POWYS TOBACCO CONTROL STRATEGIC PLANNING. Interim Director of Public Health. Senior Public Health Practitioner

Transcription

1 FOR DISCUSSION POWYS TOBACCO CONTROL STRATEGIC PLANNING BOARD MEETING 24 APRIL 2013 AGENDA ITEM 4.2 Report of Paper prepared by Interim Director of Public Health Senior Public Health Practitioner Purpose of Paper Action/Decision required Link to Doing Well, Doing Better: Standards for Health Services in Wales : Link to Health Board s Corporate Plan Acronyms and abbreviations To provide the Board with an update on the Powys Tobacco Control Strategic Group and Action Plan and to highlight implications for Powys teaching Health Board (PtHB) and Public Health. The Board is asked to: 1. Note the contents of this paper for information 2. Support the leadership role of Powys teaching Health Board to achieve a reduction in smoking prevalence including; strong partnership working, staff training in brief intervention, targeting smoking cessation services at pregnant women and pre-operative patients and the updating and maintenance of a smoke-free hospital grounds policy This paper supports Standards 3,11,12,15,18 and 22 Improving Health & Well-Being Making Every Pound Count Powys teaching Health Board Powys thb Stop Smoking Wales SSW Brief intervention training BIT World Health Organisation WHO Welsh Government WG National Institute for Health and Care Excellence - NICE Tobacco Control TC Carbon monoxide - CO Tobacco Control Strategy Page 1 of 34 Agenda Item 4.2

2 POWYS TOBACCO CONTROL STRATEGIC PLANNING Purpose of paper The purpose of this paper is to update the Board on the Powys Tobacco Control Strategic Group and Action Plan and highlight implications for Powys teaching Health Board (thb) Public Health. Background In 2003 the World Health Organisation (WHO) identified tobacco smoking as the primary cause of premature illness and death in developed countries. Despite a fall in smoking prevalence rates in Wales in recent years, figures from the latest Welsh Health Survey (2011) show the Welsh prevalence for adult smokers is 23% and in Powys the prevalence is 21%. Tobacco smoking remains the biggest preventable cause of morbidity and mortality in the country and it is widely recognised as one of the main contributors to inequalities in health. Recent research from Swansea University 1 reported that treating smoking related diseases in Wales cost the Welsh NHS 7% of the total healthcare expenditure in 2007/8, which is equivalent to 129 per head of population. It is estimated that approximately 20% of all admissions and bed days are attributable to people suffering from smoking related disease resulting in significant costs to the NHS. Smoking also has significant cost implications to the NHS through working days lost. A review of the health and well-being of the NHS workforce in England found that among NHS employees, those who smoke are more likely to be absent due to illhealth and for longer than those who do not smoke. The Welsh Government (WG) has set a target of reducing smoking prevalence in adults who live in Wales to 16% by Each local authority area is tasked with producing local Tobacco Control Action Plans based on the WG All Wales Action Plan Within the plan, four action areas are identified: Promoting better leadership and partnerships Prevention (especially amongst children and young people) Cessation Reducing exposure to second-hand smoke The Powys Tobacco Control Action Plan has been developed and approved by the newly formed Powys Tobacco Control Group (Appendix 1). This is a multi agency partnership group with a collective goal of achieving smoking cessation targets and ultimately a smoke free Powys. 1 Phillips, C.J. and Bloodworth, A. (2009) Cost of smoking to the NHS in Wales. Cardiff: ASH Wales.

