Health Living Pharmacy & MECC workshop

1. Health Living Pharmacy&MECCworkshop Gill Hall & Tania cork

2. Objectives • Welcome and Introduction • HLP update & successes • MECC • Q & A

3. The Stoke & Staffordshire HLP Story 2013 • South Staffordshire • 32 accredited HLPs • 36 working towards accreditation • North Staffordshire and Stoke • 24 accredited HLPs • 34 working towards accreditation

4. Stoke & Staffordshire HLP Successes • 12 month plan of campaigns • Use the free resources we signpost • Fill in data recording sheets for public health • Show commissioners we deliver

5. Mental Health campaign

7. Mental Health campaign promotion • Obtained free material from the rethink website (bags, posters, pens, postcards, badges and balloons). • Made information packs for Customers. • Set up a ‘Mental health day’ and advertised on the Rethink website. • Liaised with our local rethink centre, who set up a display in the Pharmacy. • Collected all data.

8. No Smoking Health Campaign

9. Stop Smoking Lose Weight

10. Alcohol Awareness

11. Stoke & Staffordshire HLP • Why do we need to have health promotion campaigns? • Talk groups for 5minutes • feedback

12. Staffordshire HLP • Someone following all of these healthy lifestyle choices would live on average ? years longer than a person who followed none…………. • Not smoking • Eating a healthy diet • Drinking alcohol within the recommended limits • Doing the recommended amount of physical activity

13. Health Inequalities ‘…people living in the poorest areas will on average, die ? years earlier than people living in the richer areas and spend ? years more living with ill health’ Health Lives Healthy People: update and way forward July 2011 Multiple influences on health and wellbeing. Dahlgren, G. and Whitehead, M. (1991) Policies and strategies to promote social equity in health

14. Healthy Lifestyles in the Midlands and East(NHS West Mids, East Mids and East of England) • Smoking- 19 to 25% of population smoke • Alcohol – 14.6 to 17.9 % drinking at increasing risk and 4.0% to 6.1% drinking at high risk levels • Physical activity- ? % of men and ?% women do not meet recommended PA levels • Obesity- men 22% to 26%, women 24% to 28% • Diet ? % of men and ? % of women do not eat 5 a day.

15. Staffordshire HLP • What can we do to make a difference? • Make Every Contact Count

16. What is MECC? MECC means making the best of every appropriate opportunity to raise the issue of healthy lifestyle Developed for the East Midlands Health Trainer Hub, hosted by NHS Derbyshire County

17. 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 area • 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 life It is about you helping other people to know how they can improve their own health and wellbeing Developed for the East Midlands Health Trainer Hub, hosted by NHS Derbyshire County

18. An example of MECC Impact In NHS Midlands and East • 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 member = 2.88 million opportunities to influence behaviour change. Developed for the East Midlands Health Trainer Hub, hosted by NHS Derbyshire County

19. Making contacts more effective We can’t make people change…but we can: • provide a suitable environment • talk to people we meet • encourage them to change to more healthy behaviours Developed for the East Midlands Health Trainer Hub, hosted by NHS Derbyshire County

20. Possible Barriers? • We all want to help improve people’s health • What will stop us Making Contacts Count? • What barriers may get in the way?and • What can we do about them? Developed for the East Midlands Health Trainer Hub, hosted by NHS Derbyshire County

21. Barriers to MECC? • outside our comfort zone • not sure we know enough • assume they won’t want to listen • afraid to cause offence • these may be our friends and neighbours • too busy • don’t know how to start Developed for the East Midlands Health Trainer Hub, hosted by NHS Derbyshire County

22. The elephant in the room We might find it difficult to raise a lifestyle issue with a client if we… • smoke • drink too much • eat an unhealthy diet • don’t exercise enough • have sexual health issues • have emotional health problems …ourselves! Developed for the East Midlands Health Trainer Hub, hosted by NHS Derbyshire County

23. But….. We have to find a way • We have a responsibility to convey healthy lifestyle messages to our clients • Providing information provides choice • Proving information and support about unhealthy behaviours may lead to us considering lifestyle changes ourselves. Developed for the East Midlands Health Trainer Hub, hosted by NHS Derbyshire County

24. Clients may: • Be really appreciative that you encouraged them to make changes they had been considering for some time • Be grateful you have taken the time to talk to them and have experience with the same issue • Make connections between their lifestyle and what they want from life • Live longer and healthier lives because of what you did. Developed for the East Midlands Health Trainer Hub, hosted by NHS Derbyshire County

25. MECC process • What do you think the steps are?

26. MECC process a short conversation about healthy lifestyles....... Brief Advice Engage Close Raise issues • Short intervention • Opportunistic • Simple, structured advice • Raises awareness • Giving info on behaviour change • Agree on action • Positive • Thank them • Openers? • Willing to engage? • Ask questions • Assess their health priorities

27. Staffordshire HLP • Brief advice • Aims to introduce and encourage change by providing information • A few words given at the right time by the right person can have a significant influence…

28. Brief advice • What qualities and behaviours do you need to be able to offer brief advice?

29. Stoke & Staffordshire HLP • Principles of Brief Advice • Empathetic • Avoid labelling • Understand there are preconceptions: both healthcare professionals and customer • Supportive • Non-threatening / non-confrontational • Body language and speech tone

30. Stoke & Staffordshire HLP • When is it a brief intervention? • The recommended brief intervention is five minutes of brief advice (developed by the World Health Organization). • If you are too busy now • ask them to call back for more info • suggest a time when you are likely • to be a bit quieter • If it is outside your expertise - signpost

