An Implementation Guide and Toolkit for Making Every

Contact CountMaking the Case Presentation

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.

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 behavioursHealth 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. Khaw et al. PLoS Med 2008 Jan 8: 5 (1): e12

4

3

2

10

Number of prudent health behaviours

-2 0 2 4 6 8 10 12

100

90

80

70

Year of study

% s

till

aliv

e

NHS Midlands and EastExample 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.

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

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.

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.

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.