3 The scale of the challenge According to the latest Welsh Health Survey (2011), 21% of the Powys adult population smoke. The adult population of Powys is 110,473 (ONS, 2011), which means that there are approximately 23,199 adult smokers in Powys. To reach the target of 16% prevalence (17,675 smokers) by 2020, this means that 5,524 smokers would have to quit. Evidence from the General Household Survey (2010) shows that 7 out of 10 smokers wish to quit and 5% are successful. This means potentially 16,300 smokers in Powys want to quit. Current smoking cessation services in Powys Most of the smoking cessation services in Powys are delivered by Stop Smoking Wales (SSW) and the Powys thb s Level 3 Pharmacy Cessation Scheme. These services offer different levels of support to smokers who wish to quit. SSW offers a behavioural support programme, offering both group and one to one support over a six week period. Clients can self refer by phoning an 0800 number and make an appointment to be seen in a local clinic. The Pharmacy scheme offers motivational support to people who wish to quit over a 10 week period. Clients access this service directly through contact with their local pharmacy. Having both services means that smokers who wish to quit have a choice of cessation methods. It also means there is a good geographical spread of smoking cessation services across Powys (Appendix 2). For 2011/12, 696 contacts were made to SSW, although this figure dropped to 318 smokers who actually attended SSW services in Powys. Many clinics were not filled. SSW is currently investigating the drop out from referral to attendance at a clinic. In 2011/ adult smokers accessed Community Pharmacy Level 3 schemes. The number of peole who made initial contact and then dropped out prior to accessing the services is not recorded. For 2011/12, 39% of Powys adult smokers who had attended SSW cessation service for treatment had a 4 week carbon monoxide (CO) validated success, compared with 40% of adult smokers attending the Powys Pharmacy Scheme smoking cessation services. The National Institute for Health and Care Excellence (NICE) recommends smoking cessation services aim to treat 5 per cent of the smoking population annually. In Powys this equates to approximately 1,160 smokers. NICE also recommends smoking cessation services aim for at least 35% 4 week success rate. The combined SSW and pharmacy figures for treated smokers in 2011/12 was 3.5% of the smoking population. Of this figure (817) 39% had a carbon monoxide validated 4 week quit.

4 Table 1: Smoking cessation services in Powys Powys Pharmacies Stop Smoking Wales Total Contacts made NICE recommendations Treated smokers Quit at 4 weeks (CO validated) 4 week quit rate (CO validated) ,160 (5% Powys smoking population) % 39% 35% Currently we are not reaching the NICE recommended 5% of smokers attending smoking cessation services. However for smokers who do become treated smokers outcomes are good. Clearly more smokers need to be referred to these services. Pregnant smokers and pre-operative smokers are a priority for smoking cessation services, since there is overwhelming evidence of the benefits from quitting in these cases. Pregnant smokers The table below shows the number of estimated pregnant smokers in Powys. Table 2: Pregnant smokers in Powys Year Powys Live Births (Stats Wales) Estimated number of smokers (based on 21% Estimated number who smoke before / during pregnancy (Infant feeding survey 2010*) prevalence) * Infant feeding survey 2010 found approximately a third of women smoke throughout their pregnancy in Wales higher than other areas of the UK Figure 1 shows Powys maternity contacts to SSW. The number of contacts increased following the introduction of a new referral pathway in January Rates peaked at 5.98 contacts per 100 pregnant smokers. The mean rate of maternity contacts per 100 live births was 2.60 between April 2010 and March Recent data for January 2012 December 2012 shows that the total number of Powys maternity referrals to SSW was thirty six.

5 Figure 1 Pre Operative patients SSW offers a pre-operative cessation programme called Get well Sooner. This is aimed at smokers awaiting elective surgery. Smokers who quit before surgery have better health outcomes in terms of wound healing and fewer respiratory complications. This means a shorter hospital stay and cost savings. Statistics from the 2011/12 show that for every 10,000 population there was less than 1 person referred for pre-operative smoking cessation support in Powys. Figure 2 shows the pre-operative contact rate for Powys.

6 Figure 2 Brief Intervention Training (BIT) Health care workers can make a significant difference in helping their patients quit smoking 2. Brief intervention is an evidence based approach to discussing smoking and quitting with smokers, with the aim of triggering a quit attempt. It can be delivered by a broad range of health and community workers. Research shows that people who attend Smoking Cessation services are four times more likely to quit than those who attempt a self quit. SSW offers BIT to frontline health staff. This is currently a whole day accredited training, but from April 2013 a shorter version of 3.5 hours will be available. The training supports staff to develop skills in smoking cessation, recognising the important role brief advice and brief intervention play in recruiting smokers to smoking cessation services, where they can access support to quit. The previous approach taken by SSW was to identify training venues and dates within Powys and advertise to local staff through their various communications networks.this has not always been successful in Powys and at least one training session has been cancelled through lack of bookings. The most successful approach has been to speak directly to key managers and arrange bespoke training e.g. 25 pre-operative staff were trained in 2010/11 and 22 therapists were trained in Autumn Stead et al (2008)