31. Stoke & Staffordshire HLP • It sometimes feels like it doesn’t work….. • “I’ve spoken to loads of people and no one wants to know”! • “No one agreed to change behaviours today”

32. Brief Advice • For every eight people who receive simple alcohol advice, one will reduce their drinking to within lower-risk levels.www.alcoholconern.co.uk (Moyer et al, 2002) • This means 250,000 men and 67,500 women each year change from higher-risk to lower-risk drinking • Higher- and increasing-risk drinkers who receive brief advice - twice as likely to moderate their drinking 6 to 12 months after an intervention when compared to drinkers receiving no intervention • Brief advice can reduce weekly drinking by • between 13 % and 34 %

33. Brief Advice • For every twenty people who receive advice on smoking, one will act on the advice given. • Remember they may not seem interested today but store the info • A future trigger may make them remember your advice • You may never know the difference you made to someone’s life

34. Remember • Public and patients expect to have conversations with healthcare professionals on relevant lifestyle issues • – otherwise it is a licence to continue bad habits! • Public and patients value the opinions of those that have changed their own behaviour – eg lost weight, stopped smoking etc. • Practice on your work colleagues – MECC each other, you might even make a change

35. MECC process Engage Brief Advice Close • Openers? • Assess willingness to engage

36. Time to Practise Developed for the East Midlands Health Trainer Hub, hosted by NHS Derbyshire County

37. How to Start • “We are a healthy living pharmacy now, so can I show you our lovely new health promotion zone........” • “We are providing a new service…” • Draw attention to a leaflet or poster – “Have you seen that we are offering…” • “We are randomly asking our customers about their alcohol drinking and…” “their exercise and…” “their fruit and veg intake and....” • “Looking at what medication you are on you may wish to consider the effects of alcohol/exercise/weight reduction…” OR even better “did you know there are things you can do to help with the condition?” • “Your (husband, partner, daughter, boyfriend, • friend) might want to pop in and see us…”

38. Things to avoid • When a person doesn't wish to participate in the brief intervention process. • When a person is in a highly emotional state. • When a person is drunk or intoxicated on any other drug, or not well enough to engage effectively. • Preaching / Being judgemental • Telling the person off / Arguing • Being rushed / Unsuitable environment • Medical jargon

39. Consider • Offer not just for today but for the future if wanted • Confidentiality • Privacy – customer’s right to refuse to engage • Customer’s right to say ‘no’ to the service • Don’t use labels, eg, ‘alcoholic’ • Cultural sensitivity…eg a first question could be: “Do you drink alcohol at all?” • Stigma– customers may become defensive

40. How to finish? • Use closed questions… • Are you happy to go and have a think about what we talked about? • Has our chat been useful for you? • Have you got some ideas on how to cut down now? • Would you like to talk to someone about your alcohol use? Always thank them for talking to you; people are more likely to re-engage with a service after a positive experience.

41. Agree on action What is your role after discussing a lifestyle issue? • Provide information • Signpost • Make a referral • Record it on data sheet! Always wish the client well. Developed for the East Midlands Health Trainer Hub, hosted by NHS Derbyshire County

42. Time to Practise Developed for the East Midlands Health Trainer Hub, hosted by NHS Derbyshire County

43. Consider these patients / customers • Elderly couple, she walks with a walking stick • Obviously pregnant woman • Female customer of “middle years” who looks overweight • Male customer – looks mid-twenties • Male customer of “middle years” who smells of cigarette smoke • Young girl – say an older teenager

44. Feedback discussion How did you raise the lifestyle issue? How did it go? What if they said this……? Developed for the East Midlands Health Trainer Hub, hosted by NHS Derbyshire County

45. Smoking cessation conversations! • I thought smoking would improve my chest, but it’s been two weeks now and I’ve got a rotten cough. What’s causing it ? • My great uncle Rodney smoked all his life and he’s 83 next year! • What about alcohol, I can’t give up drinking as well ! • I’ve got 3 small children. Cigarettes are my only time out and help me relax. What am I going to do instead ? •  I smoked through my first pregnancy and the baby was fine so why should I stop?

46. Smoking cessation conversations! • I’m worried that if I go to the pub I’ll have a pint and won’t be able to resist a fag, but I don’t want to give up my social life as well ! • My friend is still using the gum a year after quitting. Will I get addicted to the gum? • Have you ever smoked ? • What about herbal fags, are they ok ? • I’m going to miss my cup of coffee and fag in the mornings, what should I do ?

47. Smoking cessation conversations! • I stopped smoking 5 weeks ago but I’ve put on 5lbs already • My doctor sent me to see you…just tell me what you’re going to do to get me to quit ! • I’ve cut down from 40 fags a day to about 5, so that’s ok isn’t it? • Do you think my asthma will be affected by quitting ? • Can I still smoke cannabis ?

48. Stoke & Staffordshire HLP • Free Resources? • CPPE – www.thelearningpharmacy.com for the whole team – bite size online learning • ww.mcneilproducts.co.uk/club – The Pharmacy training club • “Its OK to ask” posters http://learning.nhslocal.nhs.uk/features/making-every-contact-count/communications-support/3-its-ok-ask • Various leaflets

49. Finally If you think you are too small to have an impact, try going to bed with a mosquito in the room! Author Unknown Developed for the East Midlands Health Trainer Hub, hosted by NHS Derbyshire County

50. What are you waiting for? Developed for the East Midlands Health Trainer Hub, hosted by NHS Derbyshire County