Widening engagement in public health – the Wessex Public Health Network experience

School of Public Health Dr Julie Parkes Head of School of Public Health Em Rahman Head of Public Health Workforce Development Programmes Claire McLeod Public Health Wider Workforce Lead Debbie Durrant Public Health Development Support Manager Laurie Didlick Public Health Administrator Viv Speller Public Health Development Consultant, FPH CPD Co-ordinator

Background & history Part of South Central SHA Developed PH Practitioner registration programmes since 2010 SE Teaching PH Network PH Knowledge and Skills Framework Various projects to improve PH competencies of ‘wider workforce’ PH Courses Guide Curriculum review of Public Mental Health & Well-Being Advice on PH content of pre-registration education & training Inclusion of PH content in competencies for Assistant/Associate Practitioners PH in initial teacher education – ongoing collaboration and research

Public Health Practitioner Registration Programme Ongoing PH development projects for wider workforce Making Every Contact Count Wessex Public Health Network

Public Health Practitioner Registration Programme Recruited 4th cohort 2014 (12) min criteria: PH work 2 yrs; degree level; level 5 PHKSF Currently 27 registered with UKPHR from Wessex Support programme includes: Master classes and/or educational support (currently K311 OU course) Portfolio development groups Mentor Assessment and Verification Also provide bursaries for MSc PH Southampton

Making Every Contact Count Pilot implementation and evaluation Current spread and plans to support implementation Influences on training of health and social care workers Further information: Em.Rahman@wessex.hee.nhs.uk Claire.McLeod@wessex.hee.nhs.uk S.Dewhirst@soton.ac.uk (evaluation)

What is Making Every Contact Count (MECC)? An approach to cultural change within organisations based on behaviour change theory: 1) To create a healthier population 2) To train health-promoting workforces to routinely interact with the public to promote good health and healthy lifestyles 3) To use every opportunity to encourage long term behaviour change 4) Staff health benefits Ref East Midlands Health Trainer Hub, NHS Derbyshire County (2011) Making Every Contact Count is a particular approach to behaviour change. It is achieved by changing the organisational culture to support continuous health improvement through staff contacts with individuals SEE DIAGRAM: This diagram is about Behaviour Change in an Organisational environment. Stage one (READ) at the top of the diagram the focus is on Making Every Contact Count. It involves ALL STAFF -Promoting the benefits of healthy living with individuals (Stage 4 is more individual support ) So, MECC is about: 1) Creating a healthier population, by Making Every Contact Count 2) Training staff to routinely promote the benefits of good health and healthy lifestyles to patients/ clients. 3) Encouraging patients at every opportunity to achieve positive long-term behaviour change Making Every Contact Count can also benefit the staff themselves as they reflect on their own lifestyles and may take action to improve them. MECC has already been developed and used in other parts of England (such as in Derbyshire)

Wessex Pilot of Making Every Contact Count Aim: Test organisational change/staff training/implementation Pilot sites / pilot leads recruited March 2013 Intervention Engagement of senior managers and assessment of organisational readiness ‘Healthy Conversations Skills’ training for trainers and staff Evaluation tools to assess: Organisational development and changes Changes in practice of workforces Process of staff engagement, training and implementation The aim is for Making Every Contact Count to be adopted across Wessex. and to test the processes of organisational change, staff training, implementation of MECC and to develop an evaluation framework, for use in the future. To compare and contrast the introduction and implementation of MECC in different settings Recruitment of the Pilot sites by Health Education Wessex began March 2013, including NHS Hampshire Hospitals. The Intervention: Pilot Leads began to engage senior managers about MECC to discuss their organisations’ readiness to start introducing it. They began to select workforces in the organisation who would implement MECC with the public. Training provided for staff trainers called ‘Healthy Conversations’ which was developed by the MRC based at the University of Southampton who then trained staff. Staff then implemented MECC in their particular setting Evaluation We developed tools to assess Organisational engagement and readiness, based on those used elsewhere in the UK And developed survey tools to measure the changes in workforce practice, and Process evaluation including interview schedules to assess staff views during the whole process of staff engagement, training and implementation