7 Way Forward in Powys The Powys Tobacco Control Action Plan (Appendix 1) shows the actions required in Powys to achieve smoking cessation targets and a smoke free Powys. Key actions that specifically relate to Powys thb are: Increasing awareness Improve communication, so that Powys thb staff and key partners are aware of the current local smoking cessation services available. Raise awareness, ensuring all staff are aware of the benefits of referring clients to local smoking cessation services. Brief Intervention Training: Train a large number of the Powys thb front line staff in Brief Intervention, with the aim for all Powys thb staff with close patient contact to be trained, giving priority to those who work in maternity and pre-operative settings. In addition, Health Visitors working in areas of high deprivation and those who work with patients with chronic conditions need to be trained. Opportunities for smoking brief intervention conversations between staff and patients need to be optimised by including brief intervention in all patient care pathways. Pregnant women Improve identification of pregnant women who smoke through maternity staff adherence to NICE guidance on CO monitoring. Provide adequate support to pregnant women who smoke to maximise their quit attempts. This includes improving opportunities along the maternity pathway for quit attempts. Pre-operative smoking cessation Include pre-operative smoking cessation referral mechanisms into commissioning strategies as a matter of urgency. Powys Smoke-Free Launch the Smoke Free Cars and Smoke Free Homes campaigns in the Autumn, prioritising efforts with Flying Start staff. Update and improve the current Smoke free hospital grounds policy and launch in Autumn Improved partnership working Work with localities to motivate staff to attend BIT and to identify opportunities for joint working on smoking issues. Work with partners to deliver the Powys Tobacco Control Action Plan Improve working between the smoking cessation services in Powys, including developing an all Wales integrated data base. Work closely with partners in SSW and Medicine s Management to identify the best locations and times for sessions and advocate for further sessions according to need.

8 Continue to work with primary care on smoking cessation issues and develop a mechanism for reporting back data on GP referrals to smoking cessation services. Conclusion A Powys Tobacco Control Strategic Group has been convened to develop and implement the Powys Tobacco Control Action Plan. The action plan reflects the WG All Wales Action Plan 2012, with four action areas identified: Promoting better leadership and partnerships Prevention (especially amongst children and young people) Cessation Reducing exposure to second-hand smoke This report highlights the specific actions that need to be taken forward within Powys thb. Recommendation The Board is asked to: 1. Note the contents of this paper for information. 2. Discuss the role of Powys thb in reducing smoking prevalence and working toward a smoke free Powys. Report prepared by: Kate Heneghan Senior Public Health Practitioner Presented By: Dr Sumina Azam Interim Director of Public Health Background Papers How to stop smoking in pregnancy &followi Financial Consequences Other Resource Implications Consultees As determined by the report As determined by the report The contents of this report draw upon presentations and discussions from the Smoking Cessation Conference Achieving the Seamless delivery of Smoking Cessation Provision in Wales: Targeting 2020 together. January 29 th 2013

9 Appendix 1 Powys teaching Health Board s Strategic Tobacco Control Action Plan for a Smoke Free Powys DRAFT

10 Table of Contents 1.0 INTRODUCTION Why this work is a priority for Powys Morbidity and mortality Cost benefit Addressing Inequalities Strategic Context Local Strategic Context CURRENT SITUATION Smoking prevalence in Powys Adults Young people ACHIEVING OUR VISION Action area one leadership and partnership Action area two Prevention Action area three Reducing smoking prevalence Pregnant women Teenage girls Patients awaiting surgery People with mental health problems Action area four Environment: Reducing exposure to second hand smoke Measuring performance Tobacco Control Strategic Action Plan for a Smoke Free Powys: References Appendix A: Suggested group membership... 33

