Will MECC delivery last? The sustainability of Making Every Contact Count

Question As the 13 MECC Train the Trainer attenders describe it, how likely is MECC delivery to continue in their organisations without further outside support?

Judged against the evaluator's rubric, agreed before any interview was read, criterion by criterion: Ownership: is MECC built into the organisation's routine structures (induction, mandatory training, job roles, policy, commissioning)? Likely to last: At least 7 of 13 interviews describe MECC secured in a routine structure, and no more than 2 expect it to lapse. Partly likely: At least 4 of 13 describe it secured, and fewer expect it to lapse than describe it secured. Unlikely: Fewer than 4 describe it secured, or as many or more expect it to lapse as describe it secured. Cannot say: Fewer than 4 of 13 interviews say anything about it either way. Resources: are staff time and funding for delivery secured? Likely to last: At least 7 of 13 describe time or funding secured, and no more than 2 say lack of time or money stops delivery. Partly likely: At least 4 of 13 describe it secured, and fewer say it stops delivery than describe it secured. Unlikely: Fewer than 4 describe it secured, or as many or more say it stops delivery as describe it secured. Cannot say: Fewer than 4 of 13 interviews say anything about it either way. Capacity: are there trained people, in post, able to keep delivering without help from the programme? Likely to last: At least 7 of 13 describe such capacity in place, and no more than 2 describe it lost or dependent on ended support. Partly likely: At least 4 of 13 describe it in place, and fewer describe it lost than in place. Unlikely: Fewer than 4 describe it in place, or as many or more describe it lost as in place. Cannot say: Fewer than 4 of 13 interviews say anything about it either way. How the criteria combine: The weakest decides: the overall verdict is the lowest level any criterion reaches, since enthusiasm cannot keep delivery going without time and money, and money cannot without trained people. If any criterion is “Cannot say”, the overall verdict is given on the others and says which criterion could not be rated. Each criterion is also reported separately, split by whether the attender cascaded.

As the attenders describe it, MECC delivery in their organisations is partly likely to continue without further outside support. On the evaluator's rubric, ownership, resources and capacity each reach Partly likely, so the overall verdict, which the rubric takes from the weakest criterion, is Partly likely. None reaches Likely to last, because on each criterion more than two interviews describe delivery stopped, held up or at risk for want of it.

13 interviews in 2 groups · 247 passages coded · 10 October 2026 · Run 2026-10-09-6hbm

Verification in this report:
38 numbers, every one computed directly from the coded passages rather than written by the AI. Click any number to see who it counts.
247 quotations, every one found word for word in its interview. Click an interview's ID beside a quotation to read it in place.
56 findings and 6 high-level findings, every one checked against the interviews after they were coded a second time.

The verdict is moderately secure. On every criterion clearly more interviews describe the condition in place than describe delivery stopped for want of it, so no single interview read the other way would change any criterion's verdict.

Behind the verdict lies a pattern the counts alone do not show. Where delivery is secure, it mostly rests on one person, or a small team, whose paid role or contract includes delivering MECC (, , , , , , ); , whose team has sessions booked although delivery was not part of his job, , who has courses booked by her own choice outside her job plan, and , delivering in her team's weekly training slot, are the exceptions. The wider cascade, staff trained as trainers delivering alongside their day jobs, is what , , and describe as failing in their own organisations. , , and describe both at once, which is why the same interviews appear on both sides of a criterion.

The standard

The evaluator agreed the rubric before any interview was read. Each criterion counts the interviews, out of all , that describe the arrangement already in place, against those saying delivery has stopped, cannot start, is held up or will lapse for want of it. Statements of support or intention count as neither. A criterion is Likely to last where at least seven interviews describe it in place and no more than two describe it stopping; Partly likely where at least four describe it in place and fewer describe it stopping than in place; Unlikely otherwise; and Cannot say where fewer than four interviews mention it at all. The weakest criterion decides the overall verdict.

Every interview mentioned capacity (); all but mentioned ownership (); and all but , whose remarks on time only hint at it, mentioned resources (). No criterion falls to Cannot say.

The chart shows, for each criterion, how many interviews describe it in place, only intended, or stopping; an interview can appear under more than one status.

In place

Intended

Stopping

Capacity

Ownership

Resources

Attenders in each group. Each number is out of 13 attenders. Paler, and + beside a count: those that say it only implicitly, which the count leaves out. Click a count for its passages.

Ownership: partly likely

interviews describe MECC built into a routine structure of their organisation, against describing delivery stopped, held up or at risk for want of one, so ownership is Partly likely.

The structures named are concrete. In 's council MECC is "on our training plan so anyone can access it" (); for it "was part of my job description as well" (); 's trust runs "a core MECC session in the preceptorship program" every month and has it in its care certificates (), (), with competencies written by its learning and development team (); , , and place it in public health strategies and plans (), (), (), (); and was told at the training of a trust expectation that "you will deliver this training" (). In two interviews a council commissions an outside provider to deliver core MECC: 's council has a charity "commissioned to deliver it for two years" (), and 's community interest company "won the bid so we’re delivering it" ().

Against this, the interviews describe MECC kept out of the roles of the people trained to deliver it. reports trained staff replying "I’m not able to have this in my remit notes, it’s not seen as relevant to my role" (); 's manager set "no expectation" (), and "there was certainly no plan put in place from my department" (); 's team has "no sort of authority over" the staff it trained (); and in 's service "Nothing was in place at the time when I was leaving" (). cannot make it compulsory: "I would love to make it mandatory but that’s like not happening" (). , , and describe a structure in place as well.

Support and plans with nothing yet decided behind them were not counted as ownership. interviews describe some, such as "My line manager is absolutely definitely on board with MECC" () () and "They value MECC. They understand the value of it" () ().

Resources: partly likely

interviews describe staff time or funding for delivery secured, against describing delivery stopped, held up or at risk for want of time or money, so resources are Partly likely.

Where time is secured, it is mostly because delivery is part of a paid role or a paid contract: "it’s my job to deliver that training, so I have time set aside to do that" () (); "it is in my job role" () (); "that is part of our role" () (); "it’s part of my role" () (). For the commissioned providers the contract pays: the charity's trainer is paid per course () (), and MECC brings "a little income for our company to sort of keep us going" () (). Elsewhere the time comes from the organisation's own timetable: delivered in her team's weekly training slot (), and 's team has sessions booked during site closures when "all of the staff are free to come along" ().

Where time is missing, it is the time of people for whom delivery is extra to other work. , speaking of clinical managers in general, says "Management don’t have time, especially in a clinical setting, for you to go and say can I have four hours" (); for , "time has been a huge factor because we’ve had loads of sickness in our team" (); has not delivered in "a very busy environment" (); and 's sign-off was held up because her line manager "had a massive workload" (). and report this of the staff they trained: that they "have a day job and so I think they found it very difficult to prioritise MECC" (), with many replying "I just haven’t got the capacity to deliver this at the moment" (); that trainees fed back "I don't have the capacity when I get back into my team, either the managers not supportive of the extra time" (). and describe delivery delayed by logistics or workload, but both now have sessions booked, so neither is counted as delivery stopped.

The paid contracts are themselves time-limited. thinks "the contract’s for a couple of years" (), and does not know "what will happen in two years if we’ll continue with (name of charity) or whether I might have more capacity to deliver it" ().

Capacity: partly likely

interviews describe trained people in post able to deliver without help from the programme, against describing that capacity lost, unready or dependent on support they lack, so capacity is Partly likely.

The capacity in place is mostly the interviewee or a small team: has "delivered that training now for well I’m going to say somewhere between 22 and 26 times" (); reports "We seem to be doing one or two a month" (); at 's council, where the commissioned charity delivers, "Core MECC we’ve had pretty much one a month as well" (); and 's team has sessions booked, "in December we’re running five sessions" (). , , and say they have the materials they need (), (): "Well, I’ve got the basic PowerPoint. That’s all I usually need." () (); "the resources are plentiful" () (). Against this, had not yet accessed the slides (), 's service had still not finished its own slides when she left (), and "froze" when asked to deliver the core MECC slides ().

The capacity lost is mostly the cascade beyond the lead or team. reports that of "80 plus staff as trainers originally, there’s very, very few who are actually delivering" (); is "lucky to have maybe 10% of those staff delivering core MECC routinely" (); says trained colleagues in her team "go on the train the trainer and don’t do anything with it" (); and says her trust "lost a whole people" who did not realise they had to deliver (). Among those who had not delivered, confidence faded with the wait: "as time goes on your confidence does fade" () (); "it’s no longer fresh in my mind" () (). , who was to deliver for her service, has since left it (), and found no support after the course to start delivering ().

Those who cascaded and those who did not

The index records attenders as having cascaded and as not; , recorded as not, describes delivering MECC on the care certificate ().

