What is a healthy conversation? I’ve spent a lot of time and thought on this over the last few weeks due to a deep dive into the literature for an assignment. The assignment was submitted, and feedback has been received but I’m still thinking about it. 
 
Coaching is all about having a healthy, productive conversation. But unlike a ‘normal’ conversation where there is an expectation that each participant would contribute equally, a coaching conversation requires one participant to be the listener and the other the speaker. 
 
I wrote Improving the Maternity Experience – is a golden thread of coaching the answer?  just as I was starting to think about the subject of my dissertation. In that blog I considered how the skills I deploy as a coach could be used to improve the experience and outcome for women in labour.
 
I started to delve into the literature on coaching in health. Coaching in this area (health professionals, other carers, patients) could be described as a fairly new activity but it is a process that has been frequently utilised. However, as it is not referred to explicitly as ‘coaching’  it can be difficult to recognise.
 
My starting point was a paper delivered at a Coaching and Mentoring Research Conference entitled Making Every Conversation Count: The role of informal coaching and mentoring in the NHS. This effortlessly led me to an NHS policy initiative dated 2008, Making Every Contact Count (MECC). Much of the literature made no reference to the skills required to deliver this policy but  one or two did. 
 
For example, a factsheet produced by the Infant and Toddler Forum referred to the use of open discovery questions ‘to help someone explore an issue’ and ‘spending more time listening than giving information’.  Another writer described the use of  ‘exploratory conversations through which the practitioner attempts to understand the world of the client and the context of the presenting problem and supports clients to plan their own solutions’.
 
Both were describing coaching.
 
But now a confession. MECC rang a bell, but it was never on my radar as a senior leader in the Royal Collection of Midwives. Maybe if there had been a greater overlap between my qualifying as a coach in 2019 and my subsequent leaving the RCM in 2020 it may have done. 
 
Did it mean that it had ceased to be a policy during my time working for the RCM? Or was it still a policy?  It took a bit of digging to find out. Most health professionals that I spoke to had never heard of it. This was supported by research that had  uncovered a lack of awareness of the policy.  Nobody could tell me if it was still a policy but maybe I just asked the wrong people. Finally, I found reference to it in the NHS Standard Contract 2023/24 under Service Condition 8: Unmet Needs, Making Every Contact Count and Self Care.  It is still a policy. 
 
I started to think about my own contact with NHS staff. Had I experienced MECC as a patient?
 
Over the last few years, I’ve had a lot of contact with health professionals. Not so long ago I was under the care of three consultants: a cardiologist, rheumatologist and endocrinologist. I’ve now been discharged by the latter, but I’ll have a lifelong relationship with the other two. Have I had MECC conversations? I’ve definitely had conversations about my lifestyle, but they have usually been instigated by myself. For example, the most recent conversation I had with a cardiologist about exercise was very encouraging. I didn’t learn anything new, but I got his full support in what I was doing. 
 
The same can’t be said about all health professionals many of whom have very little knowledge about exercise. Back in 2017 I blogged about a very disconcerting conversation I had with a pharmacist who followed the Trump view of exercise. He initiated a MECC conversation but the advice he tried to give me was wrong and could have been damaging to my health if I had taken it.
 
Comparing these two experiences suggests that MECC cannot just be about the giving of correct information, it has to include empowering people to take control of their health. I left my cardiologist  consultation with a spring in my step, whilst that pharmacist left me angry and undermined. 
 
Finally,  I was reminded of my earlier blog  when following a thread on X (formerly Twitter) on deploying ‘listen, believe, act’  when caring for women and their babies. I couldn’t agree more. But it is sad that this even needs to be stated. Has MECC failed as an NHS policy? Can the introduction of a coaching culture in the NHS revive it? Let the conversation continue.