The Prevention and Lifestyle Behaviour Change: a competence framework is the essence of the regional 'Making Every Contact Count' strategy and will deliver on improving health and wellbeing, prevention and health inequalities. This framework is an innovative whole system response to enable a sustainable commissioner led approach to promoting healthy lives.
The framework is split into generic and specialist level competences and is being used by service and education commissioners; service providers, including human resources and organisational development; education providers and individual workers to bring together the required processes and systems to realise whole workforce change.
Collaboration across the former SHA region facilitated agreement of the required workforce transformation to achieve this and with the NICE (2007) challenge to 'equip practitioners to support behaviour change' serving as a critical evidence base, the framework was developed.
Aims and objectives
The aim of the programme was to implement the NICE guidance using large scale change methodology to industrialise the delivery of behaviour change in our workforce. It was to be simple and easy to use to address the organisational development along with organisation and service needs population needs
The programme objectives were to:
- Be patient/client focused and 'start where the community/individual is'
- Be simple and flexible adding value to current good practice
- Support the system to change and be generic enough to be added into current services i.e. reinforce commissioning of services
- Support responsive and accountable appraisal processes and procedures to enable the workforce to succeed
- Address and align the 'Good Business' agenda of the Black Report (2007), Health and Wellbeing Review (2010) and Boorman Review (2009) regarding Health and Well-being at work along with 'Staying Healthy'
- Support the development of measureable outcomes and the effectiveness/efficiency gains required within the current public sector environment
- Support capacity building across the whole workforce so all can respond to opportunities support or instigate lifestyle behaviour change but not necessarily be experts i.e. aware of, able and confident to signpost to other appropriate practitioners or services.
- Build a whole system, responsive to health and wellbeing and prevention, not just a programme or illness service.
- Take into account behaviour change focused roles sometimes take responsibility for the totality of the change process when in reality, the contribution to enabling an individual to take the decision to change is made by a chain of contacts with health and social care staff, family and friends.
Reasons for implementing your project
The programme was initiated in the regional strategy Healthy Ambitions (2008) along with Directors' of Public Health workforce strategy which had behaviour change as one of the top three priorities.
At the time there was little behaviour change education provision but following stakeholder engagement training was not the only solution. The programme responded to the need for service and workforce redesign to support workforces to feel confident and competent to deliver appropriate advice and interventions. In response to the limited academic and other evidence on enabling behaviour change to be practiced by all workforces instead of a specific, often specialised few, the programme required standards based on recognised or newly developed competence. Commissioning behaviour change services is problematic as the level of service from brief advice through to complex interventions, workforce competence etc, is difficult to articulate.
The notion of behaviour change and wider public health ethos is not embedded into the culture of commissioners so that it is not seen as everyone's business, rather it is the responsibility of key roles. Directors of Public Health including health and wellbeing as part of their strategies, but corresponding workforce strategies do not demonstrate how the workforce would need to be developed to demonstrate impact. Rather they focus on numbers of staff in particular roles, e.g., more Drs or nurses without articulating what they will practically contribute to delivering behaviour change. Workers need to know when it is appropriate to introduce the notion of change within the bigger scheme of the individual's health and wellbeing needs and also take into account the service limitations. They also need to know when to stop.
How did you implement the project
The programme achievements are set out here:
- January 2009 - Sheffield Hallam University awarded contract to develop Competence framework
- February 2009, 2010, 2011 - Making Every Contact Count Regional events
- January 2009 - October 2009 Framework Research and Development
- December 2009 onwards - Development of a wide range of case studies to demonstrate the range and use of the framework.
- October 2009 - Jan 2010 Framework testing with range of stakeholders across the SHA Region
- January 2010 commissioning of self assessment tool MECCAT June 2010 - Professor Malcolm Whitfield produces report on the economic case for this work
- September 2011 development of resource pack November 2011 NIHR bid submission
- December 2011 - academic case for framework and MECCAT due publication
The main costs for the programme were the commissioning of the framework and assessment tool along with hosting regional events. The key challenges are justifying, using the academic and in practice evidence, this new approach which blends workforce competence with function rather than occupation or service. Along with the condition specific DH and programme approach to disease and individual health. At this current time of NHS transition there is a challenge to ensure NHS delivery remains focused on health and well-being including behaviour change when public health is moving to local authority.
The benefits to patients of a social movement led by our frontline services to ensure that every encounter is a health and wellbeing encounter supports the business cases for employee health and wellbeing (NHS Constitution) along with the evidence regarding self-care and facilitating individuals and communities to stay healthier and preventing unnecessary or no longer required treatment.
The benefits to patients can be evidenced in the NICE guidelines and the powerful 'fully engaged' Wanless scenario of engaging people in their health and well-being. The framework contributes to this in ensuring the workforce is fit to succeed in coming from where the individual or community is and undertaking behaviour change techniques to support or maintain lifestyle and preventative action. For example, NICE recommend initiatives to reduce blood pressure are cost effective, many of these are related to lifestyle e.g. diet, exercise, smoking.
The workforce is competent to address the interaction with patients need to understand behaviour change or where to signpost the individual to access further services, as a basic skill. The aim is to support patients to make choices that add quality life on years. It is likely to deliver improvements in terms of current workforce productivity i.e. more activity for the same money.
The evaluations have been undertaken in a number of ways including case studies and a small scoping study undertaken by Manchester Business School that identified 'viral' spread and use of the framework. Much of the spread has been outside of Yorkshire and the Humber region. The diffusion can be seen across the workforces of health, local government, social care, fire services and schools which has exceeded expectations.
Key learning points
- Utilising the framework enables partners to work together on a common language and standards which have impact on practice.
- The flexibility and simplicity of the framework enables it to be used across differing organisations and services.
- The framework supports the workforce being an enabler/asset for transformation T
- enacity and energy to continue with an academic and evidence based approach to wide spread adoption is a necessity, this cannot be underestimated.
- Using a systematic workforce approach to diffusion of NICE guidelines, not just training and education.
- Co production between academia and service.
- Considering behaviour change as a role (or specific occupation) rather than the function it is for all workforces.
- Prescribing how the framework should be used, the local and service lead adoption encourages creativity. Welcome challenge but be clear about academic and evaluation evidence.