The table sets the two groups side by side, each count out of its group.

	Cascaded	Did not cascade
Ownership in place
Resources in place
Capacity in place
Ownership lacking, delivery stopped or held up
Time or money lacking, delivery stopped or held up
Capacity lost or unready

Those who cascaded describe the conditions in place far more often. All describe capacity in place () and time or funding in place (), and describe ownership in place; of those who did not, describe capacity, resources and ownership in place. Since capacity in place includes delivering, the cascaded group describes it almost by definition; the differences on resources and ownership are clear, and would survive one interview being read the other way.

On delivery stopped, the picture is less even. Lack of time or money stops or holds up delivery in of those who did not cascade against of those who did, a difference that would survive one interview being read the other way, though two more who cascaded (, ) hint at it. Capacity lost or unready is described in both groups ( who did not cascade, who did), as is ownership lacking ( who did not cascade, who did); those differences are unclear with this few interviews.

Limitations

The evidence is the attenders' own account, at one point in time, of delivery they do or would do. Nothing here comes from commissioners, budgets or later records, so the verdict is about what attenders described, not about whether delivery in fact continued.
The rubric counts interviews, and an interview can count on both sides of a criterion. Several interviews (, , among them) describe a lead's own delivery secured and the wider cascade failing; the verdict treats each as both secured and stopping. § Capacity: partly likely
Two contracts that secure ownership and resources for the commissioned providers (, ) run for about two years; the interviews do not say what follows.
The difference on time or money stopping delivery rests on holding and only weakly (the cell's 2 weak documents); read as saying it plainly, those who cascaded would describe it about as often as those who did not, and the difference would not be clear. § Those who cascaded and those who did not

Annexes

How this report was written

What was read. Rubicon read all 13 documents in full. The counts below are of attenders, one document each.

Coding. It then marked every passage that bears on the question and coded pillar (which condition for continued delivery the passage concerns) and status (what the passage says about that condition now, on the interviewee's account).

Second coding and check. The same documents were coded again to the same definitions; the run does not record whether a separate coder did it, so it is not called independent here. The two codings differed in 7 places. A reader ruled on each against the text: 4 for the first coding, 3 for the second. It tightened 1 definition as a result, and corrected the coding to match. It searched the documents each count leaves out for passages both coders had missed, and added them. It also checked every sentence and quotation of the answer against the documents, so the coding and the answer in this report are the corrected ones, counted again after the check.

Counting. Attenders were then counted in 4 tables: by pillar and status; by pillar; by pillar, status and “cascaded”; by “cascaded”.

Verdicts. Rubicon reached its verdicts by rules agreed beforehand. They come from the evaluator's rubric, drafted with the evaluator from the question and agreed by them before any interview was read (9 October 2026). For each question a rule asks, such as “How many of the 13 interviews describe ownership in place?”, the answer was counted from the tables and set against the thresholds the rule gives. The verdicts reached were Partly likely for ownership, Partly likely for resources and Partly likely for capacity.

Writing and checks. Rubicon wrote the answer from these counts and verdicts, citing for each finding the passages it rests on. Every number in the answer, 38 in all, was computed directly from the coded passages rather than written by the AI, and all 247 quotations were found word for word in their documents.

Revisions. The report was revised twice after it was first drawn, and counted and checked again each time; the changes are listed at the end of this annex.

The workflow x-ray beside Step by step, below, draws the same procedure, a box for each stage and what it made.

Step by step

The analysis was written down as a workflow before it was counted: what to look for, how to code it, what to count. It was then counted directly from the coded passages rather than by the AI, so anyone can check a number, and another coder can follow the same definitions and code the interviews afresh.

What was read

All 13 documents, read in full: 6 no, 7 yes.

Coding: Sust

one row for each passage that fits; 247 rows.

The instruction a second coder would follow

This is an interview with someone who attended a MECC (Making Every Contact Count) Train the Trainer session, which prepares people to deliver MECC training in their own organisations. The question is how likely MECC delivery is to continue in their organisation without further outside support. Find every passage where the interviewee says something about one of three conditions for that: ownership (MECC built into the organisation's routine structures), resources (staff time and funding for delivery) and capacity (trained people in post able to deliver without help from the programme). Code only what bears on MECC training delivery that the interviewee does, would do or leads, or that their own organisation runs, including delivery under a contract their organisation holds; not what they say about other organisations they have no part in, and not their own use of MECC conversations with clients unless it bears on delivering the training. Code the interviewee's words only, never the interviewer's. Give one row per passage and condition; a passage that speaks to two conditions gives two rows. Do not code suggestions for how the programme could be improved unless the passage says the lack of that thing is stopping or will stop delivery. Copy the quote exactly: the shortest span, usually one to three sentences, that shows both the condition and its status.

Pillar

Which condition for continued delivery the passage concerns. Weak: A passage that only hints at the status rather than saying it, such as one that implies MECC is in the training programme without saying so, or a vague remark (“it's difficult”) whose bearing on delivery has to be inferred.

Code	Means	Counts	Does not count
Ownership	Whether MECC is built into the organisation's routine structures, so that it does not depend on one person's enthusiasm.	MECC in induction, mandatory or core training, the training calendar or learning system; MECC in job descriptions, competencies or appraisal; MECC in a policy, strategy or implementation plan; MECC commissioned or written into a service specification or contract the organisation holds; leaders requiring it.	Staff time or money to deliver sessions (resources); whether trained people are there and able to deliver (capacity); a manager's goodwill alone, which is ownership only as intended.
Resources	Whether staff time and funding for delivering MECC training are secured.	Protected or agreed time to prepare and deliver; delivery counted as part of the paid role; a budget, grant, paid contract or funded post that pays for delivery; venues or release of learners paid for; or, as stopping, delivery not happening for lack of time, workload, staffing or money.	MECC being in a policy or the training programme (ownership); the trainer's confidence or skills (capacity).
Capacity	Whether there are trained people, in post, able to keep delivering MECC training without help from the programme.	The interviewee or colleagues trained to deliver, still in post, delivering or with delivery scheduled; having the materials and the confidence to deliver alone; a pool or team of trainers; or, as stopping, trained people having left, lacking confidence to deliver, not having materials, or depending on programme support (refreshers, co-trainers, the regional team) that has ended or is not there.	Whether there is time or money to deliver (resources); whether MECC is in the organisation's structures (ownership).

Status

What the passage says about that condition now, on the interviewee's account. Weak: A passage that only hints at the status rather than saying it, such as one that implies MECC is in the training programme without saying so, or a vague remark (“it's difficult”) whose bearing on delivery has to be inferred.

Code	Means	Counts	Does not count
In place	The arrangement already exists at the time of the interview, on the interviewee's account: a decision taken, a structure or resource actually in place, or delivery actually running on it.	MECC is in the mandatory or induction training programme; delivery is written into their job or a funded contract; protected time has been agreed; trainers are in post and delivering or have sessions booked.	A plan, hope, proposal, offer or expression of support with no decision behind it (intended); an arrangement that existed but has ended (stopping).
Intended	Only an intention, plan under discussion, hope, wish or statement of support for the arrangement, with nothing yet decided or in place.	“We're looking at putting it in induction”; “my manager is supportive” with no time or plan agreed; “I'm hoping to deliver next year”; a proposal awaiting sign-off.	Anything already decided or running (in_place); a plan the interviewee says has been dropped or cannot go ahead (stopping).
Stopping	The interviewee says delivery has stopped, cannot start, is held up, or is expected to lapse, because this arrangement is missing, has ended or is at risk.	“I just haven't got the time to deliver it”; funding ending; the trained people have left; the trainer does not feel confident to deliver alone; no slot in the training programme so it has not happened; support they relied on has ended.	A difficulty the interviewee says they have overcome and delivery goes on (in_place, if the passage shows the arrangement); a delay the interviewee says held delivery up in the past where, at the time of the interview, sessions are now running or booked (the booking is in_place; the past delay is not coded); a general remark about pressures that does not bear on delivery of MECC training.

