePowell-Tuck Prize, a new venture to encouragetrainee doctors to produce quality nutritionresearch, along with sitting on the BAPENProgrammes Committee and BAPEN Council. Thisled to Sheldon being elected to BAPEN Executive in2011, and he is leading the development of BAPENnutrition guideline production.

Dr Nic

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Dr Sheldon Cooper


BAPEN Executive

Wendy-Ling Relph – HonoraryOfficer: Communications

Wendy is currently Matron for Nutrition andQuality at East Kent Hospitals University NHSFoundation Trust. Over the last four years she hasbeen a founding member of the lead group forimplementing Essence of Care and sharing bestpractice across the Kent Health Economy. Sheleads on nutritional issues throughout the Trust,but is also involved in leading improvements byembedding the concepts within the nationalprogrammes of Harm Free Care and theProductive Wards.

Wendy has led multi-disciplinary teams,including patients and their representatives todescribe the Nutritional Quality Strategy for EastKent Acute Trust, along with setting up aNutritional Steering Group and OperationalGroups, ensuring clear lines of responsibility andaccountability from ward to board. She iscurrently working with the Community Teams todescribe and embed a cross-boundary nutritionstrategy for East Kent. Wendy is leadingCommunications for BAPEN and will be focusingon both internal and external communicationsand working closely with Helen Lawn Associates,BAPEN’s new PR Media Company.

Dr Trevor Smith – HonoraryOfficer: Data and measurement

Trevor is a Consultant Gastroenterologist workingin Southampton and, together with Dr MikeStroud, leads a clinical nutrition and regionalintestinal failure service. Trevor chairs the BritishArtificial Nutrition Survey (BANS) and is amember of BAPEN Council. He is also a member ofthe British Society of Gastroenterology smallbowel and nutrition committee and the BritishIntestinal Failure Alliance (BIFA). Trevor will leadon data and measurement for BAPEN; in additionto exciting developments within BANs, BAPEN isfocusing on nutrition ward to board dashboarddevelopment and exploring national datacollection options for measuring performanceand quality improvements in nutritional care.

Contact the Executive Team

Honorary ChairDr Tim BowlingEmail: [email protected]

Honorary TreasurerDr Simon GabeEmail: [email protected]

Honorary SecretaryDr Ailsa BrothertonEmail: [email protected]

Treasurer ElectDr Nicola SimmondsEmail: [email protected]

Honorary Officer: MembershipAndrea CartwrightEmail: [email protected]

Honorary Officer: Education & TrainingDr Sheldon CooperEmail: [email protected]

Honorary Officer: Data & MeasurementTrevor SmithEmail: [email protected]

Honorary Officer: CommunicationsWendy-Ling RelphEmail: [email protected]

Wendy-Ling Relph Dr

Trevor

Smith

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B A P E NAdvancing Clinical NutritionRegistered Charity 1023927




BAPEN Conference

Sunday 17th is the DDF postgraduate day and the nutrition highlights willbe the BAPEN Medical study day and a debate featuring the current andformer BAPEN Chairs. The BAPEN Medical study day will be an all-encompassing look at nutrition in liver disease with UK experts coveringsubjects from nutritional assessment, micronutrients and macronutrients,in and outpatient hepatic disease, peri-liver transplant to non-alcoholicfatty liver disease (NAFLD) – including a debate on surgical versus medicalmanagement of this condition. The main DDF teaching session will alsofeature a key debate with Dr Mike Stroud taking on Dr Tim Bowling onparenteral versus enteral nutrition in the critically ill. Hopefully Mike will beconvincing us that we don’t need to worry about Greet Van den Berghe’slatest theory that TPN is very bad because it interferes with apoptosis.

Monday 18th June will be the start of the main BAPEN Conference,with the morning giving us an update of BAPEN news from Dr Tim Bowlingand other key figures, some examples of good practice and an unmissablePennington Lecture from Professor Marinos Elia – with the evocative titleof ‘Money Matters’.

The afternoon sessions are an absolute must for anyone involved inartificial nutritional support. In ‘Doing it Safely – Enteral Nutrition’, DrSheldon Cooper will give us a case-based session to answer all those difficultquestions on the finer points of managing refeeding syndrome. Delegateswill then learn how to deal with anything that can go wrong with a PEG frommajor problems such as pain, bleeds and buried bumpers to minor ones likesoreness, granulomas and those common and irritating blockages.

