An Implementation Guide and Toolkit for Making Every Contact Count Making the Case Presentation Trainer notes – the notes accompanying the slides are to provide additional information on the content of the slide. You should tailor the slides to ensure it appropriately makes the case for your organisation The session should take approximately 2 – 2.5 hours to deliver Prior to delivery of the session you should consider how best to tailor the slides to make them relevant to your organisation and the team you are delivering the session too. You may use some or all of the slides or even add your own. However you tailor the training it is important you meet the learning outcomes and ensure staff and competent and confidence to deliver MECC in their role after the session. Please amend any images etc make the presentation as relevant as possible to your audience. The session is designed to be delivered with a team or department who have had the orientation session and are looking to implement MECC. If an orientation session (or a version of it to introduce MECC) has not been delivered to the team you are training you may wish to include some introductory slides on what MECC is etc

The challenge ‘strengthening self-esteem, confidence and personal responsibility; positively promoting healthy behaviours and lifestyles…Protecting the population from health threats should be led by central government, with a strong system to the frontline.’ Healthy Lives, Healthy People ‘…every contact must count as an opportunity to maintain, and where possible, improve their mental and physical health and wellbeing’ ‘…preventing poor health and promoting healthy living is essential to reduce health inequalities and sustain the NHS for future generations’. NHS Future Forum Summary Report – Second Phase

Healthy Lifestyles in the Midlands and East Smoking- 19 to 25% of population smoke Alcohol – 14.6 to 17.9 % drinking at increasing risk and 4.0% to 6.1% drinking at high risk levels Physical activity- 61 % of men and 71% women do not meet recommended PA levels Obesity- men 22% to 26%, women 24% to 28% Diet 75% of men and 71% of women do not eat 5 a day. These data show the prevalence of unhealthy lifestyles across the West Midlands, East Midlands and East of England. Details for each are below. Organisations may wish to use even more local health profile demographic data to make their local case. Smoking ranges from 19% in the east of England to 22% in east Midlands and 25% in West Midlands, data from smoking toolkit study ( Professor R West, UCL) Drinking at increasing risk and high risk levels are taken from the recent NWPHO report, Topography of drinking behaviours , August 2011. East Midlands increasing risk = 17.9% High risk = 6.1% East of England increasing risk = 14.6% High risk = 4.0% West Midlands increasing risk = 14.%, High risk = 4.3% Physical activity levels taken from NHS Information report; Statistics on Obesity, Physical Activity and Diet: England 2010. National figure with little regional variation. Obesity levels from sane NHS Information report , derived from Household Survey for England East Midlands: Men 22% Women 25% West Midlands: Men 26% Women 28% East of England: Men 23% Women 24% Diet figures from same NHS Information report and derived from the HSE 2008. These data are for individual behaviours, we know from national and regional lifestyle surveys that only 1 in 8 people follow all four healthy lifestyle behaviours, 1 in 3 follow three , 1 in 3 follow two and 1 in 8 do not follow any.

Health Inequalities ‘…people living in the poorest areas will on average, die 7 years earlier than people living in the richer areas and spend 17 years more living with ill health’ Health Lives Healthy People: update and way forward July 2011 Multiple influences on health and wellbeing. Dahlgren, G. and Whitehead, M. (1991) Policies and strategies to promote social equity in health

Survival in 20,244 healthy adults aged 40-79 by healthy behaviours Khaw et al. PLoS Med 2008 Jan 8: 5 (1): e12 4 3 2 1 Number of prudent health behaviours -2 0 2 4 6 8 10 12 100 90 80 70 Year of study % still alive Health Behaviours: Non smoker Alcohol <14 units/wk Not inactive Blood vitamin C >50 mmol/l (5 servings fruit and vegetables daily). Overall impact: 14 year difference in life expectancy.

NHS Midlands and East Example impact: 288,000 staff Millions of patient contacts a year in primary and secondary care Very brief advice given 10 times a year by every member of staff = 2.88 million opportunities to change lifestyle behaviour Less than an hours time a year for each member of NHS staff A healthier workforce. Every day we have opportunity to influence behaviour – in the E midlands if all did a little have a big impact as Tesco says One pilot site say they are in contact with 30,000 individuals each year through sport – created over 117,000 opportunities to influence You may want to adapt this slide using data and an example more local and relevant to your organisation

Business case example Alcohol brief advice changes drinking behaviour of 1 in 8 people For a PCT of 310,000 cost = £48,000 to deliver IBA to 10,000 increasing risk drinkers 1,250 will change drinking behaviour Resulting 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

MECC: a definition There is a need for a culture change amongst organisations towards prevention, to bring the promotion of mental and physical health and wellbeing into the mainstream – doing this has become known as MECC Frontline staff should be trained to raise healthy lifestyle issues opportunistically. This is often known as Brief advice which is less in depth and more informal than a brief intervention. It involves giving information about the importance of behaviour change and simple advice and sign posting to appropriate lifestyle services for support.