The coded passages 247 rows

Ownership 85 passages

I didn’t know from our end, from our organisation that the plan was to roll it out and train other members of staff
one of the things that we’ve been doing in terms of getting ready for delivery is having a lot of team meetings about how we’re going to implement it and stuff like that
And then we’ve scheduled in for early next year some more sessions for anybody that for whatever reason couldn’t attend.
And then we’re looking further ahead to do refresher, annual refresher training.
so I think from an organisational point of view there would be no value in just letting people sit back and not deliver.
there’s things I’ve gone back to management with and said that we’re not really comfortable with this and we’d like to think of a different approach to do with this, and they’ve kind of just said OK whatever works for you.
My boss was really good about making sure that we did a lot of health and wellbeing training, and we got access to all of those resources.
Getting signed off from the line management was the main issue
it’s very structured and hierarchical. So, if you’ve got like a blockage above you, you can’t move through
I’ve got faith it will get done at some point
Nothing was in place at the time when I was leaving and there’s lots going on at the moment with it coming up to (redacted for confidentiality) and they’re very busy at the moment so I don’t think anything will have happened since I left.
So, then I got signed up to do the train the trainer and part of my role is to do the MECC training for the public health team.
They value MECC. They understand the value of it
it’s on our training plan so anyone can access it, the core training
So, implementation plan, we’ve got it onto (name of platform) which means anyone who has a council email address can access MECC.
I would love to make it mandatory but that’s like not happening.
I had some really good sort of help with the girl who’s like the lead on MECC in our trust.
Yeah, they were really good actually. They were really good about it.
the trust does have quite a good push, big push towards physical health and health promotion because the NHS, you know, it’s part of the five year plan and all that sort of thing
that’s a rolling programme, so we’ll probably put it on again next year
I think there is, like I say, there’s a big drive for physical health and health monitoring and health promotion so I think it will be in there somewhere. I just don’t know about it.
Had the training actually not already been booked in then I probably would have contacted them and said can we put this into the bite size training.
And, you know, we had very loose targets around, you know, we want 80% of the organization MECC trained
like we've got preceptorship and care certificate, health and well-being champions is another one that we've got and we weave MECC into those.
we ask staff if they, as part of signing up to the training they've got to deliver four core MECC sessions within a year.
people go away, back to their workplaces, and they aren't supported to deliver their training when they get there.
But again, it's just trying to get the buy-in from the organization about how to, you know, we need to support the staff that have done this training to deliver it and to keep their knowledge and skills up.
we need to get MECC embedded in the organization it sits within our public health strategy and it's part of the wider organizations’ sort of preventative approach.
So theyve decided that there would be a more targeted approach to the training, so we would work with engaged teams and say yes we’ll do your train the trainer.
And we’re asking them to document best practice, and we're asking them to if they haven't already been trained, to go through the training and sort of commit to having that role out across their service.
And we always still do a monthly core MECC session for anybody to drop into.
what we do again on a monthly basis is have a MECC session, a core MECC session in the preceptorship program.
and then we have it in our care certificates.
So, and then there's always conversations about where else could MECC be delivered, you know, we've got lots of apprenticeship schemes in the trust and lots of business development schemes coming in that, and manager training.
we've got a MECC portal being developed at the moment where we signpost people to our training
we've worked closely with the management team there and they decided they want 50% of staff within the Community to be trained in MECC.
Longer term, I'm not sure whether the grand plan would be just to continue having training opportunities, you know, forever more, or whether, I'm not sure, I really dont know
we would just ask them to arrange it in house and then just send us the registers and evaluations and then we update them onto the staff’s record automatically.
And we’ve had MECC competencies created by our learning and development team and that’ll link, as soon as they've gone through the preceptorship program and it's updated on their record, that will automatically ping to say they've been MECC trained as well.
next, two weeks time I'm delivering it to our new cohort of public health fellows with a view to base it within medical education.
You know we can send them emails but we've got no sort of authority over them
rather than it just coming from, from sort of one or two staff within the public health team, which is still how it is at the minute
We've got an implementation as with everybody across the region, so we use that documentation
we've got a public health midwife in our wider team and so then she was MECC trained and would deliver on maternity education days. So that was inbuilt.
our director of public health was really keen to embed MECC within (name of location) Council and the city.
But we’ve now been told like do it internally and sort of get our cards in order that, you know, within the council first.
But I mean now we’ve got like more buy in from senior managers and they’re very keen to have MECC, so that’s where I’ve got the core MECC module.
So initially I was happy just to put it in the health champion modules, like put it in the alcohol one, put in physical activity, but now it’s like a stand-alone module as well.
I do look at them regularly because we’ve got name of charity) who are commissioned to deliver it for two years.
And it’s part of our public health plan that we want to get, and the wellbeing strategy that we want to get everyone at (name of location) Council kind of MECC trained. It’s part of the health champions plan.
I think MECC will…it’s getting written into the charter, so it’s certainly going to be pushed, that as well. That’s the whole city.
so I’ve got like a MECC task and finish group with (name of location) Council staff now, we had the third meeting yesterday
I believe that in my trust MECC used to be sort of part of the core programme of induction for anybody who comes to work for the trust. I’m not sure whether that’s the case or not anymore now
Totally supportive of me delivering it and I can’t really say more than that, you know. It’s something that I talk about in management meetings, it’s something that I talk about in team meetings.
I’ve got the lead for MECC and community smoking cessation services
my line manager said get in touch with (name of regional MECC at scale coordinator), get in touch with (name of principal trainer), you need if you’re taking the lead on MECC, you need to organise some training sessions.
My line manager is absolutely definitely on board with MECC.
she said that she gets the MECC stuff, she sees its importance as well. It’s not to say that it’s not…there’s not some work to do around cascading that message more broadly across senior managers.
they come on and do their inductions and so I’m kind of trying to integrate that, or infiltrate, the training days so that we can actually get in to speak to people right at the beginning of their careers.
But because working public health it’s my job to deliver that training, so I have time set aside to do that
I’m not able to have this in my remit notes, it’s not seen as relevant to my role
nobody else that’s done the Train the Trainer will – and that comes from me being the lead for MECC in public health for our trust – nobody else has it in their remit.
So, we now do the care certificate. We do smoking, alcohol and exercise.
Then coming into public health, there was an expectation that you delivered some type, so once I saw it delivered at care certificate level and what we’re delivering, I embraced that.
It’s like public health have got a massive implementation plan. That’s what they want to do, they want to see MECC and obviously they’ve come up with the figures, how much they want to impact it.
but again it’s that senior management don’t really get it so from other people being supported I think or have an implementation plan within their service, I don’t think that’s…
I mean public health, because I work for public health, MECC is kind of talked about every day of the week. So, we’re supported massively. That’s part of our expectation and part of our strategy is to make sure that we come into the hospital, and we try and support them and that’s more relevant.
they are trying to hit in preceptorship, so we are hitting the newbies, you know.
I think we’ve got lots of different strategies and policies where MECC is featured within that
I think in terms of staff, in terms of kind of the managers and leaders, absolutely get the whole concept of MECC and so yeah, I mean I think as an organisation MECC is very much a part of it.
It goes onto a platform called (name of platform) so it’s quite widely promoted with people, I suppose our own staff, and so we get a lot of (name of location) Council staff come on board but broader than that as well.
But they have delivered their training with MECC as the overarching framework so it’s all about MECC conversations around health weight, MECC conversations around mental health, so it’s early days.
It was part of my job description as well, so I knew that that was this deliverable that had to kind of be delivered on.
they know that they want to kind of deliver on MECC within the joint health and wellbeing strategy and they know that there’s people in the team that kind of have that, or within the staffing structure, that have that kind of role.
within our own team within the health improvement practitioners there was an expectation there that that was what the intention was, that they needed to kind of develop their training to like rework it around the MECC framework. There was that expectation that everybody was going to do that, so it wasn’t really optional
I think she got pressure from above that somebody needed to do it.
They’re really supportive.
I know there’s a trust expectation because we were told that at the training, but certainly from my manager there was no expectation and when we discussed it at appraisal, she just said oh that’s fine.
There was an expectation that we were told in the training that you’ve been given time to do this training so the expectation is you will deliver this training.
And there was certainly no plan put in place from my department.
we applied for the bid from (name of location) Council to actually go and deliver the training and we won the bid so we’re delivering it.
Oh, they were really keen. They were really keen because they knew, I think, they were forward thinking and they knew it’s something that we’re going to hear a lot of in the future
No, because I think we had to then apply, because (name of location) put out a call for commissioning to teach the core MECC
Yes. So many over the year. I think it was something like eight to twelve over a year.
I think the contract’s for a couple of years.

