Have your say on the Stop Smoking service in Ealing

Transcription

1 Appendix 1 Have your say on the Stop Smoking service in Ealing Stop Smoking Service Consultation Findings 19 February to the 23 April

2 Feedback Report This report provides an overview of all consultation activity undertaken as part of the Have your say on the Stop Smoking Service in Ealing. This consultation presented our proposals to discontinue stop smoking service from April Ongoing, deep cuts to government funding will mean the council has 143million less in government funding by 2021 than it did in This is equivalent to a 64% reduction. This cut, along with a series of other factors including an aging population, rising costs and increasing demand for social care services, means that the council has no choice but to rethink the way that it pays for and delivers local services in order to secure their future sustainability. The government has confirmed that in addition to cuts to the council s main grant that Ealing s Public Health Ring Fenced Grant allocation is to be reduced by 641,000 in 2018/19 and that there will be further reductions of around 642,000 by Ending the local Stop Smoking service from April 2019 will achieve a saving of 395, Proposal The Council proposes to end the following Smoking Cessation programmes by April 2019 to deliver the agreed savings: Locally provided Stop Smoking support for all residents, including specific groups such as smokers with mental health issues, pregnant women, routine and manual workers, and those with long term health conditions Training on tobacco control and basic smoking cessation for health professionals, social workers and pharmacy staff Local campaigns to raise awareness of the harm of smoking, to promote attempts to quit smoking, and to stop young people from smoking Stop Smoking expertise for businesses, professionals and partners Stop Smoking support in primary and secondary schools 2

3 As a result, there would be no stop smoking service provided locally and Smokers wishing to find help to stop smoking will be able to access alternative resources and support through GPs, pharmacies (if willing to provide), Smokefree NHS support services, other national, charitable or commercial smoking cessation resources. 2. How we conducted the consultation The public consultation on the proposal regarding the Stop Smoking service has run from 19 February 2018 to 23 April A consultation questionnaire (Appendix 2) was made available online and paper copies were available on request. The consultation was publicised to a wide audience including the Tobacco Control Alliance, Ealing CCG, Local Medical Committee (LMC), Local Pharmaceutical Committee (LPC), voluntary sector, West London Mental Health Trust and other local hospitals trusts. The Stop Smoking service consultation supporting information (Appendix 2) and EIA (Appendix 3) was published alongside explaining the proposals in order to assist participants in making an informed decision. We also ensured that stop smoking and drugs and alcohol services, tobacco control alliance members, CCG and community groups shared the consultation link via their communication channels. The stop smoking consultation event was organised to discuss the proposal on 21 March A dedicated address was set up chauhans@ealing.gov.uk for any help, such as requesting a paper copy, or queries regarding this consultation 3. Your Feedback 546 responses were received, of which 524 were submitted online and 22 hard copies were submitted by the current Stop Smoking services provider (WLMHT). The paper copy findings were manually entered so they can be reported and analysed alongside other responses.. 3

4 Q1 In what main capacity are you responding to this consultation? (please select one option only) Answer Choices Responses Number As a resident of the London borough of Ealing 49.45% 270 As someone who works in/ visits the London borough of Ealing 14.65% 80 As a provider of Stop Smoking services 20.51% 112 As a commissioner of Stop Smoking services 3.66% 20 As a community or voluntary organisation 4.40% 24 Other (please specify) 7.33% 40 Answered % 50.00% In what main capacity are you responding to this consultation? (please select one option only) % 30.00% 20.00% 10.00% 0.00% As a resident of the London borough of Ealing As someone who works in/ visits the London borough of Ealing As a provider of Stop Smoking services As a commissioner of Stop Smoking services As a community or voluntary organisation Other (please specify) 4

5 Local Stop Smoking support for all residents, including specific groups such as smokers with mental health issues, pregnant women, routine and manual workers, and those with long term conditions Training on tobacco control and basic smoking cessation for health professionals, social workers and pharmacy staff Local campaigns to raise awareness of the harm of smoking, to promote attempts to quit smoking, and to stop young people from smoking Stop Smoking expertise for businesses, professionals and partners Stop Smoking support in primary and secondary schools Extremely important Very important Moderately important Slightly important Not at all important Don't know/ can't say 80.1% 9.7% 3.1% 1.4% 5.2% 0.5% 70.2% 17.9% 6.2% 0.5% 4.5% 0.7% 74.1% 12.5% 6.2% 2.6% 4.3% 0.2% 55.2% 15.2% 14.5% 2.9% 6.8% 5.5% 76.3% 11.3% 4.7% 2.9% 3.4% 1.5% Q2: How important do you think it is that the Council should continue to provide the following types of support? 5

