By the end of the session:
You should be able to:
• apply Make Every Contact Count within your role
• ask people about their lifestyle choices
• advise people of facts and tips to help change unhealthy
lifestyle behaviours
• be confident to deliver Brief Advice (and Brief Interventions)
• refer people to appropriate help and support
• record your contacts
• know where to go for more information
Today’s timetable
10.00 Introduction to Making Every Contact Count
10.15What is MECC
10.45 Group activity and break
11.30 Health information
12.30 What does MECC mean to me?
13.00 Lunch (30 minutes)
13.30 Health Improvements and brief Interventions
14.45 Next steps for cascading training
15.15 Summary, evaluation, questions
15.30 Close
Why are we here?
• NHS Ambitions / CQUINs
• Role of the MECC trainer
• Aim of the day – provide input and knowledge
on the MECC ambition, and to jointly agree
resources and support required to cascade
across the Trust
Making Every Contact Count
Making Every Contact Count focuses on short,
one-to-one opportunities with service users to advise
and signpost to healthy lifestyle information on:
• stopping smoking
• drinking alcohol within recommended limits
• eating a healthy diet
• taking regular physical activity
• maintaining a healthy weight
• mental health and wellbeing
What MECC is not
• It is not about adding another job to your already busy
working day
• It is not about you becoming a specialist in a certain lifestyle
• It is not about you becoming a counsellor or providing ongoing
support to particular individuals
• It is not about you telling somebody what to do and how to
live their live
• It is about you helping other people to know how they can
improve their own health and wellbeing.
MECC approach
MECC is about encouraging people to make healthier choices to achieve
positive long-term behaviour change for better health and wellbeing
among patients / service users and staff themselves
MECC involves:
• Systematically promoting the benefits of healthy living across the
• Asking an individual about their lifestyle and if they want to make a
• 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
An example of MECC Impact
In East Midlands
• 288,000 staff
• Millions of patient contacts a year
• If staff MECC with just ten people
• Less than one hour a year for each staff
= 2.88 million opportunities to influence
behaviour change.
Cost basis
• Sarah to input local data of alcohol costs .
Where are we now?
Where do we want to be?
• What is the teams/
departments vision about
providing health
promotion messages?
Health Inequalities
Unhealthy lifestyles
‘…people living in the poorest
areas will, on average, die 7
years earlier than people living
in the richer areas and spend 17
years more living with ill health.’
‘…the commitment to reduce
health inequalities is a priority
for ...the health system, drawing
upon the Marmot review to
address the wider determinants
of health…’
Healthy Lives, Healthy People: update and way forward. July 2011
• What is the profile of our
service users?
• What are their lifestyle and
information needs?
• What influences their
lifestyle choices?
• Does the issue differ for
each stage of life?
• 30% of the elective surgical population will be smokers
• Stopping smoking is the single biggest thing you can
do to improve your health.
• The systems most commonly affected by smoking are pulmonary
function, cardiovascular function, the immune response, and tissue
• The most common complication related to smoking is impaired
wound and tissue healing and wound infection, and
cardiopulmonary complications.
• You are up to 4 times more likely to quit with the support of NHS
Stop Smoking services and medication compared with going it
Smoking in pregnancy
• Increased risk of miscarriage and stillbirth
• Increased chance of pre-term birth (premature babies)
and low-birth weight
• Even if the pregnant woman / new mother does not smoke,
there may be partners or others in the household who
smoke? Second-hand smoke can still damage an unborn
baby or a new born baby.
NHS Stop Smoking services
Birmingham Services
Call Quit line on- 0800 052 5855
Open; Monday to Friday 9am to 7pm
- 10am to 2pm
You can also text ‘Quit’ to 80800.
What do you
think about
• Men should not drink more than 3-4 units per day
(1 pint of strong 5% beer or cider).
• Women should not drink more than 2-3 units per day
(1 standard 175ml 12% glass of wine.)
• You should have at least 2 alcohol free days a week.
• Avoid consuming any alcohol during pregnancy as
rigorous research has not yet determined what safe
levels of consumption are in terms of preventing adverse
effects to the foetus such as foetal alcohol syndrome.