PETE TURNERChair of BAPENProgrammes Committee

The Digestive Disorders Federation (DDF) Conference will feature no less than four days of the very latest in clinical nutrition in the mainBAPEN symposia and those organised with the other DDF partners – the British Society of Gastroenterology (BSG), the Association of UpperGI Surgeons (AUGIS) and the British Association for the Study of the Liver (BASL). Starting on Sunday 17th June with the BAPEN Medicalstudy day and finishing on Wednesday 20th with a joint BAPEN BSG symposium on dietary fibre, the conference represents fantastic valueat only £55 per day for BAPEN Members (rate for BAPEN Nurses and AHPs who register for the event between 01/03/2012 – 14/06/2012).All this and the opportunity to explore the vibrant and historic city of Liverpool!

BAPEN at DDF Why you simply must go!

Sunday 17th June – Wednesday 20th June 2012

Arena Convention Centre (ACC), Liverpool

8 BAPEN In Touch No.64 March 2012

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BAPEN Conference


Critical care and parenteral nutrition (PN)aficionados will welcome The Nutrition Societysymposium ‘Immunonutrition and NovelSubstrates’ as it will feature omega 3 guruProfessor Philip Calder giving us an update on thepros and cons of the vast range of differentparenteral lipid emulsions now available. The stateof the art PN theme will continue in ‘Doing itSafely – Parenteral Nutrition’ which will featureno less than the internationally renowned JosephBoullata, Professor of Pharmacology andTherapeutics at the University of Pennsylvania,telling us about ‘Risk Management in PN – TheUS perspective’. Prescribing, compounding andmonitoring of PN will be covered in detail byPharmacist Jackie Eastwood before a subject thatshould be close to the heart of all nutrition teamsis tackled by Nurse Consultant Alison Young –‘Avoiding Catheter Related Sepsis’. The patient’sperspective will not be forgotten with PINNT’sRichard Shawyer giving the low down on what it’sreally like to manage PN at home.

‘Feeding Decisions at the End of Life’ willfocus on some the most difficult decisions facingnutrition teams and anyone working with artificialnutrition. This will include use of PN at the end oflife, when to stop feeding and the use of PEGs inlearning difficulties. Monday will finish with aclassic BAPEN themed Annual Dinner at theCrowne Plaza Hotel.

The second day of the main BAPENConference will have a strong gastro andenhanced recovery from surgery feel but will stillfeature many crucial subjects in nutritionalsupport. It will certainly be worth getting up earlyto attend ‘Feeding in Chronic Conditions’.Dietitian Jen Warburton will look at the challengeof providing adequate nutrition within thecontext of the dietary restrictions often imposedon patients with chronic kidney disease –including some controversial topics such asintradialytic PN. Sinead Duggan, Vice Chair of thePancreatic Society Nutrition Interest Group, willlook at effectively treating the malnutrition oftenassociated with chronic pancreatitis beforeProfessor Marinos Elia looks at some newevidence for feeding in COPD.

Diet can be an effective treatment for manycommonly encountered gastroenterologicalconditions and ‘Dietary Management of GIDisorders’ will give the very latest evidence andexpert opinion. Dietitian Lucy Goddard will look atincidence, diagnosis and management of lactoseintolerance before dietitian Miranda Lomer givesan overview of the many dietary interventionsavailable for treating IBS. Professor Jonathan

Rhodes, President of the BSG, will give us afascinating look at the possible role of dietaryemulsifiers in the pathology of Crohn’s diseaseand how artificial nutrition can induce remission.

Nutrition Strategies and the latest guidelinesfor treating malnutrition will be detailed inOrganisation of Nutritional Care. This will includethe launch of the BAPEN and BDA guidelines onFood and Oral Nutritional Supplements and thelatest on improving outcomes through food andbeverage services.

Paediatrics has not been forgotten – theBritish Society of Paediatric Gastroenterology,Hepatology and Nutrition have dedicated thewhole of symposium 9 to current issues inpaediatric nutritional care.