6 How important do you think it is that the Council should continure to provide the following types of support Stop Smoking support in primary and secondary schools Stop Smoking expertise for businesses, professionals and partners Local campaigns to raise awareness of the harm of smoking, to promote attempts to quit smoking, and to Training on tobacco control and basic smoking cessation for health professionals, social workers and pharmacy Local Stop Smoking support for all residents, including specific groups such as smokers with mental health % 20.0% 40.0% 60.0% 80.0% 100.0% 120.0% Extremely important Very important Moderately important Slightly important Not at all important Don't know/ can't say 6

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8 Any other comments Question 2.1: Local Stop Smoking support for all residents, including specific groups such as smokers with mental health issues, pregnant women, routine and manual workers, and those with long term conditions Theme General overview Example of response Overall support Vulnerable people There was the overall view that specialist support via the local stop smoking service provision should continue, particularly providing support to vulnerable groups (viz. mental health patients). Respondents cite the need for continued support for smokers die to higher hospital admission rates attributed to smoking. Respondents felt that vulnerable groups tend to access the stop smoking services more than other groups. Others expressed that lack of support to smokers would only increase the prevalence of smoking related diseases in the long run. Respondents felt that face to face support provided by the stop Smoking services are essential to support residents who wish to quit, the interaction with a specialist advisor and behavioural change interventions are vital for your residents the percentage of mental health smokers has still not gone down despite many years. As a mental health specialist, they require a lot support and can make a big difference. The stigmatizing culture that they need to smoke has not changed and we are not empowering them enough. By cutting the service we are condoning this culture. Although / whilst smoking prevalence and smoking related mortality rates in Ealing are lower than the national average, smoking attributable hospital admissions are higher in Ealing than the London and national average, placing the borough in the lowest 25th percentile in England. The evidence is clear that there is still a significant group of smokers that need support. In particular people using e-cigarettes can be prone to relapse back to full smoking in some cases. Young people are still smoking real cigs not just e-cigs Smokers who experience disadvantage: those on low incomes, living in social housing, experiencing mental health problems or coping with other addictions, not only have higher rates of smoking but face many more barriers to quitting than those who are more affluent. While these smokers are as likely to want to quit, they are less likely to be successful. However, stop smoking services are effective at addressing this inequality. This is still the number one killer in the country and many lives have been saved by the service. 1 in 3 cigarettes are consumed by mental health patients, it's the main 8

9 GPs, NHS smoking advisers is crucial in helping smokers to quit successfully. Further, some indicated that the increase in life expectancy gap would surely increase if the stop smoking service provision was no longer available. The overall view was that the lack of a local stop smoking service provision would increase the costs to the NHS and primary care (GPs) through costs associated with smoking related long term conditions. cause of three top reasons for hospital admission of people <75 years of age (cancer, COPD, CVD). While it may not be necessary to treat all the "healthy" smokers, those who fall into key priority groups such as pregnant smokers, those with a long term conditions, or those with mental health issues, would have significant impact upon their other comorbidities to remove their stop smoking support. These are often the patients that do not respond well to other forms of support and respond best to face to face support. Smoking is the primary preventable reason for premature morbidity, mortality and heath inequalities. People with mental health problems have a reduced life expectancy of around 20 years which is mostly caused by increased smoking rates. The gap in smoking between those in routine and manual occupations and those in other occupations is growing if anything, increasing inequalities. Many long-term conditions are made worse by smoking and deterioration can be reduced with smoking cessation. The burden being placed on the NHS and other public services as a result of smoking is a problem that will last for many many years to come. Quitting smoking is not easy at the best of times - services such as this are invaluable as they work and will ultimately reduce the number of smokers thereby improving quality and length of life to the participant and reducing the burden on the health service and costing less than the alternative of cancer and cardiac treatment The more people you help to give up smoking the more the NHS has to spend in the long run on other departments. Cutting this service is a false economy, trying to save now will cost more in the future. I'm sick to death of Ealing council cutting services without thinking of the future. In the ASH and CRUK annual survey for 2018 it was estimated that at least 1 in 10 GP practices are no longer prescribing NRT or varenicline. Work being undertaken by the British Lung Foundation is showing that local authority areas which disinvest in specialist services subsequently dispense far fewer items for nicotine dependence, suggesting that smokers no longer have access to prescriptions which increase their chances to quitting 9