• Find out how many units are in your favourite drink.
• Have drinks with mixers.
The Cost
• Cost of alcohol misuse in Birmingham is £200 million per
- Alcohol related health disorders & disease
- Crime and anti social behaviour
- Loss of productivity in the work place
- Problems with those who misuse alcohol and their families
including domestic violence
Cost to NHS for alcohol related harm- £54 million
Cost of drink driving £10 million
Cost of criminal justice system - £37 million
Cost of economy of alcohol related absenteeism - £30 million
Impacts on health:
AUDIT (Babor et al, 1989)
Comprises of 10 questions about:
• Frequency of alcohol consumption
• How drinking affects their life
• Signs of dependency
• Injuries sustained as a result of drinking
• Previous advice to cut down drinking
• Alcohol consumption
Alcohol units
How to calculate units in mls
• Multiply the percentage ABV by the
volume/amount of drink in millilitres then
divide by 1000.
• For example with a 13% ABV glass of wine in
175ml glass
• 13 (%ABV) X 175 (amount) = 2275
• Divided by 1000 = 2.275 ie 2.3 units
Unit Calculation in cl.
Multiply %
alcohol content
By volume in
centilitres (cl's)
Then divide it all by 100
7 5 cl
14 x 75
Royal college of Physicians Guidelines
Drinking levels
Low risk
(Units / Week)
≤ 21
(Units / Week)
≤ 14
22 -50
15- 35
> 50
Binge drinking
(Regular drinking in one
Sensible drinking guide suggests 2 drink free days.
Alcohol Withdrawal
• Some patients are not troubled by alcohol withdrawal
• 40% will develop an acute withdrawal syndrome upon
stopping or significantly curtailing alcohol intake
• The risk of withdrawal is not directly related to intake
(DTB 1991, Morgan 1998)
• The alcohol withdrawal syndrome may be a continuum
from simple tremulousness (the most common symptom)
through to seizures and more severely, life threatening
delirium tremens
(Hall 1997, Rubino 1992, Turner 1989)
Symptoms of uncomplicated alcohol
• Characteristic tremor, starting in the hands but
progressing to the head and trunk as the severity
• Anxiety, restlessness, irritability, depression,
insomnia and tiredness
• Anorexia, nausea and weakness
• Confusion
• Sweating, Tachycardia (100+ b.p.m), Raised BP, Fever
Preparation for Detox Groups
Module 1
Meet your
4 sessions
Module 2
Module 3
1 session
to Groups
internal /
1 session
Module 4
1 session
Low Risk/ Hazardous
Harmful /Complex
Dependent requiring
A team
113 Griffins Brook Lane
B30 1QN
236 Bristol Rd
B5 7SL
Birmingham & Solihull
Mental Health Foundation
Email: complete form called
Birmingham Alcohol
Services Referral Form
Arch - Addiction Recovery
Community Hub
Tel. 0121 475 8885
Fax. 0121 475 9018
Tel. 0121 414 0888
Fax. 0121 414 1222
Tel. 0121 3013900
And ask for alcohol
practitioner for information
and advice.
Email address to send
referral form to:
Tel. 0121 414 0888
NHS Choices
Alcohol concern
Tel. 0121 301 0000
Tel: 0800 917 8282
Alcoholics Anonymous
Tel. 0845 7697555
Al-Anon Family Groups
Tel. 07966237613
Healthy Eating
• You should aim to eat at least 5 portions of varied fruit
and vegetables a day and cut back on sugar, salt and fat.
Check the label and swap higher levels for lower ones
‘Swap it don’t Stop it’.
• Aim for one third of the food you eat to be starchy foods like
potatoes, cereal, pasta, rice and bread. Your 5-a-day can
include unsweetened fruit juice for one portion, and try
adding a handful of fresh, frozen or tinned veg into meals like
pasta sauces.
Healthy Eating
0300 123 4567
How do you
feel about healthy
eating and your
Weight Loss
• The only way to lose weight healthily, and keep it off, is to
reduce your calorie intake and increase your physical activity.
For more help ask your GP or Practice Nurse.