Resources 51 passages

we actually have some site closures in December, so we’re putting on sessions at every centre during those closures where the staff are free, all of the staff are free to come along to the session.
So, we’ve had quite a few sessions together already to go through the presentations, the core training and we’ve got time booked in to practice the delivery.
So, once we hopefully get it going, and things are in place, then the workload’s been done, and it should be hopefully quite an easy thing to carry forward.
I need an hour to do this so I’ve got two hours where I can do the MECC training, let’s just ram all of this together and get out and do the delivery.
my line manager had a massive workload, she’s just been promoted so she was doing like two job roles at the same time
getting the time to go out and see them is a barrier and because I’ve left there’s now even more of a staff shortage than there was
we had a lot of people move on at the same time so there’s just little bits of that all the way throughout the team that’s just going to be a little bit of a challenge until they get the staffing done and the new process at (name of organisation) is cost saving, every job has to be reapproved before you can hire for it.
So, I’ve done a couple of sessions already, so it is in my job role.
I think they are worried about the amount of time it will take because with (name of service) I’ve got three sessions in to try and get them
So, if she ever needs any help then I would quite happily stack up if I can job wise, job role wise, you know.
So, had we not had that slot already kind of pencilled in and had (name) not sort of given me the support she was, it would have been a lot more difficult.
And then the other part of my role was to develop or deliver the MECC program of work across the organization.
I don't have the capacity when I get back into my team, either the managers not supportive of the extra time it's going to take
I mean in terms of the capacity within our team there is also a clinical educator who’s supporting this piece of work.
So we have got a lady in the team who supports that.
and that won't be an issue because that's part of their work within the team, so we'll do it for them.
so they were public health fellows with medical education, so they have to do that and it was part of their role
You know, where there isn’t any, well there isn’t any real financial outlet, you know.
Of course, it’s always time as well, and people’s time, you know.
Again, it’s a very busy environment and it’s liaising with the project manager (name), who’s very busy.
If we can only get to exercise it.
I think with the right sort of input, and I think that’s possible as well, you can create the time because you’ve got to prioritise your time and say yeah, that needs to be a priority.
Like I said at the beginning, I didn’t have the capacity to do it once a month, so they’ve got a two-year contract. We just wanted to make sure that MECC was getting delivered every month.
And the things are we mightn’t, I don’t know what will happen in two years if we’ll continue with (name of charity) or whether I might have more capacity to deliver it.
We’d have to print them ourselves and (name of trainer) , she’s made up the cards and everything, but we’ve got a budget that she gets paid for, for doing that.
And you get paid per course so.
Not for me, because my own work’s fairly well self-directed
Trying to book training venues is very hard because as you can imagine there’s a lot of clinical training and mandatory training that has to take place in a trust. I have got one face to face but I’m also going to do an online one
a lot of them have either moved jobs or they haven’t got the capacity to do it anymore, or they don’t feel comfortable.
people were saying there’s no way we can release staff for three hours, it needs to be sort of half that
But because working public health it’s my job to deliver that training, so I have time set aside to do that
They were practitioners, or they have a day job and so I think they found it very difficult to prioritise MECC around everything else.
got so many emails back from people saying I just haven’t got the capacity to deliver this at the moment
we can’t ask that he goes travelling off to other sites to deliver it because that’s beyond the call of his kind of role.
Management don’t have time, especially in a clinical setting, for you to go and say can I have four hours of your team, or three hours of your team, or even an hour of your team to talk about MECC. They do not have time.
Oh, again, in this role absolutely because it’s part of my role.
I think this is your problem is you’re expecting that these people to be able to book out a lot of time and it’s not just going to deliver it, it’s the preparation time sorting out.
For no extra money, so with all due respect as well, to go and deliver that again, say a Band 2 to go and deliver some sort of training, it’s a higher remit.
so we offer or part of my role and people within the team, we offer this core MECC training.
It was part of my job description as well, so I knew that that was this deliverable that had to kind of be delivered on.
they know that they want to kind of deliver on MECC within the joint health and wellbeing strategy and they know that there’s people in the team that kind of have that, or within the staffing structure, that have that kind of role.
actually the health improvement team, myself, we do deliver training, that is part of our role.
So, and to be fair time has been a huge factor because we’ve had loads of sickness in our team so we’ve been really short staffed.
everybody is pretty stressed working really, really hard, so I would have to get my timing right
so I had it on my to do list and then it just kept getting pushed because I had also just completed and audit. So, I had to write my report for that as well as my workload and stuff.
With regards to MECC, I think it’s a hard one because I think it’s time. It’s the time pressure when everybody is working so, so hard.
maybes it’s managers need to understand more that time needs to be given to the trainers to cascade the information. It’s really tricky. I think it all comes down to time and workload.
And it’s a little income for our company to sort of keep us going, so although we’re a (type of) organisation in our centre, we do outside training as well, so keeps sort of money coming in to keep the centre going.
Because I’m already either a tutor in (name of organisation) in the centre, or a trainer doing outreach things.
I think the contract’s for a couple of years.
No. Like (name)’s good that does the organising. I give her some dates I’m free, she’ll advertise it and then obviously we just go from there.