Background to the Southampton Initiative for Health (SIH) Aim to improve the diets of young women and their families The SIH has trained UK practitioners (inc Children’s Centre staff) in ‘Healthy Conversation Skills’ to enhance their communication and reflection skills, specifically to support disadvantaged women to improve their diets and physical activity levels. Develop a training intervention for health & social care practitioners in skills to support behaviour change Dr Mary Barker, Sr Lecturer in Psychology Dr Wendy Lawrence, Sr Research Fellow MRC Lifecourse Epidemiology Unit Lawrence et al, Psych Heal (2009); Lawrence & Barker, Proc Nutr Soc (2009); Lawrence et al, Appetite (2011); Lawrence et al, JHP (2011); Baird et al, Proc Nutr Soc (2009)

“Healthy Conversation Skills” HOW? WHAT? “Healthy Conversation Skills” Five key skills: Identifying/Creating opportunities – for having a healthy conversation Asking open discovery questions – ‘how’ and ‘what’ questions that lead people to explore their own world and find their own solutions. Listening more than talking – empowering people to identify and take control of their own behaviour change. Reflecting – on practice in order to be more effective. Supporting goal-setting – using SMARTER action planning, staff and women have a sense of change and progress. The SIH team trained 153 SSCC practitioners in 3 x 3hr sessions, plus some follow-up activities Barker et al, JHP (2011)

Pilot sites Organisation /Pilot Site NHS Hampshire Hospitals: a) Therapy services b) Occupational Health c) Diabetes services 2) Portsmouth City Council Housing services 3) Southern Health NHS Trust Minor Injuries Unit

Pilot evaluation phases Recruitment of pilot sites March 2013 Organisational Readiness Assessment ‘Train the trainer’ Healthy Conversations Training Baseline pre-MECC staff survey Healthy Conversations staff training MECC Implementation Overview-READ each stage The process evaluation interviews take place following the staff training and during the implementation of Making Every Contact Count Baseline includes staff demographics: age range, gender, role, qualifications, previous training Post-MECC staff survey / Organisational re-assessment Post-MECC interviews & focus groups

Where next? Evaluation of pilot to be completed by University of Southampton Data collection by Sept 2014 Evaluation report by end of 2014 Health Education Wessex plans to: Develop a ‘Toolkit’ for the implementation of MECC and the evaluation early 2015 Roll out MECC in Wessex Negotiate for public health knowledge and skills to be included in health-care training Bigger study for potential cost evaluation and impact evaluation

MECC implementation ongoing Healthy Conversation Skills training at Southern Health continuing, inc at Ravenswood Mental Health Secure Unit Diabetes Services beginning to rollout MECC to general practice Southampton Solent and University Hospitals Southampton: exploring use of MECC with support workers in health and social care Looking at PH content of foundation nursing course Uni of Southampton: curriculum review to consider integrating MECC across training

Other PH development projects for wider workforce Neonatal nurse preceptorships incorporating stronger PH skills with their standards. (support for newly registered practitioners) The development of the BSc Paramedic course, working to get PH and MECC integrated into the new curriculum. PH Education, Training & Development of the Voluntary and Community Sector (VCS) Workforces project. Working with HEW Colleagues such as education commissioners for NHS bands 1-4 staff, APHs and Primary Care - early years and integrated care to ensure PH remains high on everyone’s agenda. Health Trainer Network

Wessex Public Health Network Survey in 2012 to establish need and support for WPHN Regular bi-monthly CPD meetings Website www.wessexphnetwork.org.uk WPHN covers Hampshire, IOW, Southampton and Portsmouth, and since 2013 Dorset CPD meetings are pitched at ‘specialist level’ but all public health colleagues are invited - practitioners, academics and others Meetings run from 1.30-4pm following a networking lunch for all. In the morning extra meeting rooms are available for more efficient use of time and networking opportunities.

CPD Events - topics Offender Health Making Every Contact Count Role of PH in Local Authorities Public mental health Fuel poverty Behaviour change management Health protection updates ‘bite-sized’ statistics updates Forthcoming: PH Ethics and Law Healthy Settings The opportunity to network over lunch is so valuable, as are the availability of meeting rooms which I used for the first time this month Great session, enjoyed it all. Particularly hearing from service providers – interesting/great to hear a different perspective Very helpful session – good to have a variety of topics and spread between practical & more strategic areas. Very useful and packed afternoon

Wessex Public Health Network CPD Events have proved successful with regular high attendances (40 – 80) and quality presentations. The networking opportunities and the increasing links with academic public health and PHE are valued highly. At a time of uncertainty and change the WPHN has maintained and expanded a vibrant, energetic and diverse public health community in the area.

For further information contact: viv.speller@healthdevelopment.co.uk Em.Rahman@wessex.hee.nhs.uk Claire.mcleod@wessex.hee.nhs.uk