Symposium 10 should prove quite interesting!In ‘QI Nutrition’ the most challenging, bafflingand controversial questions in clinical nutritionwill be put to two teams of nutritional academicscaptained by Dr Mike Stroud and Dr Tim Bowling.

The pioneer of preoperative carbohydrateloading professor Olle Ljungqvist will give twolectures on Tuesday – the first in the DDF plenarysession will be entitled ‘Best Peri-operativeNutrition’. The second ‘Surgery, Nutrition andERAS’ will round off Tuesday and the main BAPENconference. Enhanced Recovery After Surgery(ERAS) programmes are being introducedthroughout the NHS and this provides a fabulousopportunity for anyone involved in them to see apresentation from a man who was at the forefrontof its development in Scandinavia.

Although the main BAPEN conferencefinishes on Tuesday, Wednesday will feature somejoint BAPEN BSG symposia that are well worthattending. ‘Dietary Fibre – The good, the bad andthe ugly’ will cover everything you wanted toknow about fibre – where it comes from, thedifferent types, what they do in the gut and howto use them clinically. There will also be someexcellent joint DDF sessions on ‘Intestinal Failure’and ‘Chronic Intestinal Pseudo-obstruction’featuring the leading UK experts.

In conclusion, the aims of the DDF areperhaps best summarised by Professor JonathanRhodes, President of the BSG: “Nutrition ishugely important to gastrointestinal and liverhealth but often overlooked. This joint DDFmeeting between BAPEN, BSG, BASL, AUGIS andwith involvement from BSPGHAN…provides awonderful opportunity to remedy this and tostimulate interaction, education and research.”With up to 4,000 attendees anticipated, the DDFoffers delegates the chance to be involved inraising the profile of nutrition in patient care.

17-20 JUNE 2012 | ACC, Liverpoolin association with BSG, AUGIS & BASL combined as theDigestive Disorders Federation (DDF) Conference

2012BAPEN MEETINGddf

DIGESTIVEDISORDERSFEDERATION

Are you a Doctor, Dietitian, Nurse, Pharmacist, Scientist with an interest in digestive diseases, nutrition, bariatrics? Then don’t miss the unmissable – DDF 2012.

DDF 2012 is the UK collaborative meeting which brings together the UK’s leading organisations specialising in digestive diseases and nutrition, including BAPEN.

Daily delegate rate as little as

£55 for BAPEN Members*

*Rates for BAPEN Nurses and AHPs who register

For BAPEN@DDF programme visit:

www.bapen.org.uk/2012programme.pdf

For full DDF programme and to register to attend visit: www.ddf2012.org.uk

Image courtesy of The Mersey Partnership / Visit Liverpool

registration fees for BAPEN members

Not a member of BAPEN?Join at www.bapen.org.uk/join.html

4 organisations, 4 days, one venue:

Leading experts discuss key digestive and nutritional issues

High impact multi-professional symposia

State of the art lectures

Over 1,000 abstracts

BAPEN symposia plus combined symposia explore:

Enteral and Parenteral Nutrition – Safe care

Dietary Management of GI Disorders

Ethical Dilemmas in Clinical Nutrition: Consent, End of Life, Dementia

Nutritional Care in the Community

Dietary Fibre – The good, the bad and the ugly

Intestinal Failure, Immuno-nutrition and Pseudo-obstruction

Nutrition in Liver Disease

Bariatrics

National Strategy for Nutrition

11

Core Group Updates

RUTH MCKEEChair BAPEN Medical

We are running a taught course on NutritionalSupport at the Association of Surgeonsmeeting in Liverpool on Thursday 10th May.This aims to cover the essentials of nutritionalsupport in surgical patients and will includethe aspects of nutrition from the GI surgerysyllabus. Please let your local surgeons knowabout this!

BAPEN Medical Teaching Day will takeplace on Sunday 17th June at the DDFmeeting, also in Liverpool. The topic is

Nutrition and Liver Disease, and includes avariety of topics from nutritional assessmentto management of NAFLD and nutritionalmanagement of both stable and unstable liverdisease patients.

BAPEN Medical has a combined meetingwith the Pancreatic Society of Great Britainand Ireland on Thursday 15th November atCameron House, Loch Lomond. Chronicpancreatitis is one of the major topics to beaddressed, but nutritional support in the

perioperative period in pancreatic cancer willalso be discussed and the difficult problem ofmaintaining nutrition in severe pancreatitis.

