Making the case

Overview of presentation Background to MECC Rationale for MECC Operationalising MECC Examples from practice

Background to MECC Originally conceived as every clinical encounter, shifting the NHS towards prevention, saving money (Wanless 2002, 2004). Healthy Lives Healthy People Changing adults’ behaviour could reduce premature death, illness and costs to society, avoiding a substantial proportion of cancers, vascular dementias and over 30% of circulatory diseases. More recently the NHS Future Forum (2012) made the recommendation that every healthcare organisation should deliver MECC and ‘build the prevention of poor health and promotion of healthy living into their day-to-day business.’ In the North East we have always considered it to be an opportunity for any public encounter.

Development of MECC Local Embedded within Multidisciplinary School of Public Health vision and is the overarching objective for Building Public Health Futures (wider workforce capacity building) Embedded as a principal within North East public health strategy Embedded within Local Education and Training Board structures as a principal for educational development North Cluster (North East, North West and Yorkshire and Humber) priority

Rationale for MECC Evidence of effectiveness (from work on brief advice/brief intervention) Cost effective Based on values underpinned by social justice, inequalities, asset based

Health of the North East Source NEPHO Average life expectancies of 77.2 years for men and 81.2 for women ( ), 1.4 years less than England average. Smoking kills over 1700 people every year in the North East before they reach the age of 70 (2011). Adult smoking prevalence in the North East has fallen but remains higher than the England average (2011). Comparing the North East with England, premature alcohol- related death rates are 71.2 versus 58.2 per 100,000 population for men, and 31.3 v for women (2012). High levels of deprivation compared to the rest of England.

Evidence for MECC The evidence is based on interventions using brief advice and brief interventions NICE – Behaviour Change Guidance Outlines key recommendations for successful behaviour change programmes SIPPs – alcohol brief advice All brief intervention approaches resulted in reductions in alcohol use Evidence from Health Trainer projects

Cost effectiveness Alcohol brief advice changes drinking behaviour of 1 in 8 people For a local area of population 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

Underpinning values Whilst we focus on how bad our health and health inequalities are in the North East MECC takes an asset based approach and aims to support and enhance resilience in individuals and organisations It is underpinned by social justice, taking account of the decisions we all make, health behaviours being a small part of that It takes into account the wider determinants of health and recognises that health decisions are influenced at many levels

Operationalising MECC Uses a capacity building framework to demonstrate at a system level how MECC might be achieved Practical resources to support organisations in implementing MECC, Training framework to support MECC Case studies

Capacity Building Framework Action areas Organisational Development Workforce Development Resource allocation Partnership Leadership Examples Vision statements, policies and procedures Health Champions at executive level Inclusion in contracts/job descriptions and appraisal systems All aspects of training and development Support and supervision Takes account of health impact of resource allocations Financial, human and physical resources allocated health improvement budget Use of public health intelligence in resource allocation Shared goals Partners involved in planning and evaluating Strategic vision and articulating the priorities for health improvement Managing the resources

Practical resources to implement MECC Guidance document Case Studies Developing contract and job description examples Training Framework Networks: real and virtual Evaluation National examples e.g. competency frameworks

Levels of Training Wider workforce MECCHealth trainerPractitioner Induction e-learning RSPH level 2City and guilds level 3 Foundation degree RSPH level 1Brief Intervention Specific to post e.g. weight management L3/L4 Undergraduate programmes Bespoke training Level 3 Hybrid Course Locally bespokeTop up diploma Topic based training Post graduate

Identifying roles within MECC Influencing Self care, looking after own health Environmental scanning Informational, supporting health campaigns Signposting and brief advice Brief intervention Longer term interventions Contracting and commissioning Promoting healthy environments.

Training Framework example 1 Type of interventionCompetenciesWorkforceTraining and supportOutcome measures Promoting healthy environments A knowledge of the determinants of health An understanding of what contributes to a healthy lifestyle Understanding and using the evidence base for a range of public health interventions that improve public health and address health inequalities Communication Skills Environmental Health Officers Regular tailored updates Networking with practitioner workforce Healthy catering awards/nutritional standards/food mapping Healthy Workplace Reductions in fuel poverty

Training Framework Example 2 Type of interventionCompetenciesWorkforceTraining and supportOutcome measures Influencing roleA knowledge of the determinants of health An understanding of what contributes to a healthy lifestyle Leadership Elected members, Governors, lay board members, Chief Executive, identified health champions Some materials developed through LGA Tailored workshops and support networks Leadership for Improving Health and Well-being (NELIHWB) MECC in policy documents, evidence in planning Environmental scanning Eyes and ears A knowledge of the determinants of health Refuse collection, Community Safety Wardens e-learning ECAHIC Tailored half day course on role Part of induction and update Monitor referrals

Training Framework example 3 Type of interventionCompetenciesWorkforceTraining and supportOutcome measures Signposting and brief advice A knowledge of the determinants of health An understanding of what contributes to a healthy lifestyle Communication Skills Anyone with a support role e.g. Domiciliary Care, Anyone with a health role e.g. Leisure Staff, nursing staff, pharmacy assistant. E-learning MECC. RSPH level 2 + tailored to cover local resources. Numbers completing training; Services uptake.

Examples from practice Embedding MECC within curricula: pre-registration nursing Using commissioning power to embed MECC: CQUIN targets Using Health trainer and workplace champions /advocates Embedding MECC within Local Authority: Gateshead & SOTW

References Wanless, D Securing our future health: taking a long term view. Wanless, D Securing good health for the whole population. Department of Health, Healthy Lives Healthy people: Our strategy for public health in England. NHS Future Forum, The NHS’s role in the public’s health. NICE Behaviour change at population, community and individual levels. SIPPS alcohol brief intervention