10 I think it is very short sighted not to keep smoking cessation services at the forefront of care. As a HCP I am confronted and deal with the long term effects of smoking on a person's health. Some people need an extra hand in dealing with this addiction and of course it is a huge cost burden to the NHS. So why would you stop it? Question 2.2: Training on tobacco control and basic smoking cessation for health professionals, social workers and pharmacy staff Theme General overview Example of response Training of stop smoking advisers and related healthcare staff Training within the NHS and primary care (GPs) Respondents felt that training was essential to provide an effective frontline health service in terms of helping smokers to quit, with the need to reach a larger number of smokers. Respondents felt that apart from the stop smoking advisers, professional training should also be provided to other healthcare staff. Some respondents also indicated the training needs of health professionals around dealing with tobacco use in various The importance of training is to reach wider residents through healthcare professional interaction to increase clients motivation and their resilient There is still much work to do to ensure smoking cessation conversations are part of routine practice of all health professionals and other front line staff. I don't see how stopping access to this training can be justified at the current time. If they're not trained, how else are smokers going to get support? Can we extend this training to any staff who is public facing? Make it into a normalise smokefree culture. As a council, you have leverage and influence to mold and shape communities - a healthy one! The consultation documents state that if the smoking cessation service is decommissioned, smokers will still be able to get support from their GP and local pharmacies, but this support is far less likely to be effective if those delivering this support have not received smoking cessation training Training on tobacco control and smoking cessation for other healthcare professionals and pharmacists is extremely important in delivering effective support for smokers to quit. There is clear evidence that healthcare professionals are less likely to discuss smoking with patients if they have not received training. In a survey of staff working in mental health inpatient services, staff who had received training were more than twice as likely to report discussing smoking with their patients, 72% compared to 34%. Healthcare professionals also report 10

11 forms, and not just through smoking. Others suggested that to make MECC work in Ealing, there needs an existence of a strong training competent for staff. wanting to receive smoking cessation training, especially on tailoring cessation support to the needs of various population groups such as those with mental health conditions. health professionals, social workers and pharmacy staff should be trained to at least VBA level 1 NCSCT Very Brief Advice Training given their likely interaction with smokers. This is a simple piece of advice designed to be used opportunistically in less than 30 seconds in almost any consultation with a smoker, allowing them to Ask, Advise and Act if the person wishes to stop smoking The public consultation document states that if Ealing s specialist service is discontinued, smokers in the borough will be able to access alternative resources and support through GPs etc. However, the lack of a defined referral pathway into a specialist stop smoking service from NHS Health Checks or Primary Care (QOF indicator) will have a knock on impact on GP income, and we anticipate an immediate increased demand in primary care settings for prescribed interventions currently accessed through One You Ealing, without the specialist training, support and remuneration provided to practices by the service for this activity. Several local GP stakeholders have expressed concern to us that it is not safe to assume they have the capacity or expertise to fill the gap left when the Council discontinues the One You Ealing smoking cessation service without any additional resources. Question 2.3 Local campaigns to raise awareness of the harm of smoking, to promote attempts to quit smoking, and to stop young people from smoking Theme General overview Example of response Campaigns and awareness programmes Respondents felt that campaigns and information explaining the harms of tobacco use and smoking should be targeted at children and young people as well The younger we can help people with a quick attempt the better the earlier they will be aware of the risks with each cigarette they smoke Preventing uptake of smoking is important for our future generation. Early education will benefit the society and reduced cost to the government, local authority and NHS. 11

12 as adults. Raising awareness in early life may prevent individuals becoming smokers in their adult life. Respondents suggested that people need to be made constantly aware of the dangers of smoking to their health. Some respondents expressed concerns that the council is turning a blind eye to establishments which encourage the use of tobacco products. Work to raise awareness of stop smoking support, and campaigns such as Stoptober, are effective at motivating cessation attempts. Campaigns targeted at young people are less evidence based. According to recent Freedom of Information requests, the number of shisha cafes (places where customers can buy and smoke tobacco on the premises) has increase 500% in ten years, from 10 in 2007 to 50 in This is the third highest in the country and the second highest in London. Cafes tend to concentrate around schools and market their flavoured products heavily to young people. If local campaigns stop, then the Council is tacitly approving the use of shisha in its borough. This is not acceptable given shisha causes the same sorts of diseases as cigarettes. Targeting campaigns to children and young people Respondents felt that campaigns should be specifically designed and targeted more towards children and young people, where there is further opportunity of carrying out these campaigns within schools. Question 2.4 Stop Smoking expertise for businesses, professionals and partners Theme General overview Example of response Health of workers Respondents felt that workplace health was important, but were also People should made constantly aware of the harm of tobacco smoking and the impact upon their future health. Over 6% of 15 years are regular or occasional smokers and even a greater number of 15 year olds use e-cigarettes. This means the council cannot afford to let up on the smoking issue among young people. Young People should be the main target of all anti-smoking campaigns and smokefree services, as they will represent the new prevalence in the community. We currently work in the borough raising awareness of the dangers of smoking with young people and the demand from schools and organisations in the past 6 months is huge. Many ask if we are continuing our work next year and there is a demand, but without money this can't happen. In order to create a smokefree future we must prevent young people from taking up smoking. Prevention is cheaper in the long run. Healthy Workplaces are vital to promote in work efficiency, turn up rate and holistic health 12

