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