1. Making Every Contact Count (MECC)

2. Content What is Making Every Contact Count?
Who is Making Every Contact Count for?
The Need for Making Every Contact Count
Implementing Making Every Contact Count
Making Every Contact Count Training

3. Is Making Every Contact Count?
Making Every Contact Count enables organisations and individuals to develop and be able to use a different approach to working with people to address health and wellbeing. Telling people what to do is not the most effective way to help them to change. Making Every Contact Count is about altering how we interact with people through learning how to recognise opportunities to talk to people about their wellbeing.
Making Every Contact Count (MECC) is about supporting workforces to maximise on the public health opportunity they have with their regular contact with the public. Staff from a variety of organisation can make a difference to the health and wellbeing of the population by encouraging people to change behaviours that may be damaging to their health.
DEFINITION
Making Every Contact Count training allows workforces to:
Deliver a ‘very brief’ or ‘brief’ evidence based advice/intervention for lifestyle behavioural change;
Be competent and confident to do this; and
Be knowledgeable about local services and how to access them.
MECC is about transforming the culture to one that looks to enhance positive outcomes through providing people with information and encouragement.
MECC is not about additional workload but developing skills to enable staff to use a different approach to engage with people to support them to make changes to their lifestyles to improve their health.

4. Core MECC definition
MECC is an approach to behaviour change that uses the millions of day-to-day interactions that organisations and individuals have with other people to support them in making positive changes to their physical and mental health and wellbeing.
MECC supports the opportunistic delivery of consistent and concise healthy lifestyle information and enables individuals to engage in conversations about their health at scale across organisations and populations:
For organisations, MECC means providing their staff with the leadership, environment, training and information that they need to deliver the MECC approach
For staff, MECC means having the competence and confidence to deliver healthy lifestyle messages, to help encourage people to change their behaviour and to direct them to local services that can support them
For individuals, MECC means seeking support and taking action to improve their own lifestyle by eating well, maintaining a healthy weight, drinking alcohol sensibly, exercising regularly, not smoking and looking after their wellbeing and mental health.
Making Every Contact Count (MECC): MECC Consensus statement
Produced by Public Health England, NHS England and Health Education England, April 2016

5. Making Every Contact Count as a Behaviour Change Intervention
This diagram illustrates MECC as a behaviour change intervention, the triangle maps Making Every Contact Count to the NICE PH guidance 49 Behaviour Change: individual approaches
Starting at the top....
ORANGE - Behaviour change service providers and practitioners providing high intensity interventions (typically these last more than 30 minutes and are delivered over a number sessions) for people they regularly work with. Examples include Health Trainers, alcohol teams, smoking cessation advisors and IAPT workers.
GREEN - Health and social care staff dealing with the general public to provide an extended brief intervention to people they regularly see for 30 minutes or more who are involved in risky behaviours (for example higher risk drinking), have a number of health problems, have been assessed as being at increased or higher risk of harm, have been successfully making changes to their behaviour but need more support to maintain that change have found it difficult to change or have not benefited from a very brief or brief intervention. More intensive behaviour change training such as Health Coaching or Motivational Interviewing would equip people with the necessary skills to be able to support people.
The bottom 2 levels, pink and blue, represent MECC
PINK - Staff who regularly come into contact with people whose health and wellbeing could be at risk to provide them with a brief intervention. A brief intervention involves oral discussion, negotiation or encouragement, with or without written or other support or follow-up. It may also involve a referral for further interventions, directing people to other options, or more intensive support. Brief interventions can be delivered by anyone who is trained in the necessary skills and knowledge. These interventions are often carried out when the opportunity arises, typically taking no more than a few minutes for basic advice.
BLUE – for everyone in direct contact with the general public - very brief intervention to motivate people to change behaviours that may damage their health. The interventions should also be used to inform people about services or interventions that can help them improve their general health and wellbeing. Examples include paramedics, receptionists.
Triangle illustrates smaller proportion of staff and people they work with as you progress up the pyramid.
Recruitment of pilot sites
March 2013
Organisational Readiness Assessment
Healthy Conversation Skills Train-the-Trainer courses
Baseline pre-MECC survey
Healthy Conversation Skills staff training
MECC Implementation
Post-MECC Staff survey & Organisational reassessment
Post-MECC Interviews & Focus Groups
Recruitment of pilot sites
March 2013
Organisational Readiness Assessment
Healthy Conversation Skills Train-the-Trainer courses
Baseline pre-MECC survey
Healthy Conversation Skills staff training
MECC Implementation
Post-MECC Staff survey & Organisational reassessment
Post-MECC Interviews & Focus Groups
Recruitment of pilot sites
March 2013
Organisational Readiness Assessment
Healthy Conversation Skills Train-the-Trainer courses
Baseline pre-MECC survey
Healthy Conversation Skills staff training
MECC Implementation
Post-MECC Staff survey & Organisational reassessment
Post-MECC Interviews & Focus Groups