We welcome Jamil Aqeel to the committeeof BAPEN Medical. The committee met at theend of February where we discussed e-learning to cover nutrition in thegastroenterology syllabus.

The abstracts for the Powell Tuck prizehave been submitted and are currently beingscored. Plan ahead to enter next year.







BAPEN Medical

KATE HALLCommunications Officer PEN [email protected], www.peng.org.uk

PEN Group – supporting excellence in nutritional care

Membership: March 2012 has come around veryquickly! We are now into the 2012/13 PEN Groupmembership year and it is time for all members torenew their membership and for us to welcome anynew members for this new year. PEN Groupmembership renewal or annual subscription remainunchanged this year £20 inc. VAT. The benefits ofbecoming a member of PEN Group include: • Subsidised rates at the PEN Group meetings• Subsidised rate for the Pocket Guide to

Clinical Nutrition• Clinical meetings at reduced price for

members• Reduced cost of BAPEN membership, plus

dietetic representation at BAPEN• Min 2 copies per year of PENlines – electronic

update• Abstracts from meetings and clinical reviews• Access to the PEN Group membership section

of the website www.peng.org.uk – currentlybeing updated to make it more interactive formembers and meet members needs

• Facility to ask fellow PEN Group memberstheir best practice or advice through themembership email address

• CPD opportunity to serve on the committeeor work on individual projects for BAPEN /the dietetic profession

For dietitians to become a new PEN Groupmember or renew membership please go to thePEN Group website www.peng.org.uk or contactthe committee [email protected] – newmembership year begins March 2012.

PEN Group website: New for 2012 will be areaswithin the member's section of the PEN Groupwebsite such as a dietetic outcomes project –alluded to at our November 2011 PEN Groupmeeting. Look out for more news on this project inthe coming months. We are also in the process ofsetting up a best practice forum on the member'ssection of the PEN Group website so member'sneed to keep a watchful eye over the comingmonths. In the meantime please email us with anyexamples or case studies at [email protected].

A new voting system has been set up on themember's section of the PEN Group website.Voting is currently on topics to focus on inarticles for Dietetics Today. Each month we hopeto change the voting theme with the aim ofkeeping in touch with PEN Group member's needsand views.

Dietetics Today: PEN Group are pleased to becovering some dietetic articles in this year'sDietetics Today (DT), this is a great opportunityfor us to showcase some of the work thatmembers are involved in and focus specifically ontopics that are of particular interest to PEN Groupmembers – if you would like to contribute or havesome suggestions for topics please contact us [email protected]. The first contribution toDietetics Today is entitled 'Nutritional Support -360 degree journey' and will be in the Marchedition of DT.

Pocket Guide to Clinical Nutrition: New edition(4th) now available to order through the PENGroup website www.peng.org.uk.


12

Core Group Updates


LIZ EVANS Chair NNNG

NNNG

BAPEN ReportsBAPEN are continuously working as an Association, and with otherlikeminded Associations, to collate information and produce reportson current nutritional issues affecting hospital, community andsocial care. BAPEN has recently produced a number of new reportsthat are now available to purchase or download via the BAPENoffice and website.

Reports• Annual BANS Report 2011• Improving Nutritional Care & Treatment: Perspectives &

Recommendations from Population Groups, Patients & Carers• Combating Malnutrition: Recommendations For Action• Nutrition Screening Week 2010 Results• Malnutrition in Sheltered Housing Report• British Consensus Guidelines on Intravenous Fluid Therapy

for Adult Surgical Patients - GIFTASUP

For further information, or to order a BAPEN Report, simply visit the publications section of the BAPEN website: wwwwww..bbaappeenn..oorrgg..uukk//rreess__ppuubb..hhttmmll – order online, or contact the BAPEN office on: 0011552277 445577 885500

This year is going to be a very busy and excitingone for the NNNG. Since the launch of our newwebsite in November 2011 there has been a lot ofinterest in the site. In the first three months it had574 visits. With a ‘member’s only’ facility, it is fullof the latest news and views and will host policydocuments relating to the field of nutrition.