Capacity 111 passages

A lot of the team have to do very similar things with the programmes that they deliver on, so I think we’re all pretty confident about it and want to go ahead and do it.
But I think the bulk of the team that I work on did the core training and then there was a select few of us who went on to do the Train the Trainer.
Yeah, I mean don’t get us wrong, I went away from it still feeling comfortable enough to deliver the training
I think it’s really good that pretty much everything’s been done for you, so the slides are there, the PowerPoint slides are there. The resources are there, the handouts are there, everything’s there for you.
I’d say it was a decent level. It was already probably high enough to go away and start and deliver
So, we’re going to be doing it in December, so in December we’re running five sessions. So, we’ll have two people delivering each session.
we’ve got more dates booked in before December where we’ve invited members of the wider team to come along and be our guinea pigs while we deliver to them before we actually get to the actual delivery.
So, all of us who attended the Train the Trainer will be.
As I say, I’ve kind of found myself taking a bit more of a lead role on it because I probably do have the most experience with it.
I don’t think anybody would be scolded for saying that, so but everybody’s stayed on board so.
So, we have rejigged it a little bit just to make it a little bit more appropriate for the participants and do it in a format that we felt more comfortable delivering it in, in terms of the order of the slides, if you like.
I left the (public sector service) about a month ago and the slides still hadn’t been prepared.
Oh, I was really confident. I would have done it the next week.
it got to the point where I was sort of feeling like well it’s no longer fresh in my mind.
because I’ve left there’s now even more of a staff shortage than there was
So, I’ve done a couple of sessions already, so it is in my job role.
But getting people to sign up to do train the trainer is a nightmare.
I’ve started to say actually if you want me to deliver your MECC training I’ll deliver it on the proviso that you have someone go on the train the trainer so that when you get new staff coming in you can train them, you don’t need me to come back.
the main thing is they either go on the train the trainer and don’t do anything with it, because there’s people in my team who are trained in MECC.
one girl’s really keen but she’s not delivered training before, so she’s got to come along with the couple that I’m doing, so I think that is an issue. So, they’re not confident to go and discuss.
with (name of service) I’ve got three sessions in to try and get them
So yes, I’ve got five people who are willing to do the train the trainer.
I delivered my first training the other day.
I think I’m now down as a trainer so if they need some training, you know, I mean we’ve already got one trainer, one very good trainer
I’ll probably just do it next year, verbatim so to speak.
up until very, very recently, I had a small team of health coaches that were part of the public health team
because from a sustainability point of view, really, really challenging with one or two people delivering an hours training every week forevermore.
actually, I've really enjoyed it, but I don't feel confident or comfortable delivering the MECC training.
Of those (number), I would say we're lucky to have maybe 10% of those staff delivering core MECC routinely.
we do still try because we keep in touch with the cohort of trainers. So we've built in a bit of a support package for them after they've done train the trainer,
So we would club together and try and deliver some update training to our cohort of MECC trainers across that patch, and every organization would take responsibility for sourcing a speaker and we would agree the topics six months in advance.
So we do that as well and we'll always offer to co-facilitate if people aren't feeling massively confident.
they're already flying with their own training they've got, across the locality they’ve got four or five people who are doing it routinely
And we always still do a monthly core MECC session for anybody to drop into.
next, two weeks time I'm delivering it to our new cohort of public health fellows with a view to base it within medical education.
So for example, in December we’re delivering train the trainer to (name of organisation) so their management team are coming along, they're quite keen, and then they will develop, they'll deliver Core MECC to their staff over time.
So I wouldn't advertise a 1/2 day train the trainer session on our staff portal because at the minute it's not deemed to be a good use of time because we might get 5 people signed up, but then based on past experience, we know those five people probably won't do anything with it.
we've got a public health midwife in our wider team and so then she was MECC trained and would deliver on maternity education days. So that was inbuilt.
Then we had clinical educators who were MECC trained. And again, lots of opportunities within their role to deliver MECC
I mean, our health coaches, they've all done MECC train the trainer, so they would, as part of their role they would be delivering on the care certificate or they might co-deliver a session.
So sometimes yeah, I think on the face of it, it's not technical training, but I think there's elements to it which can be hard for people to deliver confidently.
And getting the confidence as well, because obviously when you’re doing sort of teaching sessions it can be quite daunting at times, but I think that helped as well.
it was actually a lady who used to work here, and she said do you want to do the course together. Now, you know, like deliver any aspect of the MECC
What structure, you know, can be in place to actually try and achieve your objectives and there didn’t seem to be any support in that respect there.
I used to do a lot of training and such, you know, so it hasn’t left us entirely.
No. I must be honest I haven’t as yet.
Well, there hasn’t been any positive communication to go on from, from the end of the course so to speak.
I think initially I would look for support, but once I think it had been done, I think then I will feel OK to do, set it up myself.
And I haven’t, maybes that not comfy enough to carry on and say right I’ll go online and I’ll—
I’m more after looking after the trainers that we’ve got, so we’ve got (name) and (mame) from finance, they’re delivering finance module, and then there’s two from (name of charity) who are delivering the core MECC.
Like I said, I would do it. I’d probably have to read through the slides a few times but yeah. I suppose I’ve got the advantage that I have read the slides quite a lot, so I am familiar with them.
Yeah. I could if I wanted to. Like if (name of trainer) was on long term sick or something I could go out and do it.
And (name) and (name) from our finance team they’ve been delivering that like pretty much every month since.
Core MECC we’ve had pretty much one a month as well.
I don’t think so. I think everything’s been there.
I suppose the one thing that’s probably came up is some people will do it and maybe not realise that they have to deliver training.
I mean, that’s why I’ve never held another Train the Trainer to date because I know we’ve got quite a few delivering to (name of charity). I think that’s 7 sessions so far.
hence I have got two courses booked but they haven’t been delivered yet.
So, the resources are plentiful. You can’t say there’s anything missing because there isn’t, it’s just a bit all over the place.
I’ve got a post graduate certificate in adult education so I’m a little bit more confident in delivering
my plan would be to do one online and one face to face. Probably three times a year each, so every four months.
I’ve delivered that training now for well I’m going to say somewhere between 22 and 26 times.
But I don’t do that for MECC. I just deliver MECC by myself.
a lot of them have either moved jobs or they haven’t got the capacity to do it anymore, or they don’t feel comfortable.
And out of the 80 odd staff I think I only got about 10 that came along to that, and even then, I don’t think many of those are delivering now at all.
One of the guys in exercise therapy’s been really good at delivering, certainly to his kind of departments and areas
I don’t think I feel too bad about having to deliver that training by myself.
In terms of my delivery, I think I’d probably now feel more secure delivering it online just because I’ve done that more often
I mean we have obviously tweaked it for our own organisation but at least you know you’re kind of working to a bit of a template around that.
I’ve just literally schedules ones that I’ve prearranged with a particular group of staff
So, we’re delivering tomorrow. I’m delivering to about 200 preceptees
she said can I joint deliver that with you so it gives me the opportunity to kind of have a go without feeling like I’m thrown into the deep end. So, we’re doing that
considering we trained 80 plus staff as trainers originally, there’s very, very few who are actually delivering.
sorry three, three people that have delivered some training, or have delivered one or more sessions.
we’ve had I think 34 staff since September last year and I don’t think any of them, as I say, other than these three, have delivered one session.
logging on to things like training apps and the NHS, Future NHS forum, and using the passwords and having to log on, I think, becomes a bit of a barrier.
Yeah, we’ve kind of done it unofficially, so I think when I do the care certificate I say to them, especially because there are a lot of health care assistants, and they do that without them realising it.
So, that’s in all honestly why you lost or why our trust, lost a whole people because they weren’t prepared to do the training because they didn’t understand they had to deliver training.
I think like where I deliver it now I think is the right place, so even though I didn’t have motivation to deliver it as such, I’m now really motivated to deliver it at a certain level.
But if I go back to when now that I’m delivery it to the care certificate people who haven’t had that experience, who aren’t embedded in the service, who are not confident speaking to patients, that’s a really good way of getting them motivated and understanding and confident and also giving them permission to have that conversation.
So, we now do the care certificate. We do smoking, alcohol and exercise.
And I’ve been honest with my boss, it’s like one of the reasons I don’t do the new slides is it’s way beyond my pay grade.
So, I think like my boss tries to do it, and I think they do do it, they kind of earmark what is the speciality and there’s sometimes requests, and can you do, so that’s an interesting thing isn’t it?
Whereas now I understand what I’m trying to deliver.
I’ve offered to be the main care certificate deliverer because there’s a lot of people that don’t like to have that conversation with people.
So, I love that level, but then my boss did ask me to deliver one to HR and the proper MECC, core MECC. I froze because I looked at the slides and went, I don’t understand them.
I think I’m lucky enough at the moment I’ve got like my support for MECC is very verbal because it’s part of my team. Like as I’ve said, I work with most of them that are trying to deliver it in this area.
Because MECC is massive. Like they are massive, and I know it’s two people that run sort of MECC in this area, and then their expectation’s other people will help them deliver it.
So, we deliver a little bit of training, but we also look at kind of how do we work with other services, organisations, to get them on board with MECC and do the training
so we offer or part of my role and people within the team, we offer this core MECC training.
The training that I deliver tends to be online but then I’ve got colleagues who do deliver face to face and deliver more bespoke, so we approach it as a bit of team.
But they have delivered their training with MECC as the overarching framework so it’s all about MECC conversations around health weight, MECC conversations around mental health, so it’s early days.
there’s people in the team who are delivering on MECC
I did have to do a lot of work adapting it and making it comfortable for me to deliver, making it (name of location) specific.
my colleague, one of the health improvement practitioners who does, who has the healthy weight portfolio, has developed one of her training sessions with the MECC framework
we’ve had about three or four train the trainer sessions delivered in (name of location) and probably only a handful of people have then taken it on board and cascaded it.
So, kind of every day we’re practicing MECC as part of our job, so then part of my having not delivered any further MECC training from doing the Train the Trainer course I feel a bit like I would be teaching my colleagues what they’re doing every day, every minute of every day.
you’ve got access to all the information, all the slides and stuff.
but then as time goes on your confidence does fade, it wanes away the less you have to do with it.
and then I think I got much less confident and thought, you know, it’s like teaching your granny how to suck eggs, like this doesn’t feel right, it’s what they’re doing day in and day out. So, I think confidence dropped off quite quickly.
I could maybes say look guys, I did this, would youse be interested in me presenting to you and I would just do it on Teams
I think I would probably reach out to (name of principal trainer) or (name of regional MECC at scale coordinator) and just ask for some guidance and help to make sure I was delivering it correctly.
I think for me personally, to be perfectly honest with you Beth, I think I could do the full training again. Train the Trainer that half day, because I think to do something like that and then have what happened the next day, trying to retain that, and it’s hard to try and go back to it, in my head.
So, me and a colleague went to do the train the trainer session
We seem to be doing one or two a month, so it’s going quite well.
But I’m hoping to do the MECC mental health training and then probably start teaching that as well.
I’ve done them all in person but there is one planned for online in a couple of weeks’ time.
Well, I’ve got the basic PowerPoint. That’s all I usually need.
I think they’ve got it spot on really with what I need. Everything seems to be there. And if I’m struggling, I just get in touch with (name of regional MECC at scale coordinator).
And I still have my days where I’m not confident and my colleague sometimes will deliver with me, but just again she sort of has other roles as well so it’s just occasional
So, but I’ll try it and then I’ll probably pass it on to (name of organisation) where I work, probably do a practice run teaching some of the women there and then see what happens if (name of location) Council want me to do it for them.

Counting: Status

Attenders by pillar and status

The table 9 cells

Pillar	Status	Attenders
Capacity	In place	of 13 +3 implicit
Ownership	Intended	of 13 +2 implicit
Resources	In place	of 13 +1 implicit
Ownership	In place	of 13 +2 implicit
Capacity	Intended	of 13
Capacity	Stopping	of 13 +2 implicit
Resources	Stopping	of 13 +2 implicit
Ownership	Stopping	of 13 +2 implicit
Resources	Intended	of 13 +1 implicit

Counting: Spoken

Attenders by pillar

The table 3 cells

Pillar	Attenders
Capacity	of 13
Ownership	of 13
Resources	of 13 +1 implicit

Counting: Status cascaded

Attenders by pillar and status and cascaded

The table 18 cells

Pillar	Status	Cascaded	Attenders
Capacity	In place	Yes	of 7
Resources	In place	Yes	of 7
Ownership	In place	Yes	of 7 +1 implicit
Ownership	Intended	Yes	of 7 +1 implicit
Capacity	Intended	Yes	of 7
Capacity	Stopping	No	of 6
Resources	Stopping	No	of 6
Capacity	In place	No	of 6 +3 implicit
Capacity	Intended	No	of 6
Capacity	Stopping	Yes	of 7 +2 implicit
Ownership	Intended	No	of 6 +1 implicit
Ownership	Stopping	Yes	of 7
Resources	Intended	No	of 6
Ownership	In place	No	of 6 +1 implicit
Ownership	Stopping	No	of 6 +2 implicit
Resources	In place	No	of 6 +1 implicit
Resources	Stopping	Yes	of 7 +2 implicit
Resources	Intended	Yes	of 7 +1 implicit

Counting: Base

Attenders by cascaded

The table 2 cells

Cascaded	Attenders
Yes	of 13
No	of 13

Judging: Ownership

The evaluator's rubric, drafted with the evaluator from the question and agreed by them before any interview was read (9 October 2026).