11 1.0 INTRODUCTION In February 2011 the Welsh Government produced a document for consultation called A Draft Tobacco Control Action Plan for Wales. This plan builds on and takes further current activity in Wales around Tobacco Control. A number of recommendations were made including that there should be a Tobacco Control Forum and Action Plan in all Local Authority areas in Wales led by local Public Health Teams. Following a Workshop in Powys in 2012 this draft Strategic Action Plan has been developed and is aimed at key partners who will make up this group. It provides the rationale and key drivers for such a group and seeks to work toward a shared vision for a smoke free Powys Why this work is a priority for Powys In 2003 the World Health Organisation identified tobacco smoking as the primary cause of premature illness and death in developed countries 1.There has been a fall in smoking prevalence rates in Wales in recent years (Figure 1) from about 40% in 1978 to between 20 and 25% in However smoking remains the largest single cause of avoidable morbidity and mortality across the country 2. Figure 1:

12 1.1.1 Morbidity and mortality In Wales, in 2010 around 5,450 deaths in those aged over 35 years were as a result of smoking. This accounts for 17.8% of all deaths in this age group. More men than women are affected (23% vs 13.1%) and may go some way to explain why women live longer than men 3. Almost a quarter of the Welsh adult population are smokers 4. Smoking is associated with a number of cancers, heart disease and respiratory disease 5. Smokers risk of dying before the age of 65 years is double that of non smokers. There is also evidence to show that non smokers are affected by secondary smoke. In adults secondary smoke has been associated with lung cancer, and heart disease 5. In children secondary smoking has been associated with respiratory disease, cot death, ear infections and asthma. Using tobacco is a risk factor in six of the eight leading causes of unnecessary death worldwide. Mortality from smoking is higher than the next six most common causes of preventable deaths put together; drug misuse, road accidents, other accidents and falls, Type 2 diabetes, suicide and alcohol abuse 6 (Figure 2). Figure 2: Causes of preventable deaths (England) (DOH 2007)

13 1.1.2 Cost benefit Recent research from Swansea University reported that treating smoking related diseases in Wales cost the Welsh NHS 7% of the total healthcare expenditure in 2007/8, which is equivalent to 129 per head of population 7. Recent figures show an estimated 27,700 hospital admissions in Wales are caused by smoking each year 3. In the workforce, smoking is associated with loss of productivity from absenteeism Addressing Inequalities There is increasing evidence to show the link between smoking prevalence and socio economic class (Figure 3). Figure 3: In Wales, rates for smoking attributable mortality in the most deprived parts are more than double those in the least deprived parts. Recent evidence highlights an increase in this inequality gap over time Strategic Context There is widespread recognition of the severe impact cigarette smoking has on health and health inequalities in Wales. This has been recognised in a number of strategic documents in recent years. Our Healthy Future, Public Health Wales Strategic Framework has included the need to reduce smoking prevalence in the population of Wales as one of ten key priority actions. 9

14 In April 2007 legislation was introduced to ban smoking in all enclosed public places in Wales. A further legislative measure in the same year was to increase the minimum age for buying tobacco products from 16 years to 18 years. In February 2012 vending sales of tobacco products in Wales became illegal. In February 2011 the WG produced a document for consultation called Draft Tobacco Control Action Plan for Wales 10. This plan builds on and takes further current activity in Wales around Tobacco Control. Four strategic action areas are identified; promoting better leadership and partnerships, prevention (especially amongst children and young people), cessation and reducing exposure to secondhand smoke. The plan introduces the Welsh Government s aim of reducing smoking prevalence rates to 16% by The WG also lay down their intention to lobby the UK Government on non-devolved issues such as price increases through taxation and reducing tobacco imagery to young people Local Strategic Context The Powys Strategic Tobacco Control Action Group will lead the way in achieving a smoke free Powys for those living here and for generations to come. It will strive to ensure its aims are reflected in all strategic plans that relate to the health and happiness of the population of Powys. This will include: Powys One Plan Powys t HB annual plan Powys Local Authority Corporate Plan The Powys Strategic Tobacco Control Action plan aims to achieve a local coordinated approach to Tobacco Control. Key partners will be responsible for and take a lead on specific work streams.