13 not clear on how this provision would look like. Some felt that business should take on their own initiative to approach the council for support around keeping their workforce healthy. Some recommended trained staff should be working within the workplace to promote a healthy working environment. Question 2.5 Stop Smoking support in primary and secondary schools Theme General overview Example of response Supporting children and young people. The respondents felt it was essential to support children and young people to prevent them from becoming smokers. Few felt that families would also need to be targeted as parental behavior is highly influential in the attitude of children towards smoking (children whose parents smoke have a higher chance of becoming smokers. Although there is agreement that support should be provided in Can t say unclear what this support would involve and who would be included. There is evidence that high quality support in work places can improve quit rates and quitting in a group of peers increases chances of success. This is best delivered by trained stop smoking professionals. This is important but businesses should also take responsibility for their own efforts as part of their staff health and wellbeing responsibility culture local businesses, professionals and partners should be eligible for MECC training which should include basic public health messages regarding smoking and where and how to access support with quitting More could be done in the workplace to help people quit. Pharmacists could deliver an off-site service if they were commissioned to do so. Evaluating possible utilisation of social network to support reduction in smoking among young people People start smoking from a very young age. So the earlier we provide support & awareness from primary school, the better it is. Smoking is an inherited addiction and one of the most effective ways of ensuring that children and young people do not start smoking is through supporting their parents and other family members to quit. This makes cigarettes less available to young people and prevents the normalisation of smoking behaviours. Stop smoking services are the most effective means of supporting all smokers to quit and are therefore key to ensuring a continued decline in the numbers of young people taking up smoking I am a secondary school teacher and this knowledge is very important especially as some pupils are smoking at a very young age now The earlier we get into schools is a must. Prevention for young people will benefit the NHS in the long term 13

14 Support for educational establishments schools and similar educational establishments, some felt that funding issues can sometimes delay or thwart some of these promotion initiatives. Some suggested that the quit smoking promotional programmes need to be designed and modified for use with children and young people. Ensuring coverage of local annual school workshop activities to promote smoking prevention among young people Again - this is important but the schools already cover the dangers of smoking in their PHSE lessons. There is not always funding to provide support in primary and secondary schools and evidence shows that young people who have taken up smoking are not really ready to listen to quit messages. Quit programmes are not designed for young people and they are rarely heavily addicted. Resilience and peer pressure type workshops are better that target all rebellious and risk taking behaviours. Q3: To what extent do you agree or disagree that if the locally provided service were to cease, sufficient alternative resources are available to support people who wish to quit smoking? Alternative resources include GPs, pharmacies, Smokefree NHS support services, and other national, charitable or commercial smoking cessation resources. Answer Choices Responses Strongly agree 22.25% 87 Tend to agree 6.14% 24 Neither agree nor disagree 5.63% 22 Tend to disagree 14.32% 56 Strongly disagree 47.83% 187 Don't know/ can't say 3.84% 15 Answered 391 Skipped

15 60.00% 50.00% To what extent do you agree or disagree that if the locally provided service were to cease, sufficient alternative resources are available to support people who wish to quit smoking? % 30.00% 20.00% % % Strongly agree Tend to agree Neither agree nor disagree Tend to disagree Strongly disagree Don't know/ can't say Q4: How likely or unlikely is it that ending the local Stop Smoking service may have a negative impact on the people who smoke? Answer Choices Responses Very likely 73.01% 284 Fairly likely 12.08% 47 Neither likely nor unlikely 3.08% 12 Fairly unlikely 2.83% 11 15

16 Very unlikely 7.20% 28 Don't know/ can't say 1.80% 7 Answered 389 Skipped % 70.00% How likely or unlikely is it that ending the local Stop Smoking service may have a negative impact on the people who smoke? % 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Very likely Fairly likely Neither likely nor unlikely Fairly unlikely Very unlikely Don't know/ can't say 16

17 Question 5: If the local Stop Smoking service were to cease, do you have any suggestions about any alternative ways in which support may be available to people who smoke? Theme General overview Example of response No alternative available Provision from the pharmacies Respondents felt there were no alternative services or provisions available. Respondents felt that the pharmacies have very limited resources available to be able to provide an effective stop smoking service. Although there may be limited support from GPs and pharmacists, the Stop Smoking service would be essential to provide the crucial help to enable smokers to quit. There was some acknowledgement for support services from pharmacies. The general opinion from respondents is that both There will be no other services providing the local support. It is misleading that you have stated the support will be available from GP's or Pharmacies, have you got this in place? The current Stop Smoking Provision is provided under the Stop smoking Service and the GP and Pharmacies are sub-contracted therefore will cease with the service. There are no alternative services available for mental health patient, pregnant women, routine and manual workers. Please stop fooling Ealing residents! Cannot even comprehend how we will be able to help people quit smoking. There will be no referral pathway and in turn in time, more people will smoke If they are not there then there will be no help. Not sure what of suggestions you are after?? pharmacy support services are available but very limited without sufficient resources - in my opinion there are not many other alternative ways for support for smoking cessation services to be available To get support from GP surgeries/pharmacies/online/telephone support. Or from other health services. It is important to provide stop smoking service to people who are genuinely trying to quit. Outside of face-face support via GP and pharmacies quit rates drop drastically. Yes there is telephone support, home quit kits etc. But outside of a specialist service the quality of provision often drops. GP, would only be able to offer NRT (if they can) and they stretched far enough. Who would provide the behavioural aspect of the support? 17