How many of the 13 interviews describe ownership in place? · level met: 8
How many of the 13 interviews say delivery stops, cannot start or will lapse for want of ownership? · level met: 5
How many of the 13 interviews say anything about ownership either way? · level met: 4 or more

Verdict: Partly likely, since the rule for Partly likely holds: secured is 8; lapse is 5.

The verdicts the rule could reach

Likely to last	At least 7 of 13 interviews describe MECC secured in a routine structure, and no more than 2 expect it to lapse.
Partly likely	At least 4 of 13 describe it secured, and fewer expect it to lapse than describe it secured.
Unlikely	Fewer than 4 describe it secured, or as many or more expect it to lapse as describe it secured.
Cannot say	Fewer than 4 of 13 interviews say anything about it either way.

Judging: Resources

The evaluator's rubric, drafted with the evaluator from the question and agreed by them before any interview was read (9 October 2026).

How many of the 13 interviews describe resources in place? · level met: 9
How many of the 13 interviews say delivery stops, cannot start or will lapse for want of resources? · level met: 6
How many of the 13 interviews say anything about resources either way? · level met: 4 or more

Verdict: Partly likely, since the rule for Partly likely holds: secured is 9; lapse is 6.

The verdicts the rule could reach

Likely to last	At least 7 of 13 describe time or funding secured, and no more than 2 say lack of time or money stops delivery.
Partly likely	At least 4 of 13 describe it secured, and fewer say it stops delivery than describe it secured.
Unlikely	Fewer than 4 describe it secured, or as many or more say it stops delivery as describe it secured.
Cannot say	Fewer than 4 of 13 interviews say anything about it either way.

Judging: Capacity

The evaluator's rubric, drafted with the evaluator from the question and agreed by them before any interview was read (9 October 2026).

How many of the 13 interviews describe capacity in place? · level met: 10
How many of the 13 interviews say delivery stops, cannot start or will lapse for want of capacity? · level met: 7
How many of the 13 interviews say anything about capacity either way? · level met: 4 or more

Verdict: Partly likely, since the rule for Partly likely holds: secured is 10; lapse is 7.

The verdicts the rule could reach

Likely to last	At least 7 of 13 describe such capacity in place, and no more than 2 describe it lost or dependent on ended support.
Partly likely	At least 4 of 13 describe it in place, and fewer describe it lost than in place.
Unlikely	Fewer than 4 describe it in place, or as many or more describe it lost as in place.
Cannot say	Fewer than 4 of 13 interviews say anything about it either way.

Writing: Answer

The instruction the answer was written to

The checks that were run

247 of 247 quotations found word for word in their document.
38 numbers in the answer, every one computed directly from the coded passages rather than written by the AI; 0 written by the AI without a count behind them.
0 citations to passages that do not exist; 0 quotations not in the passage they cite.

Second coding

The same documents were coded again to the same definitions; the run does not record whether a separate coder did it, so it is not called independent here.

The second coder's rows

Sust: 153 rows

In the run's zip, under check/coded/.

The check

A reader ruled on every place the two codings differed, and checked every sentence and quotation of the answer against the documents, correcting the coding and the answer where they were wrong. The answer above is the corrected one, recounted after the check.

The check's record check.md

Counts

Disagreements between the two coders: 7. Ruled for the rows: 4. Ruled for the second coder: 3 (one of them, AP8, only on its ownership passage; its capacity passages were ruled for the rows). Left unsettled: 0.
Definitions tightened: 1 (status = stopping, in workflow.json), with every document recoded against it.
Rows changed: 14 in coded/c_sust.json. 4 deleted, 2 changed from firm to weak, 8 added (2 from rulings, 6 omissions).
Sentences changed in answer.md: 27, listed below. The report was restructured so that the answer and how sure it is come first.
Effect on the verdict: none. Ownership, resources and capacity are still each Partly likely, and so is the overall verdict. The counts behind them changed. Ownership went from 9 secured against 5 lapsing to 8 against 5. Resources went from 9 against 8 to 9 against 6. Capacity stayed at 10 against 7. Resources is therefore no longer "narrowly" Partly likely.

Rulings on the disagreements

1. AP12, pillar = ownership (first coder firm, second coder weak). Ruled for the second coder. The only firm row, c_sust.5ynva ("Had the training actually not already been booked in then I probably would have contacted them and said can we put this into the bite size training"), is a counterfactual. Read in context (lines 150–154, 188), it shows one MECC session booked into the team's weekly CPD slot. The only thing that would make that a routine structure is that "that’s a rolling programme, so we’ll probably put it on again next year", and that is hedged. The column's weakness, "implies MECC is in the training programme without saying so", fits it. Row 5ynva is now weak. 2. AP1, status = stopping (first coder only: c_sust.urz48 "We haven’t. The problem we’ve got is…", c_sust.f7k8g "…it has added a massive amount to workload"). Ruled for the second coder. Both rows are deleted. The status column records the condition "now". At the time of the interview, AP1's team had overcome the logistics problem: "in December we’re running five sessions" during site closures, with more "scheduled in for early next year" (lines 152–156). The workload passage says the work was heavy but that delivery is going ahead (lines 192–196). The stopping definition's "does not count" already excluded a difficulty that has been overcome. But both coders had coded AP4's matching past delay as stopping, so the definition was tightened (see below). 3. AP10, status = intended (first coder only: w75my, xc5dg, 3g47s). Ruled for the rows. In w75my, "I’ve got two hours where I can do the MECC training…" is a plan for drill nights that never ran (lines 30, 48–54), so intended is right. xc5dg is a manager's general support for health and wellbeing training, and 3g47s ("I’ve got faith it will get done at some point") is a hope. Both are goodwill whose bearing on delivery has to be inferred, so weak intended is right. 4. AP2, status = in place (first coder only, both weak: g8skn, 4e29t). Ruled for the rows. AP2 says he is confident from past teaching ("it hasn’t left us entirely", line 212). But he has not accessed the slides (line 314), and he says he would "initially … look for support" (line 336). The passages hint at capacity rather than show it, so they stay weak. 5. AP7, status = intended (first coder only, weak h2g6y "…managers and leaders, absolutely get the whole concept of MECC…"). Ruled for the rows. This is general goodwill from the organisation with nothing decided behind it, so it is weak intended. AP7's firm ownership rows rest on other passages. 6. AP10, status = in place (first coder weak, second coder firm: "Oh, I was really confident. I would have done it the next week."; "I think I would have had everything I needed…"). Ruled for the rows (weak). Both passages are hypothetical ("would have"). AP10 has also left the service ("I left … about a month ago", line 50; line 196), so at the time of the interview there is no trained person in post in her organisation. Her departure is already coded as stopping. These passages stay weak. 7. AP8, status = in place (first coder weak, second coder firm). Ownership: ruled for the second coder. Row added, firm, ownership in place: "There was an expectation that we were told in the training that you’ve been given time to do this training so the expectation is you will deliver this training." (line 144, with line 136 "I know there’s a trust expectation"). That is "leaders requiring it". AP13's similar requirement (gt5u3) was already firm, and the first coder's note shows they meant to code this passage in place too, but the row was missing. The manager's waiving of the expectation stays coded as stopping (r7wjj, 8rvcj), so AP8 counts on both sides, as AP5, AP11 and AP13 do. Capacity: ruled for the rows (weak). "they would signpost us…" is dependence on programme support. "I do feel like I’ve got a lot of the information that I need" answers a question about signposting information (lines 105–108). AP8 also says her confidence "dropped off quite quickly". So the passages only hint at capacity.

Definition tightened

c_sust, status = stopping, "does not count". Added: "a delay the interviewee says held delivery up in the past where, at the time of the interview, sessions are now running or booked (the booking is in_place; the past delay is not coded)". Both coders had coded AP4's past delay as stopping (see the AP4 row below) while splitting on AP1's, so the boundary between a delay that has passed and delivery still held up was not settled.
Every stopping row was recoded against it. Changed: AP1 (urz48, f7k8g deleted) and AP4 (w8673, 5g6pq deleted). Unchanged because delivery is still not happening at the time of the interview: AP2 kd3mv; AP8 hzqqj, sdut3; AP10 (has left); AP5 7n2bc, n4cgd (trainers still not delivering); AP13 yrwxz; AP6 kcgwx. Unchanged because they look forward rather than back: AP3 6dfwu and AP11 6ny5c, both weak.