15 2.0 CURRENT SITUATION 2.1 Smoking prevalence in Powys Adults Figure Young people Figure 5

16 3.0 ACHIEVING OUR VISION The Welsh Government s draft Tobacco Action Plan has identified four key action areas based on evidence of effectiveness. In line with this Powys will concentrate activity on the four action areas: 3.1 Action area one leadership and partnership Fundamental to achieving a shared vision for a smoke free Powys and the commitment to succeed is the engagement of key partners to own and take forward necessary action. Partners were invited to form a Powys wide strategic Tobacco Control group (Annexe A). 3.2 Action area two Prevention Reducing the number of people who take up smoking is paramount. Research shows smoking among school aged children increases with age. This suggests preventative measures would be most effective if they began in primary school (or earlier) and continue through high school and post 16 education. NICE guidance suggests: Schools should adopt whole school smoke free policies including staff training. This fits in well with the All Wales Network of Healthy Schools Scheme ethos where a whole school approach includes curriculum, school environment and links with family and community. Information on smoking to be integrated into the curriculum at every opportunity e.g. science, geography and PSE Schools to deliver evidence based interventions linked to national strategies. There are also opportunities to work with the preschool scheme and to influence work with families where children are at a higher risk of seeing smoking as the norm. Enforcement is also a key part of prevention including law on sales of tobacco to those under 18 years and illicit tobacco control. 3.3 Action area three Reducing smoking prevalence The WG s Tobacco Control Action Plan for Wales highlights the need for the NHS to take an exemplar role in action to discourage smoking, including staff being trained in brief intervention for smoking cessation so they are better placed to motivate smokers to quit and refer to appropriate smoking cessation services. To balance this, effective evidence based behavioural support programmes need to be widely available across Powys to ensure equity of service. This would include Stop Smoking Wales, pharmacy support and individual services. A mapping of current availability and activity is being carried out.

17 Priority will need to be given to those groups where targeted action will have the greatest impact e.g. pregnant women, pre operative smokers and parents of young children. Areas of highest deprivation in Powys will also be prioritised Pregnant women There is overwhelming evidence to show that babies born to smokers compared to non smokers have an increased risk of: Low birth weight Intra Uterine Growth Retardation (IUGR) Pre-term birth Stillbirth Dying in the first month of life Sudden Infant Death Syndrome (SIDS) 11 Women who smoke during pregnancy have a higher risk of: Ectopic pregnancy Spontaneous abortion 11 In 2010, around a quarter (26%) of mothers in the UK smoked before or during their pregnancy. Smoking levels before or during pregnancy were highest in Wales (33%) and lowest in England (26%). Mothers in Wales were most likely to smoke throughout their pregnancy (16%) compared with other home nation countries 11. NICE guidance 12 recommends a number of actions that midwives can carry out including: assessing a pregnant woman s exposure to tobacco at booking and subsequent appointments through discussion and also CO monitoring Providing information e.g. leaflets to women about the risks of smoking to the unborn child Referring pregnant smokers to a smoking cessation service Powys midwives will take the lead on reducing the number of pregnant smokers in county Teenage girls Research has shown that girls are consistently more likely to smoke than boys and Powys is no exception (Figure 5). Teenage girls will be a focus of our work in Powys Patients awaiting surgery Evidence shows that quitting smoking 6-8 weeks prior to surgery has a number of benefits. This includes Fewer infections Improved wound healing A reduction in admissions to intensive care post anaesthetic A shorter hospital stay Financial savings to the NHS

18 Targeting pre-operative patients will be a priority in the Powys Tobacco Control Action Plan People with mental health problems Research shows that people with mental health problems are more likely to smoke than the general population. Smoking has been thought to relieve the symptoms of stress. However emerging evidence shows that this is not the case. Stop Smoking Wales are developing a mental health smoking cessation toolkit and we will take their advice on how best to promote it Action area four Environment: Reducing exposure to second hand smoke Smoke free legislation in 2007 provides protection from exposure to second hand smoke in the majority of enclosed work and public places. However children continue to be exposed to second hand smoke in private dwellings and private cars. A report in 2010 from the Royal College of Physicians on Passive Smoking in Children 13 has highlighted children s vulnerability to second hand smoke. Because children have smaller lungs and underdeveloped immune systems they are more susceptible to respiratory and ear infections triggered by passive smoking. The report also showed an association between socio economic status and children s exposure to smoke. Children from poorer backgrounds have higher exposure compared to children from more affluent homes. Evidence shows 13 the strongest individual predictors of passive smoke exposure are: Where parents or carers smoke and whether they smoked inside the home. In homes where the father smokes, children s passive smoke exposure is about 3 times higher. o In homes where the mother smokes, about 6 times higher. o In homes where both parents smoke, nearly 9 times higher. In children whose carers smoked their passive smoke exposure was 5 times higher (Figure 6). We will focus action where it will have the biggest impact on reducing exposure to second hand smoke in children and young people.