6. Who is Making Every Contact Count for?
Everyone!
Individuals who have contact with the public.
Individuals who have contact with individuals who experience health inequalities.
Individuals who have contact with people in a health setting.
Individuals who may have an opportunity to talk about health and wellbeing to others.
Quite simply MECC is for everyone who has contact with people.

7. ‘we…valued the opportunity to train together, managers to admin staff; there aren’t many courses we can all benefit from’
Slide with quote to illustrate MECC is for everyone
Workforces not only recognised their role in prevention but also that there was a benefit to them as a team
Southern Health NHS Foundation Trust
Fareham and Gosport School Nursing Team

8. The Need for Making Every Contact Count
As already stated, Making Every Contact Count is about delivering a ‘very brief’ or ‘brief’ evidence based interventions for lifestyle behavioural change; the core elements of which are:
stopping smoking,
increasing physical activity,
reducing alcohol consumption
maintaining a healthy weight & diet and
promoting mental and emotional health and wellbeing
There are many benefits of Making Every Contact Count for organisations and teams and ultimately the people across populations and communities. Wessex MECC evaluation showed that as a result of implementing MECC in organisations it did have a positive impact on staff’s own health and wellbeing. So could also be a strong offer for workplace health initiatives as a way of staff supporting each other around health and wellbeing.
Evidence shows that brief interventions on healthy living are cost-effective. The annual cost to NHS as a result of lifestyle choices has a greater impact on the rest of the services and organisations that exist within a system such as social care, voluntary sector services and local authorities. This means that there will essentially be less money available for everyone as a result of the cost of increased poor health.
The green figures illustrate the cost of each of the lifestyles. It has been estimated that the economic and social costs of mental health problems in England was £105 billion.

9. The need for Making Every Contact Count
NHS Five Year Forward View: Focus on prevention is essential for better health and a sustainable NHS
HEE Mandate: “preventing illness with staff using every contact they have as an opportunity to help people stay in good health”
Local Government Association: Vehicle for not only health improvement but supporting wider determinants of health
PHE Priority: From Evidence into action: opportunities to protect and improve the nations health
NHS England: Making Every Contact Count is in NHS Standard Contract.
These are the policy drivers for Making Every Contact Count:
The NHS – Five Year Forward View, (NHS 5YFV) talks about a ‘radical upgrading of prevention and public health’ and the role the NHS has in enabling self-care and management of health. “The  NHS has an important public health role in making every contact count. The NHS must focus on preventing illness, with staff using every contact they have with people as an opportunity to help people stay in good health – by not smoking, eating healthily, drinking less alcohol, and exercising more.”
The Health Education England mandate sees the role it has in helping the workforce to make the NHS 5YFV happen. The mandate makes plain the role HEE has in developing people to have the confidence, skills and knowledge to make every contact count.
The Local Government Association (LGA) can see the important role local authorities have in supporting the implementation of MECC. Their services bring opportunities to making every contact count and can impact on the wider determinants of health (i.e. housing, social care, transport). (LGA, 2014)
Public Health England (PHE) PHE in Evidence into Action talks about a ‘fundamentally new approach to creating and sustaining health, mental and physical, at every stage of life and across all our communities is needed’. PHE have an important role in working with others to take Making Every Contact Count forward both locally and nationally. This is to make sure the way MECC is taken forward works well and is consistent and can build the evidence-base.
NHS England – NHS Standard Contract - The NHS Standard Contract is mandated by NHS England for use by commissioners for all contracts for healthcare services other than primary care. Standard Condition 8.6 states:
The Provider must develop and maintain an organisational plan to ensure that Staff use every contact that they have with Service Users and the public as an opportunity to maintain or improve health and wellbeing, in accordance with the principles and using the tools comprised in Making Every Contact Count Guidance.