Other row changes

AP4, delete c_sust.w8673 ("I think I would have got to it quicker had it not been for … a backlog…"). The delay was past and "I have got two courses booked" (line 64), so under the tightened definition it is not stopping. Both coders had coded it, so this is a judgement against agreement (see Narrow judgements).
AP4, delete c_sust.5g6pq ("Because this isn’t a core part of my job…"). It explains the same past delay and says she does not need MECC in her job plan (lines 68–72). It does not say delivery is held up.
AP1, c_sust.22jmf to weak (ownership in place, "And then we’ve scheduled in for early next year some more sessions…"). Booked sessions show capacity. As ownership, the passage only implies a training programme and names no routine structure. AP1 says delivery was "not something that I foreseeing being part of my job role" (line 192), and the annual refresher is only "looking further ahead". The second coder coded no ownership in place for AP1.

Omissions found

For every count in the report and every sentence that says how many or which documents say something, the documents outside the count were searched by reading them whole.

j_ownership.secured (outside it: AP1, AP2, AP4, AP10, AP12). One weak row added. AP12: "I had some really good sort of help with the girl who’s like the lead on MECC in our trust." It is ownership in place, weak because it only hints that MECC is part of someone's job role ("like the lead", "sort of link worker"). Neither coder coded it. Nothing fits in AP2. In AP4 and AP10, what fits belongs to other organisations (the council's trainers' brunch, the commissioned wellbeing service, the integrated wellbeing service).
j_ownership.lapse (outside it: AP1, AP2, AP3, AP7, AP9, AP12, plus AP4 and AP6, which are weak). Nothing added. AP6's resistance from management happened in her old role, in the past (lines 154, 270). AP7's account of a difficult cascade concerns other organisations.
j_resources.secured. Nothing added. AP10's two hours on drill nights were a plan that never ran. AP8's time was time to attend the training, not to deliver.
j_resources.lapse. Nothing added. AP12's "it's just time" (lines 14, 22, 186) is about health promotion generally and about other courses. AP9's time problem (line 168) is about attending meetings, and the cost of printing cards (line 162) did not stop delivery. AP7's travel time (line 66) was solved by going online. AP11's GP practices are other organisations.
j_capacity.lapse (outside it: AP1, AP3, AP4, AP7, AP9, AP12). Two weak rows added. AP3: "I suppose the one thing that’s probably came up is some people will do it and maybe not realise that they have to deliver training." AP7: "we’ve had about three or four train the trainer sessions delivered in (name of location) and probably only a handful of people have then taken it on board and cascaded it." Both are capacity stopping, weak because the people concerned trained through the council's own programme or coordination, and how far they belong to the interviewee's organisation has to be inferred. Neither changes a firm count.
t_status.c2 (ownership intended; this is the report's old {t_status.c7}) (outside it: AP2, AP6, AP8, AP12, plus AP7 and AP10, which are weak). Two firm rows added. AP8: "They’re really supportive." The second coder coded this, and the first coder's note says they did too, but the row was missing. AP12: "Yeah, they were really good actually. They were really good about it." That is management goodwill about her MECC training, coded the same way as AP9's ae57t. The count rose from 7 to 9.
"Several have the materials they need" (only AP9 was cited). Two firm rows added, capacity in place. AP4: "So, the resources are plentiful. You can’t say there’s anything missing because there isn’t, it’s just a bit all over the place." AP3: "I don’t think so. I think everything’s been there." The sentence now names AP1, AP3, AP4 and AP9, and the accounts that go against it: AP2, AP10 and AP6.
"all but one mentioned ownership": AP2 was searched and has nothing that fits. "Every interview mentioned resources": this is now contradicted. After the AP4 correction, AP4's only resources rows are weak, so the sentence now says so.
"every attender who did not [cascade] describes delivery held up for want of time or money": this is contradicted after the AP1 and AP4 corrections (now {t_status_cascaded.c7} = 4 of 6), and the sentence was corrected.
"Every attender who cascaded describes all three conditions in place": this is contradicted. Ownership is {t_status_cascaded.c3} = 6 of 7, because AP12 now holds it only weakly. The sentence was corrected.

Sentence changes in answer.md

1. Opening verdict. The wording was reordered so the answer comes first and says how sure it is. The verdict is unchanged. 2. "moderately secure for ownership and capacity, and fragile for resources … by only one". This was false after the row corrections (resources is now 9 against 6), so it was replaced with "moderately secure … no single interview read the other way would change any criterion's verdict". 3. "Where delivery is secure, it usually rests on one person…". Corrected to name the documents (AP3, AP5, AP6, AP7, AP9, AP11, AP13) and the ones that go against it (AP1, AP4, AP12). 4. "the part the interviews most often describe as failing". This is now named: AP5, AP6, AP11, AP13. 5. "Many interviews describe both at once". This is now named: AP5, AP6, AP11, AP13. 6. "Every interview mentioned resources and capacity, and all but one mentioned ownership". Corrected: resources is all but AP4 (weak only), and the one without ownership is named as AP2. 7. The ownership count sentence: "describing delivery stopped or at risk" became "stopped, held up or at risk", in line with the definition. The count is now 8 against 5. 8. "it is part of a job description ("It was part of my job description as well")". This is AP7's own role, in the past tense. It is now attributed and quoted as "was part of my job description as well". 9. "it sits in the trust's preceptorship programme and care certificate". The sentence named no trust. It is now attributed to AP13's trust, with its monthly preceptorship session quoted. 10. Strategies and plans: AP6 [e44zp] added and each citation attributed. AP8's trust expectation [73x4k] added (new row from ruling 7). 11. "a charity "commissioned to deliver it for two year"". This was a misquote and now reads "two years". "Two councils commission outside providers" was reworded: AP9's council commissioned AP9's own company, so it is "in two interviews a council commissions…". 12. ""I’m not able to have this in my remit notes…" [edrx5]" was presented as an interviewee's own words. They are trained staff's replies as AP5 reports them, and the sentence now says so. 13. AP8: the manager's waiver ("no expectation", r7wjj) was added beside 8rvcj, since the AP8 account was being quoted. 14. ""we've got no sort of authority over them" [kzk5s]" gave no context. It is now stated as AP13's team about the staff it trained. 15. "Making it compulsory was out of reach for one lead" now names AP11. 16. A new sentence names AP5, AP8, AP11 and AP13 as describing a structure in place as well, because a finding must name the accounts that go against it. 17. The goodwill sentence used {t_status.c7}, which no longer names ownership intended, so it is now {t_status.c2}. "Managers or organisations keen on MECC" overstated what the cell holds, which is plans as well as goodwill (AP1, AP5 and AP13 contribute plans). It now reads "support and plans", with the quotes attributed. 18. Resources heading and count. "narrowly" and "by the narrowest margin the rubric allows" were false after the row corrections and are removed. "stopped, delayed or at risk" became "stopped, held up or at risk". 19. "Where time is secured, it is because delivery is part of a paid role or a paid contract". This was overstated and is now "mostly". AP12 (training slot) and AP1 (site closures) are added as the exceptions. "you get paid per course" is attributed to the charity's trainer (AP3). 20. The missing-time sentences were reworded to keep whose case each passage is. kcgwx is AP6 speaking of clinical managers in general. 7n2bc and n4cgd are AP5 reporting what trainers said in the past. yrwxz is AP13 reporting trainees' feedback. The interviewees' own cases (AP2 kd3mv, AP10 ht6sv) were added, so that all {j_resources.lapse} documents are named. "staff for whom delivery is extra to a clinical or operational job" became "people for whom delivery is extra to other work", because AP2 is a volunteer. 21. A new sentence explains that AP1 and AP4 describe delays but now have sessions booked, so neither is counted as stopping. 22. "AP3 does not know "what will happen in two years"". The quote was extended to keep its alternative ("or whether I might have more capacity to deliver it"), because AP3 does not expect delivery to lapse. 23. Capacity in place: the examples are attributed, AP1's sessions are marked as booked rather than delivered, and AP3's delivery is marked as by the commissioned charity. "Several have the materials they need" now names AP1, AP3, AP4 and AP9 and the contrary accounts (AP2, AP10, AP6). 24. "The capacity lost is the cascade beyond them". This was overstated, since AP2, AP8 and AP10 are themselves trainers who are not delivering. It is now "mostly", with AP11's colleagues and AP6's trust [3fbyq] added. 25. "AP10, the trainer for one service, has left it, and its slides "still hadn't been prepared"". This merged two facts and implied the slides were still unprepared. It is split into the slides being unfinished when she left [qn3z6] and her departure [8xba2]. AP2's lack of support [cq55n] was added so all {j_capacity.lapse} documents are named. 26. The cascaded section was rewritten. "Every attender who cascaded describes all three conditions in place for their own delivery" was false: ownership is 6 of 7, and AP3's capacity is the charity's, not her own. "Every attender who did not describes delivery held up for want of time or money" was false: it is 4 of 6. "The split … is sharp" now says which differences are clear (resources and ownership in place), which are clear but rest on weak rows (resources stopping), and which are unclear (capacity and ownership stopping). AP6 is noted as recorded "not cascaded" though she delivers on the care certificate. 27. Limitations. "the verdict is about what attenders expected" became "described", since most passages describe present arrangements. The line saying "the resources verdict rests on a margin of one" is removed because it is false after the row corrections. One line was added from the narrow-judgement trace (see below).