Healthy Eating
• Lighten up
Tel 0800 5999880
Loose weight and keep it off
Speak to you GP for a referral - 12
weeks free. For people with a
BMI of over 30
• Loose weight with on line
support for men – for
• Children’s Healthy Weight
Tel 0121 4461021
Birmingham Children’s healthy
weight programmes – St
Patricks Centre for Community
• A specialist weight
management service is
available at St Patricks
Centre for community
Health for people with a
BMI over 40 and over.
Referral can be made via
the patients GP.
Physical Activity
• Adults should do at least 30 minutes of moderate
physical activity 5 times a week (150 minutes per week).
• Children should do 60 minutes of moderate physical activity
every day.
• Moderate activity is where you raise your heart rate, get
warm or break a sweat on a warm day
• Each 10 minutes counts towards your daily target.
Physical Activity
• If you have not undertaken recent physical activity, it is
best to start gradually. If in doubt, check with your GP.
• Children: community support is available through your
child’s school and your local council community physical
activity department.
• Adults: Activity for health 12 week activity referral
programme. Ask your GP or Practice Nurse.
What physical
0300 123 4567
activities do you do
each day that raise
your heart rate?
Mental Health
• 1 in 4 people experience emotional, psychological or
mental wellbeing issues at some point in their lives and
1 in 6 adults experience such problems at any one time
which can include stress, anxiety, panic attacks and depression.
• Talking to others, being active, helping others / volunteering,
learning something new and appreciating the things around
you can lead to better mental wellbeing.
If you are worried that someone is a danger to themselves or
at risk then follow safeguarding procedures.
Mental Health
How do you
feel about your
mood day
to day?
• Speak to your GP to discuss any issues, who can
recommend appropriate help and support.
• Birmingham & Solihull Mental Health Foundation
There website has a wealth of information on local
services and a website will an array of useful leaflets
Mental Health
• Samaritans
Tel. 0845 790 9090
Confidential support for anyone in a
• Rethink
Tel. 0300 500 0927/02078403188
Provides info and a helpline for anyone
affected by mental health problems.
Monday -Friday 10-1pm.
• No panic
Tel. 08001388889
• Relate
Tel. 0121 643 1638
Help with marital or relationship
• National Debt Line
Tel. 0808 808 4000
Help for anyone in debt or concerned
that may fall into debt
• Triumph over Phobia
Tel. 08456009601
Provides national network of self help
groups for people with phobias or OCD.
• Mind
Tel. 0300 123 3393
The national mental health charity, can
provide practical advice and links to local
Mental Health
• Anxiety care
• Email:
• Anxiety UK
Tel: 08444 775774
The two services above
provide information and
support to those suffering
from anxiety disorders.
• British Association for
Counselling and
Tel. 01455 883316
Offers an information service
providing contacts for counselling
in England and Wales
• CRUSE Bereavement Care
Tel. 0121 687 8010
Offers advice and support for
those affected by bereavement.
Free NHS Health Checks
If any service users are aged between
40-74 years old they may be eligible for
a free NHS Health check to screen
for heart disease, stroke, diabetes
or kidney disease risk, if they do not
already have a diagnosis.
Please ask them to request one from their GP.
Activity in pairs –
What does MECC mean to me?
• What does Making Every Contact Count mean to
you in your role or at home?
• How can you use it in your everyday contacts?
• Do you think you already include MECC in your
everyday work or home life, what do you cover?
• Is there anyone or anywhere else you think you could
use it with?
• What issues particularly affect your user group / family?
• What might motivate them to make a change?
• Do you have any concerns?
Health improvement
• Behavioural Change
• Educational Approach
• Social Change
The Behavioural Change approach
Aim: to help individuals adopt healthy behaviours
Methods used in this approach are targeted at the
• One-to-One
e.g. goal setting / action plans
• Education
Brief Advice – Level 1
BRIEF ADVICE is pro-actively raising awareness of, and
assessing a person’s willingness to engage in further
discussion about, healthy lifestyle issues. It is usually given
It normally takes between 30 seconds to 3 minutes
What to do?
• Ask open questions.