10. Wessex Pilot Three pilot settings: Acute – Community - Local Authority
Adapted from the Midlands and East Making Every Contact Count approach
‘Healthy Conversation Skills’
Independently evaluated by the University of Southampton
Report can be found at:
Based on workforce development and organisational change; it’s about transforming the culture to one that looks to enhance positive outcomes through providing people with information and encouragement.
Informed the Wessex MECC approach and toolkit:
Following the evaluation of the pilot we developed the MECC model to include:
The MECC Definition
How MECC fits in with other behaviour change interventions (triangle)
Who MECC is targeted at

11. Wessex Making Every Contact Count Evaluation Findings
Organisational buy-in is key for implementing Making Every Contact Count
Middle Managers/Team Leaders are key facilitators in implementing Making Every Contact Count
Workforce need to be supported to attend Making Every Contact Count training
Workforce recognised that they did have a role in promoting health and wellbeing.
Highlighting importance of buy in across 3 levels, senior, middle and frontline.

12. Implementing Making Every Contact Count: The Offer from the School of Public Health
Wessex Making Every Contact Count Implementation Toolkit
Making Every Contact Count Train-the-Trainer Programme
Support via the Wessex Making Every Contact Count Network
Facilitate and guide you to develop a Making Every Contact Count lead for your organisation
On-going advice and guidance on Making Every Contact Count implementation.
The Health Education England – Wessex School of Public Health has developed an implementation toolkit to help guide organisations and people to embed MECC is an effective and sustainable way.
There is also a MECC network and the Train-the-Trainer model, more information can be found in the toolkit and online at

13. Implementation Steps
The Wessex MECC approach has 8 steps to implement:
1. Organisational strategy and policy context
2. Senior leadership buy-in
3. Planning
4. Identifying resources
5. Staff – readiness and engagement
6. Infrastructure, system and processes
7. Implementation – training
8. Review and evaluation
The steps involved in implementing Making Every Contact Count are shown in the diagram. Ideally they should be done in order however, the steps can be used in a more dynamic way with many steps taking place at the same time as shown with the arrows inside the diagram.
There is an implementation guide tool in the toolkit to support the development of an action plan to identify what needs to be done, how and by whom.

14. Making Every Contact Count Training
Deliver ‘very brief’ or ‘brief’ evidence-based advice interventions for lifestyle behavioural change; the core elements of which are stopping smoking, increasing physical activity, reducing alcohol consumption maintaining a healthy weight & diet and promoting mental health and wellbeing.
Be competent and confident to deliver this intervention; and
Be knowledgeable about local services and how to signpost people to enable them to access them.
As mentioned already, the MECC training equips people with the knowledge and skills to be able to deliver a very brief or a brief intervention around key lifestyle areas.
It is about ensuring people are confident to have healthy conversations and know where to direct people for more information and support.

