Making Every Contact Count

Making the case

Overview of presentation

Background to MECC

Rationale for MECC

Operationalising MECC

Examples from practice

Background to MECCOriginally conceived as every clinical encounter, shifting the NHS

towards prevention, saving money (Wanless 2002, 2004).Healthy Lives Healthy People

Changing adults’ behaviour could reduce premature death, illness and costs to society, avoiding a substantial proportion of cancers, vascular dementias and over 30% of circulatory diseases.

More recently the NHS Future Forum (2012) made the recommendation that every healthcare organisation should deliver MECC and ‘build the prevention of poor health and promotion of healthy living into their day-to-day business.’

In the North East we have always considered it to be an opportunity for any public encounter.

Development of MECC LocalEmbedded within Multidisciplinary School of Public

Health vision and is the overarching objective for Building Public Health Futures (wider workforce capacity building)

Embedded as a principal within North East public health strategy

Embedded within Local Education and Training Board structures as a principal for educational development

North Cluster (North East, North West and Yorkshire and Humber) priority

Rationale for MECCEvidence of effectiveness (from work on brief

advice/brief intervention)

Cost effective

Based on values underpinned by social justice, inequalities, asset based

Health of the North East Source NEPHO

Average life expectancies of 77.2 years for men and 81.2 for women (2008-2010), 1.4 years less than England average.

Smoking kills over 1700 people every year in the North East before they reach the age of 70 (2011).

Adult smoking prevalence in the North East has fallen but remains higher than the England average (2011).

Comparing the North East with England, premature alcohol-related death rates are 71.2 versus 58.2 per 100,000 population for men, and 31.3 v. 24.3 for women (2012).

High levels of deprivation compared to the rest of England.

Evidence for MECCThe evidence is based on interventions using brief advice and brief interventions NICE – Behaviour Change Guidance

Outlines key recommendations for successful behaviour change programmes

SIPPs – alcohol brief adviceAll brief intervention approaches resulted in reductions in alcohol use

Evidence from Health Trainer projects

Cost effectivenessAlcohol brief advice changes drinking behaviour of 1 in 8

people For a local area of population of 310,000 cost = £48,000 to

deliver IBA to 10,000 increasing risk drinkers1,250 will change drinking behaviourResulting in reduced, acute admissions and A&E attendances Estimated benefits to NHS = £126,000*ROI = £2.60 back for every £1 spent.

* Based on DH ready reckoner v5.2

Underpinning valuesWhilst we focus on how bad our health and health

inequalities are in the North East MECC takes an asset based approach and aims to support and enhance resilience in individuals and organisations

It is underpinned by social justice, taking account of the decisions we all make, health behaviours being a small part of that

It takes into account the wider determinants of health and recognises that health decisions are influenced at many levels

Operationalising MECCUses a capacity building framework to demonstrate at a

system level how MECC might be achievedPractical resources to support organisations in

implementing MECC, www.sphne.org.uk Training framework to support MECC Case studies

Capacity Building FrameworkAction areas

Organisational Development

Workforce Development

Resource allocation

Partnership

Leadership

Examples

Vision statements, policies and procedures Health Champions at executive level Inclusion in contracts/job descriptions and

appraisal systems

All aspects of training and development Support and supervision

Takes account of health impact of resource allocations Financial, human and physical resources allocated health improvement budget Use of public health intelligence in resource allocation

Shared goals Partners involved in planning and evaluating

Strategic vision and articulating the priorities for health improvement

Managing the resources

Practical resources to implement MECCGuidance documentCase StudiesDeveloping contract and job description examples Training FrameworkNetworks: real and virtualEvaluationNational examples e.g. competency frameworks

Levels of TrainingWider workforce

MECC Health trainer

Practitioner

Induction e-learning

RSPH level 2 City and guilds level 3

Foundation degree

RSPH level 1

Brief Intervention

Specific to post e.g. weight management L3/L4

Undergraduate programmes

Bespoke training

Level 3 Hybrid Course

Locally bespoke

Top up diploma

Topic based training

Post graduate

Identifying roles within MECCInfluencingSelf care, looking after own healthEnvironmental scanningInformational, supporting health campaignsSignposting and brief adviceBrief interventionLonger term interventionsContracting and commissioningPromoting healthy environments.

Training Framework example 1

Type of intervention Competencies Workforce Training and support Outcome measures

Promoting healthy environments

A knowledge of the determinants of healthAn understanding of what contributes to a healthy lifestyleUnderstanding and using the evidence base for a range of public health interventions that improve public health and address health inequalitiesCommunication Skills

Environmental Health Officers

Regular tailored updates Networking with practitioner workforce

Healthy catering awards/nutritional standards/food mappingHealthy Workplace Reductions in fuel poverty

Training Framework Example 2Type of intervention Competencies Workforce Training and support Outcome measures

Influencing role A knowledge of the determinants of healthAn understanding of what contributes to a healthy lifestyleLeadership

Elected members, Governors, lay board members, Chief Executive, identified health champions

Some materials developed through LGA Tailored workshops and support networksLeadership for Improving Health and Well-being (NELIHWB)

MECC in policy documents, evidence in planning

Environmental scanningEyes and ears

A knowledge of the determinants of health

Refuse collection, Community Safety Wardens

e-learning ECAHICTailored half day course on role Part of induction and update

Monitor referrals

Training Framework example 3

Type of intervention Competencies Workforce Training and support Outcome measures

Signposting and brief advice

A knowledge of the determinants of healthAn understanding of what contributes to a healthy lifestyleCommunication Skills

Anyone with a support role e.g. Domiciliary Care, Anyone with a health role e.g. Leisure Staff, nursing staff, pharmacy assistant.

E-learning MECC. RSPH level 2 + tailored to cover local resources.

Numbers completing training; Services uptake.

Examples from practiceEmbedding MECC within curricula: pre-registration nursing

Using commissioning power to embed MECC: CQUIN targets

Using Health trainer and workplace champions /advocates

Embedding MECC within Local Authority: Gateshead & SOTW

ReferencesWanless, D. 2002 Securing our future health: taking a

long term view.Wanless, D. 2004 Securing good health for the whole

population.Department of Health, 2010. Healthy Lives Healthy

people: Our strategy for public health in England.NHS Future Forum, 2012. The NHS’s role in the public’s

health.NICE 2007. Behaviour change at population, community

and individual levels.SIPPS alcohol brief intervention www.sips.iop.kcl.ac.uk