19 Figure 6. Cotinine levels in non-smoking children aged 4-15 years according to smoking status of parents and carers (pooled data from ) Royal College of Physicians All rights reserved. 4.0 Measuring performance Success indicators are on the Action plan, although these need to be agreed by partners.

20 Tobacco Control Strategic Action Plan for a Smoke Free Powys: DRAFT 3 Aims of the Tobacco Control Strategic Plan To provide a co-ordinated approach to Tobacco Control in Powys in order to reduce the risks to health and reduce the impact on inequalities associated with tobacco use and to achieve Welsh Government targets. Objectives of Tobacco Control Strategic Plan: 1. To promote leadership in Tobacco Control. 2. To reduce the uptake of smoking. 3. To reduce smoking prevalence. 4. To reduce exposure to second hand smoke.

21 Objective 1: Promote leadership in Tobacco Control in order to promote joint working and ownership of the Tobacco Control process in county. Action Notes Who / how/lead 1.1 Convene a Strategic TC Group to ensure an integrated approach to planning, delivery and accountability for a Smoke Free Powys 1.2 Group to develop, implement and monitor a local multi agency action plan to reduce current smoking rates from 23% to 16% by 2020 Membership from Powys thb, Powys County Council Trading Standards, Children and Young Person s Partnership, 3rd Sector, Occupational Health, Primary Care, Public Health, Private Sector Housing landlords. Public Health to convene and support the group and establish Terms of Reference. Powys TC Action Group Timescale First group to meet by 31 st Dec 2012 Outcome measure/indicator Minutes from first meeting TC actions included in the strategic plans of all members of the TC Action Group Smoking prevalence rates (WHS) % of 15year olds who smoke (HBSC) Update 1 st meeting Feb 2013 Terms of Reference approved Action planned accepted with some small changes Group to consider developing a communication strategy in conjunction with PHW communications and Powys thb communications Contacts to SSW and quit rates at 4 weeks and 52 weeks A minimum of 5% of smokers becoming

22 1.3 Action plan to be reviewed and updated at meetings and lead organisations to take ownership for their area of TC work and for updating the group. 1.4 Group reporting arrangements to be agreed Powys County Council Powys thb 3 rd Sector Public Health Consultant in Public Health Facilitated by Public Health treated smokers per year. No. of key staff attending BIT No. of key staff completing SSW E- learning Objective 2: To reduce the uptake of smoking. Action Notes Who / how Timescale Outcome measure/indicator 2.1 De-normalise smoking Input on Public Health, through: harms Pre-school Work with pre schools from co-ordinator scheme to support No tobacco in Smoking Day, smoke training free homes and smoke days for Update Informal talks with Healthy Schools lead January 2013

23 free cars schemes, information and signposting for parents who want to quit, advice to parents to NOT smoke in front of their children. Provide ASH Step outside to smoke leaflets to parents of young children 2.2 De-normalise smoking through : Maintenance of smoke free parks scheme 2.3 Increase number of schools taking part in Smoke bugs (8-11 year olds) Map current activity pre-school staff. SSW posters and cards available at preschool settings ASH leaflets available for preschool parental packs Local Authority Trading Standards Public Health, Healthy Schools, School Health Ensure this measure is included in and monitored through Local Authority Trading Standards Strategic plan Number of children recruited to the scheme annually KH attended pre-school event to present on TC and provide resources in March well received Further work required as Trading Standards do not lead on this. KH to investigate