15. Making Every Contact Count Training
Knowledge Development: E-Learning
Introduction to MECC
Introduction to Skills
Introduction to Lifestyles
Signposting and giving information
Skills Development: Healthy Conversation Skills
Face-to-face training
Use of Open Discovery Questions (ODQ)
Reflect on practice and conversations
Active listening
Using ODQ to support goal setting
Implementation of MECC Training
Knowledge: E-Learning accessed via HEE E-Learning for Health
Skills: Healthy Conversations Skills accessed via the Train the Trainer course (accredited by RSPH)
The training is broadly in two parts;
Knowledge Development is to support the delivery of a very brief intervention, this is gained through an eLearning package.
In addition to having the skills to Make Every Contact Count it is important that people have the core, underpinning knowledge to give an understanding and awareness of why it is important to have healthy conversations.
This includes topics such as why Making Every Contact Count is important, the ‘Big Killers’, the factors influencing health and wellbeing, the benefits of health improvement and key health promotion messages.
The second part is the skills that are developed through face-to-face training in Healthy Conversation Skills.  
Developed by Health Psychologists at the Medical Research Council (MRC), University of Southampton. It is based on theories of behaviour change and grounded in the principle of empowerment, and has been evaluated and evidenced as an effective way to enable people with the practical skills to implement Making Every Contact Count. It increases trainees’ skills and confidence to be able to support people to improve their health and wellbeing.
The Healthy Conversations Skills competencies are identified as:
Use Open Discovery Questions to help someone explore an issue
Reflect on your practice and conversations
Spend more time listening than giving information or making suggestions
Use Open Discovery Questions to support someone to make set goals.
The Healthy Conversation Skills training has been accredited by the Royal Society of Public Health (RSPH). The training is delivered in two parts which takes place over two half days (approximately 3 hours), a week apart.

16. Pilot Evaluation Key Findings
The graph illustrates the increase in use of ODQs post training and there was also a significant increase in their confidence for supporting change post training.
Making Every Contact Count skills training increases individuals confidence and intention to use Open Discovery Questions

17. MECC Train-the-Trainer Model
Application Process
Selection Criteria
Employer Support
Sign up to MECC Trainer Best Practice Agreement
Train the Trainer Training
2 x 3 hour Healthy Conversation Skills Session
1 x 1 day Trainer Session
Training Delivery post TtT
Training Evaluation
RSPH Accreditation Certificate
CPD
The training is broadly in two parts;
Knowledge Development is to support the delivery of a very brief intervention, this is gained through an eLearning package.
In addition to having the skills to Make Every Contact Count it is important that people have the core, underpinning knowledge to give an understanding and awareness of why it is important to have healthy conversations.
This includes topics such as why Making Every Contact Count is important, the ‘Big Killers’, the factors influencing health and wellbeing, the benefits of health improvement and key health promotion messages.
The second part is the skills that are developed through face-to-face training in Healthy Conversation Skills.  
Developed by Health Psychologists at the Medical Research Council (MRC), University of Southampton. It is based on theories of behaviour change and grounded in the principle of empowerment, and has been evaluated and evidenced as an effective way to enable people with the practical skills to implement Making Every Contact Count. It increases trainees’ skills and confidence to be able to support people to improve their health and wellbeing.
The Healthy Conversations Skills competencies are identified as:
Use Open Discovery Questions to help someone explore an issue
Reflect on your practice and conversations
Spend more time listening than giving information or making suggestions
Use Open Discovery Questions to support someone to make set goals.
The Healthy Conversation Skills training has been accredited by the Royal Society of Public Health (RSPH). The training is delivered in two parts which takes place over two half days (approximately 3 hours), a week apart.

18. “…I think it makes you stand back and realise that people do have their own solutions and you do need to get to know their world…”
This is a quote was from a member of staff who delivered MECC as part of their role in the Wessex MECC pilot.
The Health Education England approach to implementing MECC adopts the philosophy of Healthy Conversation Skills when supporting organisations – although advice and guidance is provided organisations aren’t told how to embed MECC but are supported to find their own solutions as to what they can do and how they can do it to suit the environment and workforce.
Clinical Staff, Hampshire Hospitals NHS Foundation Trust

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