Drivers Care Quality Commission (CQC): The level of care, treatment and support that each person requires will depend on their individual health and social care needs. It includes actions taken to prevent illness or disease and to promote lifestyles that maintain health NHS Future Forum Second Phase Increasing the number of people who improve their health and wellbeing will make a significant contribution to achieving the priorities in the NHS Outcomes Framework 11/12 and public health indicators in ‘Improving outcomes and supporting transparency’. For example: Healthy Life Expectancy Differences in life expectancy and healthy life expectancy between communities Mortality from cardiovascular disease Mortality from respiratory disease Mortality from cancer Excess under 75 mortality in adults with serious mental illness Infant mortality Incidence of low birth weight in term babies Smoking prevalence in adults. What other local drivers might be more applicable to you and your organisation? Are their existing initiatives that you could build upon? The Future Forum The Forum's report on public health puts MECC at the heart of how it believes the NHS can do more to improve the health and wellbeing of the nation http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_132114.pdf. The document outlines some of the small steps every person working in the NHS can take to make a difference to the health and wellbeing of people they come into contact with. This Guidance will help organisations work towards that aim. In addition Making Contacts Count contributes to a number of other national and regional strategies.

Supporting evidence - national Wanless Review – fully engaged scenario Darzi Review – need to put prevention first Marmot Review - strengthen the role & impact of ill-health prevention NICE – Behaviour Change Guidance NICE – Smoking Cessation Services Guidance SIPPs – alcohol brief advice Improving Health Changing Behaviour NHS Health Trainer Handbook MINDSPACE – influencing behaviour change through policy COI Communications and Behaviour Change DH Health Inequalities National Support Team Health Gain Programme COI Synthesis of key behaviour change documentation. The Wanless report : Securing good health for the whole population set out the need for individuals to be fully engaged in their own health and health care to save £30bn of public expenditure by 2022/23 The Darzi review, High Quality Care for All (2008) set out the need to put prevention first The Marmot Review of Health Inequalities in England post 2010 , set out six ojectives to tackle helath inequalities, one of which was to strengthen the roll and impact of ill health prevention. A series of NICE guidance sets out the evidence base of the effectiveness of brief advice in delivering lifestyle behaviour change . The recent SIPPs study which looked at delivering alcohol brief advice in a range of settings found that brief advice when delivered in primary care settings was very effective. The Improving Health Changing Behaviour NHS Health Trainer handbook is contains evidence based approaches and techniques to working with people to make and main a behaviour change - http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085779 MINDSPACE is a neumonic that takes a holistic approach to influencing behaviour change through policy and service design - http://www.instituteforgovernment.org.uk/content/133/mindspace-influencing-behaviour-through-public-policy COI Communications and Behaviour Change – contains key theories and principles for behaviour change interventions - http://www.instituteforgovernment.org.uk/content/133/mindspace-influencing-behaviour-through-public-policy DH Health Inequalities National Support Team Health Gain Programme – for frontline staff to make every contact count. A practical resource to implement the health gain programme, containing examples of practice - http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_126036

Supporting evidence - local Improving Healthy Lifestyle pilots East Midlands Guidance Pilots Derbyshire Community Health Services NHS Coventry & Warwickshire Brief Intervention Training West Midlands Clinical Champions East Midlands Time for a Quit Chat Beyond the Midlands and East Cluster Yorkshire & Humber Prevention and Lifestyle Competency Framework North West Synthesis of Behaviour Change Interventions. Within the cluster we are building a body of evidence which shows the effectiveness of delivering brief advice. The improving healthy lifestyle pilots in EoE tested delivering brief advice at the time of the NHS health check. People were interviewed 3 months after their health check and 72% of people recalled receiving brief advice on one or more behaviours. Of those who received brief advice for a particular behaviour 1:3 said they had lost weight, 1:3 said they had increased their level of physical activity , 1:4 said they were drinking less alcohol and 1:9 said they had quit smoking as a consequence of the advice they had received. Please note this is self reported data and has not be validated by other recorded data. The East Midlands Pilot report can be obtained at: http://www.tin.nhs.uk/local-networks/influencing-behaviour-change/ The pilots showed an increase in staff awareness about the importance of promoting health with clients as being essential from 61% to 79% staff feeling very confident about raising a lifestyle issue with a client from 19% to 54% and from 19% to 35% with a colleague staff confidence. One site recorded verbal interaction regarding a health issue between service users and/or staff whether it was a comment, question or conversation. Prior to training over 3 days 23 interactions were recorded and after training on 1 day 39 interactions were recorded. DCHS has be working on implementing MCC within their organisation for the last 2 years and is integral to the organisations strategic aims Link to NHS Coventry and Warwickshire report – http://healthdc.co.uk/files/hdc_cw_report.pdf The Clinical champions for prevention project is a one year scheme which aims to release senior clinicians within acute setting to lead the prevention agenda. These senior leaders have an interest in prevention and a demonstrated ability to influence both the clinical and non clinical staff body. 9 clinical champions appointed with 2 further appointments anticipated. Clinical champions are working in collaboration with BTS smoking cessation champions and PCT public health staff to ensure consistent and coherent approach. Opportunity for integrated approach to prevention being explored through health trainer role in acute settings. The time for a quit chat project in the East Midlands has trained frontline NHS staff in acute trust to deliver stop smoking brie advice. Early evaluation has shown a 28% increase in referrals to local stop smoking services from trusts taking part. Beyond the Cluster

Why Implement the Implementation Guide and Toolkit The approach to MECC within the toolkit has been developed using expertise, experience, learning and best practice from local organisations that have embedded the MECC approach The Implementation Guide and Toolkit advocates a holistic approach to implementation to enable contacts to truly count, by ensuring that your organisation is offering a suitable environment for MECC and supporting staff to enable and empower the public to improve their health and wellbeing. Further details on the benefits etc can be found within the toolkit and its summary document.