18 GP and other NHS services Other provisions the GPs as well as other NHS staff are overstretched, and therefore would not have the capacity and resources to provide an effective stop smoking service. Respondents were concerned that the behavioural component would disappear (as has been part of the stop smoking provision). Some felt that clinicians were better placed to be more effective stop smoking advisers, while the general opinion prevailed that GPs were not adequately trained to provide the most appropriate advice. Most respondents felt that there were no other provisions available beyond their local GP or pharmacy (both of which were not effective as compared to the stop smoking service). Some felt smokers could see There is very limited support via the NHS Smokefree helpline. However, this does not provide the kind of support most hardened smokers need which is one to one behavioural advice and medication for up to 12 weeks. Speak to your GP or pharmacy. They are qualified professionals unlike those who work for these stop smoking service. They study psychology courses at university and speak to you as if they spent 6 years in medical school. Waste of time. Frankly GPs are overrun, many pharmacies have stopped providing the service and so there is nothing g left. We need a dedicated resource to deal with this issue or t will simple grow and grow. If your GP is anything like mine, it is hard enough to get a referral to the service in the first instance and his general dislike (apparent or otherwise) of his patients (at least those I know) and his lack of engagement means that no one would ever quit with his help. He has neither the time, inclination, social skills nor rapport to be any use. pharmacy support services are available but very limited without sufficient resources - in my opinion there are not many other alternative ways for support for smoking cessation services to be available People who need help to stop smoking could see the nurse at their GP surgery or at their local community centre. If the stop smoking service will be discontinue it won't be any alternative to support the community to quit smoking because GPs and pharmacies are only providing the stop smoking support thanks to the stop smoking service. Also, it's very likely that if the prevalence will go up if the service will be discontinue. 18

19 their practice nurse, or visit the local community centre for support, but without any clear idea of how this would practically work in the absence of a stop smoking service provision. Some suggested having a wider support network, with some provision linked to supermarkets. Community Clinics in accessible places (existing services (maternity, mental health etc), large workplaces, Schools and colleges, Supermarkets etc) should be made available. GPs may not be able to provide appointments / support when needed. Question 6: Do you have any other comments on the proposal to end the locally provided Stop Smoking service? Theme General overview Example of response Support from pharmacies This was a mixed response, with some feeling pharmacies would not be able to provide the level of professional support provided by the stop smoking service, where users would have to pay for the service. Others felt services could be available via the pharmacies, but would lack in the behavioral component. There are also concerns around the If the local stop smoking service ends, there will be no provision of GPs or Pharmacies that will be able to provide the stop smoking support. Research has highlighted that the best way of quitting smoking is through the local stop smoking service with the combination of behaviour and medication. Smokers are 4 times more likely to quit smoking with local stop smoking service. This is a very misleading statement and provides the perception that smokers will have the choice to go to GPs and Pharmacies and voluntary sector for support. It would be useful to detail the arrangements made with these services considering the fact that Smokefree Ealing picks up the NRT cost and remuneration cost (cost of delivery as well as the controlled training) via our SLA with these sub-providers. At this point of the consultation the LPC and Ealing CCG were not made aware of the cessation of services. You have not been clear in your document as to whether GP and Pharmacy stop smoking provision will be available or not. Will these services be decommissioned as well? Or will residents still be able to access the programme via GPs and Pharmacies? 19

20 Use of e- cigarettes, NRT Stopping the service commissioning of services to the pharmacists. Some felt the question/consultation document was not clear, or was misleading. The view was also that NRT would be most effective if provided in combination with behaviour support. The view was also that NRT would be most effective if provided in combination with behaviour support. There were also concerns raised about the possible harm caused by e- cigarettes with the notion that any form of NRT would have most effective if provided in combination with behavioural support. The general view is that stopping the stop smoking service would be detrimental to the health of current smokers. Respondents felt that the decision to terminate the service was not thought through properly, without This has a big impact on responses to this consultation and it isn't clear what provision will be available if the service is cut Alternative resources, such as pharmacy and GP will not be available as it is run by stop smoking service that you are trying to cut. Question 3 in incorrect and deliberately misleading. We want to keep the service now rather paying more for smoker illness treatments later on. Further, e-cigarettes are not sufficient replacement for the specialist support that the stop smoking service provides to residents. Nicotine containing e-cigarettes are essentially an alternative form of nicotine replacement therapy, and like with NRT are likely to be most effective when combined with the specialist behavioural support offered by a stop smoking service. It would also be appropriate to highlight the harm caused by E-Cigs as the public may not know these as well as the fact that the Council is advocating for the use of these which are not medically controlled over an evidence based intervention with proven results. For example, your argument that the general public have access to alternative services is strong, but this argument is only useful for ceasing services to the general public. You seem to be trying to apply this justification to groups that do not have sufficient access to alternative services, like people in mental health facilities. There is no specialist support for smokers to quit smoking leading to fewer people will stop smoking which result in higher prevalence in 2019/20. Overall, given the evidence that stop smoking services are effective at reducing health inequalities and the difference in smoking rates among Ealing residents in higher and lower socioeconomic groups it is likely that decommissioning the service will have a 20