It also means that, for the first time, ourmembers can renew their subscription online,which is proving to be an instant success;generating 62 per cent of our membershiprenewals online as opposed to the moretraditional method of renewal via cheque orstanding order. We have also seen an 11 per centincrease in new members this year.

This year represents the beginning of a newinitiative for the NNNG – the development ofpractice guidelines aimed specifically at nursesworking in the field of nutrition. The aim of theseguidelines is to provide a concise and easy tonavigate reference tool for nurses to refer to whendeveloping or renewing nursing nutritionalprotocols or policies. The first two guidelines to bedeveloped will look at fine bore nasogastric tubeinsertion and replacement gastrostomy tube

insertion. The first of these guidelines to bedeveloped will be Safe Insertion of Nasogastric(NG) Feeding Tubes in Adults, which will bepublished via the NNNG website on 12th March. Insupport of these guidelines, the NPSA are planningto set up a webinar to promote them followingtheir release to all our members. The plan is to thenfollow up with releasing the balloon gastrostomyguidelines by late spring 2012.

To strengthen the work the NNNG is currentlyundertaking to inform its membership and raiseawareness of the nursing role in nutrition, we areforging close links with national agencies,including the RCN Gastroenterology forum andthe RCP Nutrition committee.

We will be working with the RCNGastroenterology forum to present an interestingprogramme on the Nursing Day at the UKDD weekin June, where sessions including discussingwhether there is a need to regulate Specialist andAdvanced Practice and ‘Listening to the patientvoice’ will be held.

At the request of the RCP Nutritioncommittee we have put forward a member of theNNNG to represent nutrition in nursing and

review proposed publications.We will be holding our own conference on

29th and 30th October this year in ManchesterTown Hall and are pleased announce that CarolineLecko from the NPSA will be delivering our keynote speech. Caroline will be exploring the impactthat the NPSA alert regarding misplacednasogastric feeding tubes in adults and children(March 2011) has had on clinical practice andupon patient safety. The programme is currentlybeing finalised and we hope to be able to releasea programme shortly.

We are sad to say goodbye to Tracy Earleywho, due to an increasingly heavy workload, hasregretfully decided to step down from theCommittee. We are grateful to Tracy for all thework she has done for the NNNG but fully supporther decision. We wish her well in the future andlook forward to seeing her at conference this year.

Finally, the NNNG is only as good as itsmembers and I think it is fair to state that we arevery fortunate to have such a dynamic group ofpeople within our membership who are keen toshare their ideas and problem solve on our forum.We look forward to another successful year ahead.

Diary Dates


5th Pan London Regional BAPEN MeetingDate: Tuesday 15th May 2012Time: 1.30pm-6pmVenue: Kings College London (Waterloo Campus)

The programme includes:

• 'Abnormal LFTs and home parenteral nutrition' – A case presentation and expert panel discussion

• An integrated care pathway for nutrition in Lambethand Southwark

• Home parenteral nutrition commissioning update • Regional AGM and BAPEN Update • Keynote presentation: 'Paediatrics: early experiences

with small bowel transplantation'

For more information please contact regional secretary:[email protected]







Recipe Analysis: Maximising AccuracyDates & venues: 12th April 2012: Kings College London19th April 2012: Kings College LondonWebsite: www.nutritionandwellbeing.co.uk/training/recipe-analysis

ESPGHAN Update 2012 Date: 27th & 28th April 2012 Venue: Stockholm, Sweden Website: www.espghan2012.org

The Allergy & Free From ShowDate 18th – 20th May 2012Venue: Olympia, LondonWebsite: www.allergyshow.co.uk

The International Scientific Conference onProbiotics and Prebiotics - IPC2012 Date: 12th - 14th June 2012 Venue: Kosice, Slovakia Website: www.probiotic-conference.net/Conference

Nutrition Society Summer Meeting 2012Translational nutrition: integrating research,practice and policy Date: 16th – 19th July 2012Venue: Queen’s University BelfastWebsite: www.nutritionsociety.org

34th ESPEN Congress Date: 8th – 11th September 2012 Venue: Barcelona, Spain Website: www.espen.org

BAPEN South Region Meeting Date: 17th September 2012 Venue: Paultons Park, Hampshire Email: [email protected]

