March 2018

THE CHALLENGE The cost of lifestyle related preventable disease to the NHS and wider system is significant. Every year £17.9 billion of the NHS budget is spent treating preventable diseases and conditions: almost one fifth of its annual budget. The Health and Social Care Information Centre (2012) and Government Office for Science (2012)

THE OPPORTUNITY NHS and local authority staff each have millions of interactions with patients and the public every thirty six hours. Most people want to be healthy and improve their own health. Research has found that patients/residents welcome the opportunity to talk to staff about lifestyle issues, but don’t start this conversation themselves as they think that staff are too busy to talk.

WHAT IS MAKING EVERY CONTACT COUNT? MECC is about staff giving consistent, simple health messages and signposting them to services that help improve their health and wellbeing. In London, the goal is to support frontline staff to start positive conversations about health and wellbeing with people they meet every day, supporting Londoners to make healthier choices.

LONDON MECC DEFINITION ''MECC is a scalable, behaviour change approach that encourages positive health and wellbeing choices through individual, organisational and environmental interactions. It involves enhancing, identifying and acting on the opportunities to engage people in conversations about their health in a respectful way to help them take action for their own health and well-being.”

STRATEGIC CONTEXT The Five Year Forward View calls for a radical upgrade in prevention and public health by: increasing support available to help people to manage and improve their health and wellbeing ensuring behavioural interventions are available understanding impact on health of smoking, alcohol, weight and diet and activity levels recognising the need to change behaviour.

LONDON’S HEALTH INEQUALITIES 15 per cent of Londoners smoke. Two million Londoners experience poor mental health every year. Over 20 per cent of adults regularly drink more than the recommended guidelines each week. Over 50 per cent of adults, and 38 per cent of children in year six, are overweight or obese. Over a third of adults don’t undertake the recommended 150 minutes of exercise per week.

LOCAL PICTURE – WHY DO WE NEED MECC? ? per cent of adults smoke. ? per cent of residents/patients experience poor mental health every year. ? per cent of adults regularly drink more than the recommended guidelines each week. ? per cent cent of adults, and ? Per cent per cent of children, are overweight or obese. ? Per cent of adults don’t undertake the recommended 150 minutes of exercise per week. Insert stats on smoking, absentee rate, obesity – staff/patients/residents/clients. See: http://fingertips.phe.org.uk/profile/health-profiles/area-search-results/E12000007?search_type=list-child-areas&place_name=London Use data from staff surveys such as NHS staff survey Use Healthwatch data Incorporate feedback from patient/resident groups

LOCAL STRATEGIC CONTEXT Insert your own information here, things to consider. CQUIN Behaviour change strategies Health and wellbeing strategy KPIs in service contracts

LOCAL AUTHORITY LEVERS FOR IMPLEMENTING MECC Public Health England’s strategic plan All Our Health One You Change for Life Action on cardiovascular disease: getting serious about prevention NHS Health Checks All of these initiatives aim to improve health behaviours and MECC is one tool that can help deliver on these programmes. Local Authorities These interventions could result in: £27 saved per patient receiving alcohol brief advice each year over 4 years, from reduced alcohol-related hospital admissions & improvements in morbidity £13 saved per patient referred to stop smoking support and prescribed Nicotine Replacement Therapy each year over 4 years; (CQUIN NHS England)

NATIONAL LEVERS FOR IMPLEMENTING MECC 1. Preventing ill health CQUIN NHS provider trusts will have to screen, deliver brief advice and refer patients who smoke and/or have high alcohol consumption in order to qualify for applicable CQUIN payments in 2017/18 and 2018/19. MECC or very brief advice as it is referred to in the CQUIN guidance is part of delivering on these CQUINS. Each year over four years these interventions could result in: £27 saved per patient receiving alcohol brief advice £13 saved per patient referred to stop smoking support (CQUIN NHS England). NHS Organisations These interventions could result in: £27 saved per patient receiving alcohol brief advice each year over 4 years, from reduced alcohol-related hospital admissions & improvements in morbidity £13 saved per patient referred to stop smoking support and prescribed Nicotine Replacement Therapy each year over 4 years; (CQUIN NHS England)

NATIONAL LEVERS FOR IMPLEMENTING MECC 2. NHS standard contract MECC is now part of the NHS Standard Contract Service Conditions (Section SC8, page 11). “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.” NHS Organisations

NATIONAL LEVERS FOR IMPLEMENTING MECC 3. NICE guidance Recommendation 9: Deliver very brief, brief, extended brief and high intensity behaviour change interventions and programmes. Commissioners and providers of behaviour change services should; Encourage health, wellbeing and social care staff (see Who should take action?) in direct contact with the general public to use a 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. NHS Organisations

WILL THIS CREATE MORE WORK FOR STAFF? No - MECC capitalises on existing patient/resident contact and enhances what is already happening. MECC only requires offering basic information and signposting patients for further help. A 30 second conversation is all that is needed to inspire someone to act on a positive and healthy behavioural change.

THE BENEFITS OF MECC FOR OUR ORGANISATION Upskill staff to have the confidence to have conversations about lifestyle and/or wider determinates of health and knowing where to signpost people to. Create a culture of prevention where staff look at improving their own health as well as helping service users/residents to improve theirs. Improve job satisfaction for staff not traditionally involved in giving advice such as reception staff as they feel they can make a difference.

QUESTIONS?