21 Public health making sure that alternative provision would be in place. There are concerns that the most vulnerable within the society would no longer have access to appropriate alternative services. There were few respondents who although acknowledged that the decline in the use of face-to-face stop smoking services is due to the emergence of e-cigarettes still felt that the service should not be terminated without appropriate alternative service provisions. Most respondents felt the health inequality gap would increase, with the vulnerable groups most affected. negative impact on smokers experiencing disadvantage such as those on lower incomes or with mental health conditions. Your cost pressures may be large, but the council does still receive a large amount of money, including for public health. If you did a cost benefit analysis, or any kind of logical business case, you may find that a reduced and targeted stop smoking service may be more valuable than another service competing for these funds. It appears you simply don't know. Cutting the locally provided service is an extremely big risk to the smokers of Ealing. There is a risk of increasing health inequalities already seen in Ealing, increase in long term conditions or a worsening for smokers who already have conditions, and a risk of an increase in smoking in pregnancy rates. At a time when prevention is seen as a priority for the NHS, cutting an essential service that is highly effective is a big risk. Under the Health and Social Care Act (2012), CCGs have an obligation to reduce inequalities in the benefits which can be obtained from health services. Smokers experiencing disadvantage, such as those with mental health conditions, often have higher nicotine dependency meaning they may need more intensive support to quit, including higher doses of NRT or cessation medications and behavioural support for longer periods. Cutting the stop smoking service would cut the advisers able to deliver this style of intensive support to those with higher levels of nicotine dependency. It would therefore also undermine the long term goal of overcoming health inequalities 21

22 Health impact & policy Some respondents appreciate that austerity measures and funding cuts are causing the council to cut services, but there still should be a baseline service for the most vulnerable and those in most need. Respondents felt that health impact assessments had not been carried out. In responding to reducing levels of funding, your plans impact most obviously on the commissioning of discreet stop smoking services. The reduction in this evidence based service risks poorer health outcomes, increasing health inequalities associated with tobacco use and a failure to realise the potential savings not only to the NHS but social care from having fewer residents who smoke. This decision also does not appear to align with the fact that reducing smoking prevalence is cited as a priority in the current Ealing Health and Wellbeing Strategy Cancer Research UK is aware of the financial pressures the council is facing, but we encourage the council to reconsider its plan to end the service in lieu of saving money. The complete removal of the Stop Smoking Service is a false economy, and will undermine efforts to reduce health inequalities. We urge you to continue to provide these vital services locally. We recognise however that Ealing may find providing a universal, open access, stop smoking service no longer affordable, but a minimum level of service is the benchmark of an effective approach to tobacco control. A revised level of service could then be targeted at helping high priority groups. Suggestions include pregnant women, where the impact of tobacco affects mother and baby; and people with mental ill-health, as well as those with drug and alcohol issues, who may find it particularly hard to quit. This would be in-keeping with the recently launched national tobacco control plan for England which recommends that where local authorities are unable to provide a universal service they should identify priority populations and ensure that they are provided with an effective service. Smoking doesn t just effect health but drives crime and impacts the children of families. It shortens lives and has a huge impact on the NHS as there are so many smoking related diseases! The Council has a duty to complete an Equality Impact Assessment and this should have been completed prior to the consultation and available to see with the consultation document. People cannot respond to this consultation without seeing the impact of the service being decommissioned. It is very disappointing that the EIA is not available now. 22

