1. Making Every Contact Count (MECC) and Optimising Outcomes Dr Siân Griffiths Consultant in Public Health Medicine

2. Lifestyle and disease Lifestyle behaviour plays an important role in people's health. Smoking, excessive drinking, poor diet, lack of exercise and immunisation are major preventable causes of ill health and death. Increase the risk of Heart disease, Stroke, Dementia (vascular), Cancers, Type 2 diabetes, and many more diseases. Small changes to lifestyle will improve health. Immunisation important for health - the most effective way to prevent infectious disease. All 5 are priorities of local partners.

3. Lifestyle behaviours in Cardiff and Vale 21% of adults smoke 46% of adults drink alcohol over recommended levels 73% of adults do not meet recommended guidelines for physical activity 66% of adults do not eat 5 portions of fruit & vegetables per day Only 6% of adults have all 4 healthy behaviours Welsh Health Survey 2010+2011

4. People in deprived areas have shorter lives and are in poorer health for longer In Cardiff and the Vale: Men in deprived areas live almost 12 years less than men in more affluent areas (10 years less for women) Men in deprived areas spend an extra 23 years of their lives in poor health compared to men in more affluent areas (21 years for women)

5. Wider determinants of health Lifestyle choices are not the only factors that influence health. Social and economic conditions affect health e.g. Income, education, employment, housing.... MECC is one of a number of interventions to address the determinants of health and is one we can all do something about.

6. What is MECC? Systematically promoting the benefits of healthy living Asking individuals about their lifestyle and changes they may wish to make Responding appropriately to the lifestyle issue/s once raised Taking the appropriate action to either give information, signpost or refer service users to the support they need.

7. What MECC is not It is not about… adding another job to an already busy working day becoming a specialist in a certain lifestyle area becoming a counsellor or providing ongoing support telling somebody what to do and how to live their life

8. An example of MECC Impact In Cardiff & Vale University Health Board 14,500 staff (approximately) Millions of patient contacts a year If staff MECC with just ten people Less than one hour a year for each staff member = 140, 000 opportunities to influence behaviour change.

9. MECC topics Smoking Alcohol Food Physical activity Immunisations

10. Progress to date Pilot completed  Training package  Key messages Training now to be offered more widely (training the trainer) Embedding National links

11. Optimising Outcomes Policy Statements (OOPS)

12. Background Optimising Outcome Policy Statement proposed by the University Health Board Aim – to reduce post operative complications by offering smoking cessation and weight management support.

13. Why? Stopping smoking eight weeks before elective surgery leads to improved recovery and outcomes  Reduced complications  Quicker wound healing  Shorter hospital stay People who are obese have poorer outcomes  More wound infections  Higher rate of thrombosis  Respiratory problems

14. Optimising Outcomes Policy Statement(s) These statements must be applied in the context of a patient’s individual clinical need which is ultimately to be determined by the clinician responsible for the patient’s care. Policy Statement - Smoking Anyone to be listed for an elective intervention who is recorded as a smoker must have been offered, accepted and completed smoking cessation support prior to their listing Policy Statement - Weight management Anyone to be listed for an elective intervention who has recorded a BMI of 40 or above must have been offered, accepted and completed weight management support prior to their listing.

15. Exclusions Patients requiring emergency surgery Patients receiving surgery for the treatment of cancer Patients referred for bariatric surgery (weight management exclusion only) Patients who have a BMI of 40 and above with specific endocrine conditions which make them medically unsuitable for this pathway (weight management exclusion only) People who smoke and have BMI of 40 or above will need to complete both pathways

16. How can this be done best?

17. Contact details Dr Sian Griffiths Tel: 02920 336201 E-mail: sian.griffiths6@wales.nhs.uksian.griffiths6@wales.nhs.uk