American Dietetic Association – Food &Nutrition Conference & ExpoDate: 6th – 9th October 2012Venue: Philadelphia, USAWebsite: www.eatright.org/fnce

Fundamentals of Parenteral Nutrition Date: 24th April 2012 Venue: Regents College, LondonEmail: [email protected]: www.bpng.co.uk

Topics include:• Indications in Adults• Ethical Considerations in Adults• Indications in Children• Adult Requirements• Monitoring Nutrition Support• Interactive Case Presentations• Access for PN• Stability in PN

BPNG

2013Clinical Nutrition Week 2013Date: 9-12 February 2013Venue:Phoenix, ArizonaWebsite: www.nutritioncare.org/ClinicalNutritionWeek

14

Diary Dates

The clinical Update Course is a 7-month course aimed atexperienced dietitians working predominantly innutritional support. The course is taught at master’s leveland on successful completion delegates will be awardedwith 15 maters levels credits (equivalent to one module)from Queen Margaret University, Edinburgh.

The course starts in March, when pre-course work issent out, and ends in September when the post-courseassessment is submitted. Full details of all specific datesare detailed on the PEN Group website, and via thefollowing link: http://www.qmu.ac.uk/dn/default.htmat Queen Margaret University.

The residential week will be Monday 25th June –Thursday 28th June 2012 at Queen Margaret University,Edinburgh, more details to be found at the followingaddress: http://www.qmu.ac.uk/prospective_students/location_in_edinburgh.htm

The residential section of the course will start at9am on Monday 25th June and 4 nights self cateredaccommodation is included in the cost commencingSunday the 24th June 2012.

Cost: The cost of the course has been maintainedfor a further year:• £950, including accommodation • £850, without accommodation. N.B. accommodation price is based on self catered campusaccommodation, breakfast and evening meal are not provided. Thereare facilities to prepare your own meals and local shops nearby.Lunch and refreshments are provided during the teaching days.

Applications opened 1st October 2011 and places areallocated on a first come first served basis on receipt ofcompleted application form, manager’s form, and fullpayment. In the first instance, please submit to:[email protected] N.B. places are restricted to dietitians who will have beenworking for 2 years from the date of application, i.e. qualifiedbefore Sept 2010.

Application forms can be downloaded from the PENGroup website and also from the link found on thefollowing page: http://www.qmu.ac.uk/dn/courses/PEN-info.htm. Further information on the course anddetails on how to apply for the course can be found atthe PEN Group website (www.peng.org.uk) by clickingon Clinical Update.

Any further queries please contact:[email protected]


BAPEN Medical Teaching Day in 2012 at DDF – Nutrition and Liver DiseaseDate: 17th June 2012Venue: LiverpoolWebsite: www.bapen.org.uk/ce_annual_conf.html

Topics to be covered:• Nutritional assessment of NAFLD• Management of NAFLD• Nutritional management of both stable and unstable

liver disease patients.

BAPEN Medical Combined Meeting withthe Pancreatic Society of Great Britainand Ireland Date: 15th November 2012Venue: Cameron House, Loch Lomond, Scotland

Topics to be covered:• Chronic pancreatitis• Nutritional support in the perioperative period in

pancreatic cancer• Maintaining nutrition in severe pancreatitis







PEN Group ClinicalUpdate Course

BAPEN Contacts

Executive CommitteeHonorary ChairDr Tim BowlingTel: 0115 919 4427Fax: 0115 875 4540Email: [email protected]

Honorary TreasurerDr Simon Gabe Tel: 020 8235 4089Fax: 020 8235 4001Email: [email protected]

Honorary SecretaryDr Ailsa BrothertonTel: 01772 895 114Email: [email protected]

Treasurer ElectDr Nicola SimmondsTel: 01582 497 519Fax: 01582 565 439Email: [email protected]

Honorary Officer – Membership Andrea CartwrightTel: 01268 593 112Fax: 01268 593 317Email: [email protected]

Honorary Officer – Education & TrainingDr Sheldon CooperTel: 01384 244 074 (Secretary)Fax: 01384 244262Email: [email protected]

Honorary Officer – Data & MeasurementTrevor SmithTel: 01202 726 179Fax: 01202 726 170Email: [email protected]