23 Financial cuts and value for money Decision to terminate the stop Respondents raised concerns about the impact on the local economy, citing that terminating the stop smoking service as a poor economic decision. Some felt the consultation was misleading where costs would escalate in the future due to the burden of illnesses from smoking. Generally, respondents felt that the decision to terminate the stop smoking Although the NHS will save money short term by cutting services. When the smokers who have not been able to access the provision become terminally ill, this will be a larger cost to the service. Short term saving, longer term overall cost. The above paragraph provides a narrow picture of the effectiveness of smoking cessation within the Borough. You have omitted the fact that smokers are 4 more times likely to quit and stay quit with a combination of behavioural support and medication which other interventions fail to provide the most effective intervention to cease smoking as well as the most cost effective public health intervention. I think this is a short-term solution which will have long-term impacts in the whole of the health and social care economy. I would urge the council to consider other solutions or innovative ideas to enable specialist provision to continue in some form; for example GP hubs with specialists who provide this support to a number of GP surgery patients; provision to specific target groups with the additional offer of telephone support; commissioning specialist provision in secondary care. While the stop smoking service is costing the council approximately 395,000 a year, smoking places additional social care costs on the local authority of approximately 3.46 million per year, and 2.9m in cost to individuals who self-fund their care. Current smokers, and to a lesser extent former smokers, are more likely than those who have never smoked to need domiciliary care, placing additional costs on local authorities. Overall smoking is estimated to cost the local community and services in Ealing over 76 million a year (Ready Reckoner tool, In contrast, stop smoking services are cost effective with NICE, the National Institute for Health and Care Excellence, estimating that for every 1 invested in these services 2.37 will be saved through preventing lost productivity and treating tobacco related disease. The House of Commons Health Select Committee has stated that: cutting public health is a false economy, creating avoidable additional costs in the future. This is especially true when it comes to reducing smoking rates, given the rates of morbidity and mortality caused by smoking. Also, think of the long-term implications. I'm aware the council is short on money, and we have to priorities where we put funding. It would be short sighted to only think what you can do to save money this year or within these 3-5 years only. As a resident, I'm invested 23

24 smoking service service was done in haste without thinking through the consequences. Some felt the decline in footfall for the stop smoking service was due to the overall legislation on controlling smoking (ban in public places, plain packaging, vaping). in the future of this borough, and whether you at the council, live here or not, I hope you will consider the long-term implications and how this will shape our borough going forward. Hold on to the core values of the NHS and local government. Health impacts everyone - poor health leads to poor productivity, civic conscientiousness, togetherness and sense of community just to broadly name a few - because we are too stressed to think of anyone else when we are sick or under pressure. So as a council, please protect us from our selfish selves. As part of the overall process, the Council has a duty to consider the implications of any proposal on all members of the local community who may be affected disproportionately as a result of the proposal being carried out. Emerging evidence suggests that this trend is likely to continue in the face of the ban on smoking in public places, plain packaging legislation, and evidence about the safety of 'vaping' as an alternative to tobacco Initially you state that the Council has a duty to consider the implications of any proposal on all members of the local community. However by undertaking the EIA in parallel how is the consultation providing a balanced view to the public allowing the public to make an informed choice on the proposal? The EIA then goes to the Cabinet not the public which seems to be a dereliction of duty and not in the spirit of providing a transparent, balanced and democratic process. This is further exaggerated by the fact that the updated Ealing JSNA for Tobacco has been pulled from the Council website and therefore not providing the public with the full context of tobacco related harm and initiatives to help provide an informed decision through the consultation process. 24

25 Q8: Which of the following apply to you? Answer Choices Responses I have never smoked 29.8% 79 I smoke conventional cigarettes 19.6% 52 I only use e-cigarettes (never used conventional cigarettes) 0.4% 1 I have quit conventional cigarettes but switched to e- 6.8% 18 cigarettes I use smokeless/ chewing tobacco 1.9% 5 I have quit completely (all forms of smoking or tobacco use) 41.5% 110 Answered 265 Skipped

26 45.0% 40.0% Which of the following apply to you? % 30.0% % 20.0% % 10.0% % 0.0% I have never smoked I smoke conventional cigarettes I only use e- I have cigarettes (never quit conventional used cigarettes but conventional switched to e- cigarettes) cigarettes I use smokeless/ chewing tobacco I have quit completely (all forms of smoking or tobacco use) Q9: Are you thinking about quitting smoking? Answer Choices Responses Yes 75.0% 51 No 10.3% 7 Prefer not to say 14.7% 10 26

27 Answered 68 Skipped 478 Q10: What is your age group? Answer Choices Responses Under % % % % % % % 16 Prefer not to 4.1% 11 say Answered 267 Skipped

28 4.12% Age Group 0.00% 4.49% 5.99% 17.60% 26.97% 18.35% 22.47% Under Prefer not to say Q11. Are you Answer Choices Responses Male 37.9% 100 Female 58.3% 154 Prefer not to say 3.4% 9 Prefer to selfdescribe 0.4% 1 Answered 264 Skipped

29 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Are you Male Female Prefer not to say Prefer to self describe Q 12: Do you consider yourself to be transgender? Answer Choices Responses Yes 2.7% 7 No 91.5% 238 Prefer not to 5.8% 15 say Answered 260 Skipped 286 Q13: What is sexual orientation? Answer Choices Responses Bisexual 2.7% 7 Gay man 2.7% 7 Gay woman/ lesbian 0.8% 2 29