Narrow judgements

Overall verdict Partly likely, and each criterion Partly likely. This rests on three rules applied by code: ownership {j_ownership.secured} = 8 against {j_ownership.lapse} = 5, resources 9 against 6, and capacity 10 against 7. Each criterion would need the difference closed to zero to fall to Unlikely. One document moving from one side to the other changes the difference by two at most, so no single judgement, and no pair, changes any verdict. Likely to last would need lapse at two or fewer, and every lapse count is well above that. The judgements nearest the line:
AP8 ownership held firm in place (ruling 7). The other way, ownership is 7 against 5.
AP1 and AP12 ownership held weak (ruling 1, and the change to 22jmf). The other way, ownership is 10 against 5.
AP1's and AP4's past delays read as overcome (the tightened definition). The other way, resources is 9 against 8, still Partly likely but one interview from Unlikely. This is the judgement that most affects how sure the verdict is. It was made against the agreement of both coders on AP4 and decided by tightening the definition, so no Limitations line was added, because the definition now rules the other reading out. The evaluator may want to see it.
Weak lapse rows: ownership AP4 and AP6; resources AP3 and AP11; capacity AP3 and AP7. Each pair read firm still leaves its criterion Partly likely.
None of these could change the finding, so no Limitations line was added for the verdict.
The cascaded group describes resources and ownership in place far more often (7 of 7 against 2 of 6; 6 of 7 against 2 of 6). This rests on code counts. Reading AP4 (resources) or AP1 (ownership) as firm, or AP8's ownership as weak, leaves the difference clear. No line added.
Lack of time or money stops delivery more often among those who did not cascade (4 of 6 against 2 of 7). This holds only while AP3 and AP11 are weak ({t_status_cascaded.c17.weak}). AP11's passage is that leaders "are worried about the amount of time it will take" while she has three sessions in. AP3's is that she does not know what happens after the two-year contract. Both are fairly read as hints, but a careful reader could read them as risk to delivery. Read so, the groups are 4 of 7 against 4 of 6, and the difference is not clear. A line was added under Limitations.
The pattern (secure delivery rests on paid roles and contracts; the cascade beyond is what fails). This is a reading. It rests on AP5, AP6, AP11 and AP13 describing their own trained staff not delivering, and on AP3, AP5, AP6, AP7, AP9, AP11 and AP13 tying their delivery to a role or contract. AP1, AP4 and AP12 go against it and are named. Reading AP3's and AP7's weak cascade passages as firm would only strengthen it. No line added.
Rulings that rest on narrow readings: AP8 ownership firm (a trust expectation stated at training and then waived by her manager, counted on both sides); AP12 5ynva weak (one session booked into a rolling CPD slot, repetition "probably"); AP12 pn7zw added as weak rather than firm (a trust MECC lead, described loosely); AP1 22jmf weak; AP4 w8673 deleted against both coders. None of these changes a verdict.

The record

This is run 2026-10-09-6hbm. Its ID stays the same through every revision, and the zip's fingerprint, below, names this version of it. This report was drawn directly from the run's zip, as-the-13-mecc-train-the-trainer-attenders-describe-2026-10-10-revision-2-6eca2410.zip. The zip's fingerprint is 6eca24109c02ee7d5647d9527c53aa73730995522cf6ae1b12877dfb0d586009. It is the SHA-256 of the zip's SHA256SUMS file, which lists the SHA-256 of every other file in the zip, so changing any file breaks the match. To check that the zip is the one this report was drawn from, unzip it, run sha256sum -c SHA256SUMS, then sha256sum SHA256SUMS, and compare the result with the fingerprint above. Rubicon's own code, which is public, checks the rest: python verify.py <report> <zip> recounts every number from the coded passages in the zip, draws the report again from the zip and says whether it matches this one exactly.

Revisions

Changes made after the first report, each recounted and checked before this version was drawn. Earlier versions keep their own files.

9 October 2026: asked for the title to read "Will MECC delivery last? The sustainability of Making Every Contact Count" in place of "Will MECC delivery last?", so that it names what the report is about. Presentation: the heading of `answer.md` is the only change; the workflow, the coding and every count, quotation and finding are as before. Recounted with `recount.py --answer`.
10 October 2026: Each table now says what it counts: every count names its unit, attenders, beside the number it is out of. Workflow: every tabulate step names its unit. Coding and answer unchanged. Recounted the whole workflow; no count moved.

Every interview at a glance

Each row is one interview, each column a reason as the coding defines it. Click a mark to read the passages.

Only implicitly, so left out of the counts

	Resources	Capacity	Ownership
No






Yes

What next

For the evaluator: Treat this report as a draft. Before it is final, make sense of it with the people it concerns, such as programme staff and participants: whether the findings ring true, what they leave out, and what to do about them. You can then use the Rubicon plugin to work their responses back into a revised answer.

For evaluation commissioners: Parallel to this report is a zip file (as-the-13-mecc-train-the-trainer-attenders-describe-2026-10-10-revision-2-6eca2410.zip), saved in the same folder, which contains the whole run: the documents, the coded passages and the workflow that recounts every number. Its fingerprint, under How this report was written, ties it to this report: change a file in either and they no longer match. With it, anyone can check every number against the coded passages, and code the documents again to the same definitions without Rubicon or any other particular software. A fresh coding will not reproduce this report word for word, because AI models are unpredictable, but it should come close.

The Rubicon plugin for Claude is provided for free by Causal Map Ltd. Causal Map also runs workshops and consultancy on analysing qualitative evidence for evaluation: get in touch, or follow Causal Map on LinkedIn. Coming soon: continue your Rubicon work at the Rubicon website.

🔥 Carbon cost of this report: Between 0.014 and 5.1 km driven in an average UK family car

Making this report used between 19.4 and 6804 watt-hours of electricity, which is the carbon of driving an average UK family car for that distance. A ballpark only: Anthropic publishes no energy figures, and the run, made in the evaluator's own Claude, records no token counts, so the estimate is made from the run's size. The 13 documents were read in full once by each of the 1 coding steps, by the second coder and by the check, and the writer read the tables; everything the run wrote counts as output. That comes to about 553,502 tokens read and 56,027 written, at 4 characters a token. It covers the first run and its two revisions. The zip holds only the latest state, so each revision is counted at the low end as rereading the tables and writing the answer again, and at the high end as a whole run again.

High: 0.39 Wh per thousand tokens read and 1.95 per thousand written, with what was read counted 10 times over for the agent's own overhead. Simon P. Couch, 'Electricity use of AI coding agents', 20 January 2026, https://simonpcouch.com/blog/2026-01-20-cc-impact/: about 390 Wh per million input tokens and 1,950 per million output tokens for Claude Opus, back-solved from Epoch AI's estimate for a 100,000-token prompt with output at five times the input rate, as Anthropic's prices are. The author calls them napkin maths. Our assumption, not a measurement: an agent re-sends its instructions, earlier turns and tool output with every request, so it reads far more than the documents themselves. The low case counts only what was read and written; the high case counts what was read ten times over.
Low: the same rates divided by 20, what was read counted once. Oviedo et al., 'Energy use of AI inference, efficiency pathways, and test-time scaling', arXiv:2509.20241: a median 0.31 Wh per query for frontier models, and widely cited estimates overstated by 4 to 20 times. The low case takes the high case's rates divided by the top of that range.
0.124 kg CO2e per kWh. DESNZ greenhouse gas reporting conversion factors, UK grid electricity, 2024.
0.16601 kg CO2e per km. DESNZ greenhouse gas reporting conversion factors, average car of unknown fuel, 2024.

Made with Rubicon, free for Claude: rubicon.causalmap.app

The standardEvidence

Ownership: partly likelyEvidence

Resources: partly likelyEvidence

Capacity: partly likelyEvidence

Those who cascaded and those who did notEvidence

LimitationsEvidence

Annexes

How this report was written

Step by step

What was read

Coding: Sust

Pillar

Status

Counting: Status

Counting: Spoken

Counting: Status cascaded

Counting: Base

Judging: Ownership

Judging: Resources

Judging: Capacity

Writing: Answer

The checks that were run

Second coding

The check

Counts

Rulings on the disagreements

Definition tightened

Other row changes

Omissions found

Sentence changes in answer.md

Narrow judgements

The record

Revisions

Every interview at a glance

The standard

Ownership: partly likely

Resources: partly likely

Capacity: partly likely

Those who cascaded and those who did not

Limitations