Honorary Officer – CommunicationsWendy-Ling RelphTel: 01227 866 466Email: [email protected]

Council MembersChair: BAPEN MedicalDr Ruth McKeeTel: 0141 2114 286 (secretary)Email: [email protected]

Liaison Officer: BSPGHANDr Susan HillTel: 0207 405 9200 Ext 0114Fax: 0207 813 8258Email: [email protected]

Chair: BPNGJackie EastwoodTel: 0208 235 4094 Fax: 0208 235 4101Email: [email protected]

Chair: BIFAProfessor Jeremy Powell-TuckTel: 0207 727 2528 Email: [email protected]

Chair: FacultyChristine RussellTel: 01327 830 012Fax: 01327 831 055Email: [email protected]

Chair: MAGProfessor Marinos EliaTel: 0238 079 4277Fax: 0238 079 4277Email: [email protected]

Chair: NNNGLiz EvansTel: 01296 316 645 Email: [email protected]

Chair: PENGAnne HoldowayTel: 01225 722 851Email: [email protected]

Chair: PINNTCarolyn WheatleyTel: 01202 481 625Email: [email protected]

Chair: Programmes CommitteePete TurnerTel: 0151 706 2121Fax: 0151 706 5840Email: [email protected]

Liaison Officer: The Nutrition SocietyProfessor Alastair Forbes Tel: 0845 155 5000 ext: 9011Fax: 020 7380 9699Email: [email protected]

Regional RepresentativesNorth East & Chair: Regional RepresentativesBarbara Davidson - Senior Dietitian Tel: 0191 244 8358 Email: [email protected]

ScotlandEmma Hughes – Specialist Dietitian (Renal)Tel: 01463 706 022Email: [email protected]

Northern Ireland Sarah-Jane Hughes - Chief Dietitian/Clinical Team Lead Tel: 02890 634 386Email: [email protected]

WalesWinnie Magambo - Nutrition Nurse Tel: 029 2074 6393 Email: [email protected]

North West Dr Simon Lal - ConsultantTel: 0151 529 8387Email: [email protected]

TrentMelanie Baker - Senior Specialist DietitianTel: 0116 258 6988 or bleep 4600 Email: [email protected]

West Midlands Alison Fairhurst (joint rep) - Nutrition SupportDietitian Tel: 01384 244 017Fax: 01384 244 017 Email: [email protected]

Sue Merrick (joint rep) - Dietitian & TeamLeader for Nutrition Support Tel: 01902 695 335Fax: 01902 695 630 Email: [email protected]

Thames Valley Marion O’Connor - Nutrition Support Dietitian Tel: 01865 221 702/3Fax: 01865 741 408 Email: marion.o’[email protected]

East AngliaJudith McGovern - Nutrition Nurse Specialist Tel: 01603 286 286 bleep 0554 or 01603 287 159 Email: [email protected]

North Thames Dr Andrew Rochford (interim Chair) – SpR GastroenterologyTel: 07946 411 973Email: [email protected]

South Thames Mr Rick Wilson - Director Dietetics & Nutrition Tel: 020 3299 9000 x2811 Email: [email protected]

South WestDr Stephen Lewis - Consultant GastroenterologistTel: 01752 517 611 Email: [email protected]

South Peter Austin - Senior Pharmacist Tel: 02380 796 090Fax: 02380 794 344 Email: [email protected]

South East Dr Paul Kitchen - Consultant Gastroenterologist Tel: 01634 833 838 • Fax: 01634 833 838 Email: [email protected]

Industry Representative Carole Glencorse - Medical DirectorTel: 01628 644 163 • Mob: 07818 427 905 Fax: 01628 644 510Email: [email protected]

To Contribute to In TouchFaye Eagle – PublisherComplete Media & Marketing Ltd.Tel: 01920 444 063 Fax: 01920 444 061Email: [email protected]

BAPEN Media EnquiriesHelen Lawn - DirectorHelen Lawn & Associates PR Ltd Tel: 01892 525 141Fax: 01892 682 733 Email: [email protected]

BAPEN OfficeBAPEN, Secure Hold Business Centre,Studley Road, Redditch, Worcs, B98 7LGTel: 01527 457 850 • Fax: 01527 458 718 Email: [email protected] Website: www.bapen.co.uk


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