30 Heterosexual/ 74.3% 194 straight Prefer not to say 17.2% 45 Prefer to selfdescribe 2.3% 6 Answered 261 Skipped % 70.0% What is your sexual orientation? % 50.0% 40.0% 30.0% 20.0% % 0.0% Bisexual Gay man Gay woman/ lesbian Heterosexual/ straight Prefer not to say Prefer to selfdescribe 30

31 Q14: Do you consider yourself to be disabled? The Equality Act 2010 defines a person as having a disability if s/he 'has a long term physical or mental impairment which has a substantial and long term adverse effect on his/her ability to carry out normal day to day activities'. Answer Choices Responses Yes 12.3% 32 No 82.0% 214 Don't know/ can't 5.8% 15 say Answered 261 Skipped 285 Q15 (For women only) Are you...? Answer Choices Responses Currently pregnant 0.6% 1 Have been pregnant in the last % 1 months Have given birth in the last 12 months 2.2% 4 None of the above 90.6% 163 Prefer not to say 6.1% 11 Answered 180 Skipped

32 Q16: Which ethnic group do you consider you belong to? Answer Choices Responses White - English/ Welsh/ Scottish/ Northern Irish/ British 40.3% 102 White - Irish 4.4% 11 White - Gypsy/ Irish Traveller 0.8% 2 Any other White background 13.8% 35 Mixed/ multiple ethnic groups - White and Black Caribbean 1.6% 4 Mixed/ multiple ethnic groups - White and Black African 0.8% 2 Mixed/ multiple ethnic groups - White and Asian 1.6% 4 Any other Mixed/ multiple ethnic background 1.6% 4 Asian/ Asian British - Indian 10.3% 26 Asian/ Asian British - Pakistani 4.4% 11 Asian/ Asian British - Bangladeshi 1.2% 3 Asian/ Asian British - Chinese 2.4% 6 Any other Asian background 2.4% 6 Black/ African/ Caribbean/ Black British - African 4.4% 11 Black/ African/ Caribbean/ Black British - Caribbean 4.4% 11 Any other Black/ African/ Caribbean background 0.4% 1 Other ethnic group - Arab 2.4% 6 Any other ethnic group 3.2% 8 Answered 253 Skipped

33 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Which ethnic group do you consider you belong to?

34 4. Formal Responses Formal Reponses Formal responses (letter/ ) were received from the following (Appendix 4) West London Mental Health Trust (WLMHT), the current provider of Stop Smoking services Public Health England (London) Ealing, Hammersmith and Hounslow Local Pharmaceutical Committee Ealing Clinical Commissioning Group (Ealing CCG) Dr Rupa Huq, Member of Parliament for Ealing, Central and Acton : Cancer Research UK 4.1 Themes that emerged from these responses included: -Widen health inequalities Concerns were expressed that the reduction in this evidence based service risks poorer health outcomes, increasing health inequalities associated with tobacco use and a failure to realise the potential savings not only to the NHS but social care from having fewer residents who smoke. 34

35 People in lower socioeconomic groups are more likely to smoke and spend a larger proportion of their income on cigarettes. Smoking is the primary cause of preventable illness and death in England. Smoking is also the single largest cause of health inequalities and responsible for around half the difference in life expectancy between the richest and poorest. There are 54,000 smokers in Ealing; 15.4% of the population over age 15. Ealing has the third-highest proportion of smokers across the NW London boroughs, reflecting higher levels of deprivation in the borough. The smoking prevalence in manual workers in Ealing is 24.6%, significantly higher than the borough average. -No provision of an alternative service Cutting this service will have a knock-on impact on GP income, and response from Ealing CCG anticipate an immediate increased demand in primary care settings for prescribed interventions currently accessed through One You Ealing, without the specialist training, support and remuneration provided to practices by the service for this activity. Concerns were expressed that pharmacies in Ealing will also be affected, as they will be unable to access the training and resources provided through One You Ealing, and will be unable to make full use of the Make Every Contact Count training they have recently received to provide preventive advice and interventions The Council s proposal to cease the Ealing Stop Smoking Service means that HCAs and pharmacists would no longer be remunerated for providing specialist support. Further, as the Council s proposals also cut the training budget, the number of health professionals who could deliver the service would rapidly dwindle. According to the Cancer Research UK specialist stop smoking services are the most effective method for people to quit smoking. Alternative methods are still helpful, but they are not proven to be as effective as a stop smoking service. For example, the use of the counter Nicotine-Replacement therapy (NRT) is proven to be no more successful than going cold turkey Another method is the use of e-cigarettes which, while to be 95% less harmful than smoking, are only 60% more successful in quitting smoking than going cold turkey. Combined specialist support and prescription medication is the most effective quit methods; 22% more successful than going cold turkey 35