• Advise on how to make changes, ask service user to
suggest how they might make changes.
• Act – help the service user to set their own goals or access
further help (signpost).
Remember to think about the environment – privacy, comfort
• Time - it might only take 30 seconds to ask a question.
• You need to start from where the service user is,
not where you think they are or where they should be.
• You need to be open minded not critical or judgemental.
• Brief advice is working with the individual on their health
goals. You are not lecturing them or telling them what to do.
• You are providing simple, clear advice and signposting.
• You can’t always tell what is going on from outward
appearances. You are not expected to be a counsellor.
• Where do you live?
• Do you have children?
• What is your job?
Can you tell me about…
What do you think about…
How do you feel about…
What happened next …
Why do you think that…
So what you’re saying is…
Where to start
• Ask – use open questions
• “How do you feel about your health and wellbeing today?”
• “What could you change to make your lifestyle healthier?”
• “On a scale of 1-10 how important is it for you to make
your lifestyle healthier?” (1 being not important at all and
10 being very important)
• Listen to what the client tells you
• Reflect back “So what you’re saying is…”, “Can I just check…”
• Advise – give a fact, tip and know where to signpost to. If they
are not interested don’t force the issue – leave the door open.
How do you feel about your health and wellbeing?
Not good
Very good
How important is it for you to make a change?
Not important
Very important
How confident do you feel to make a change?
Not confident
Very confident
Spiral of Change
Progression of
Challenges to MECC
If the service user is:
• Not interested – leave the door open
• Aggressive or confrontational
• Under the influence of drink or drugs
• Too emotional
• Too ill or injured
Consider privacy – if the client is in a busy waiting room they
may be unwilling to engage. So think about when and where you
raise the issue.
Dealing with resistance
What if the person
• doesn’t want to talk?
• is defensive?
• is not fluent in English?
• is tearful?
• is in a hurry?
• is not telling you the truth?
Elephants in the room
What issues might prevent your trainees from delivering
brief advice consider:
• Being a smoker
• Having a weight issue
• Drinking above the recommended limits
• Being physically unfit
• Experiencing mental health issues
• How would you address it?
Pros and Cons
Identifying success behaviour:
• Can you think of a time in the past where you set a
goal and achieved it? (it doesn’t have to be health related)
• What made you successful – what skills and techniques did
you use? How can you use these to achieve this new goal?
Pros and Cons
• What are some benefits of changing? Personal, financial…
• What are some drawbacks of staying the same?
• What are the benefits of staying the same?
• What are the drawbacks of changing?
Time to Practice
Time to have a go
• Think of something you want to change
• Think of a previous time you achieved a goal, what
steps did you take, why was it a success?
• What are the pros and cons of making a change vs. staying
the same?
• Write down your three main reasons for making a change?
• Is now a good time to start?
• Make yourself a SMART goal related to starting to change.
Brief advice is short, simple and factual. You are raising
awareness and motivating people to think about making
a change.
• Ask and Advise – provide facts, tips and where to go for
more help. If someone isn’t interested – leave the door open.
Brief interventions build on brief advice to help equip service
users to take action.
• Act – Eliciting service user to identify areas for change, their
readiness to change, and facilitating them to set their own
goals and a means to achieve them. This may include: scaling,
SMART goal setting and signposting to further support.
Next steps for training
• In small groups discuss:
• How best to deliver this session to your
department / ward?
• What training resources would you need?
• What sections from today include / remove?
• What additional support is needed?
Using MECC could…
• Result in someone being grateful you took the
time to take an interest
• Help someone to make links between their lifestyle and
realising other life ambitions
• Make someone feel able to take control of their health
• Mean that someone could live a longer and healthier life as a
result of what you did
We can’t do it without you
Start Making Every Contact Count today.
Further training:
E-learning modules:
Making Every Contact Count:
Level 1 - Brief Opportunistic Advice
Level 2 – Brief Interventions
Online tool kit of resources:
On-going support: If you have any questions that arise following
today’s training or want to feedback thoughts or experiences please
Sarah Needham, Matron, and
David Richardson, Head of Learning and OD.