24 2.4 Provide the ASSIST programme to eligible high schools (12-13 year olds) 2.5 Increase number of High Schools taking part in the ASH Stamp it Out campaign and or No Smoking Day 2.6 Influence and progress the adoption of proof of age schemes Map current activity 2.7 Reduce access to tobacco through Test purchasing exercises Increase enforcement measures to address underage and illegal sales/use, counterfeit products, smuggled Nurses, Primary Schools PHW Health Improvement team Public Health, Healthy Schools Team, School Nurses, High Schools Trading Standards (Local Authority) Trading Standards (LA) % improvement on previous year % 15 year olds smoking weekly (HBSC) % improvement year on year No. Of proof of age cards applied for % increase on previous year No. of test purchases planned No. of completed test purchases % prosecutions related to illegal tobacco sales Currently no high schools in Powys meet eligibility criteria Resources provided to Healthy Schools via School Nurses

25 products, tobacco houses Raise awareness of TC offences through the Magistrate s Courts (Welsh Heads of Trading Standards) and publicise enforcement Scope out illicit tobacco sales Objective 3: Reduce smoking prevalence Action Notes Who Timescale Outcome measure/indicator 3.1 Establish a Smoking Cessation Task Group (SCTG) Powys thb Training needs to: supported by assessment carried Assess BI training local public out needs across Powys health team Establish a mechanism for prioritising BI training for key staff groups (through localities) Promote and deliver BI training SSW senior adviser BI training embedded into LHB training programmes for staff No. of training sessions delivered Update Progress with some staff groups Health Visitor and midwives to attend training in the Autumn 17 Dental nurses to receive BIT

26 Develop mechanism for monitoring uptake of BIT amongst staff, particularly amongst different staff groups (? Keep a database) 3.2 Promote smoking cessation e-learning module training for Powys thb staff 3.3 Map current SSW smoking cessation services across county and aim for an equitable service with good geographical spread Promote partnership working Target most deprived areas first 3.4 Reduce the number of preoperative patients who smoke by: Ensuring staff who come into contact with pre-operative patients have attended BIT and refer patients to the Locality leads No. of staff completed training Powys thb No. of staff who have completed e- learning module Smoking Report Cessation Task Group Powys thb supported by Public Health No. of pre-op referrals to SSW No of referrals from GPs No. of referrals from secondary care training this year Mapping carried out. Discussions on gaps in services with Medicine Management and SSW & Public Health

27 service Providing training/updates to GPs through CPD events (liaise with Institute of Rural Health) to ensure they are aware of fast track route for potential pre operative patients when they refer patients for a surgical opinion. Work with secondary care providers (as part of commissioning strategy requirements) to refer pre-operative patients to SSW smoking cessation service. 3.5 Reduce the number of pregnant women who smoke by working with midwives on improving referral rates through: Encouraging midwives to attend BIT Ensure midwives have access to CO monitors Encouraging midwives Maternity services Evidence of smoking cessation advice given on patient care pathways. Evidence of in pre operative referral as a condition of commissioning strategies for surgery No. of midwives attending BIT No. of midwives completing E- learning Data on CO monitoring (no. of

28 to use CO testing (as per NICE guidance) Encouraging midwives to refer women who smoke to smoking cessation services Sharing good practice 3.6 Increase number of care pathways that include smoking cessation for example chronic conditions 3.7 Work with GPs to increase the referral rates to smoking cessation services in county through: See 3.4 Proactively contacting practices to publicise and promote smoking cessation services 3.8 Increase number of referrals into smoking cessation services by Identifying partner organisations to support a smoke free Powys e.g. 3 rd sector, Powys County Council Training sessions Distributing materials Through QOF visits Include data collected for Level 3 Clinical leads at Powys thb Powys thb (Medical Director, locality managers) Supported by Public Health, SSW advisor Public Health, SSW testings) No. of referrals to smoking cessation SSW Pharmacy referrals Smoking cessation referral embedded in all care pathways No Smoking Day materials sent to all primary care

29 3.9 Promote the provision of smoking cessation in the workplace Map current activity in: NHS Local Authority All work places 3.10 Continue to deliver the Pharmacy level 3 community pharmacy stop smoking service in community pharmacies in Powys. Powys thb well being at work team Workboost Wales HSE Powys County Council, Corporate Health Team Medicine s management (Powys thb) Smoke free workplace policies Number of referrals Uptake of SSW Uptake of pharmacy support No. of pharmacies taking part in scheme. No. of people accessing the service 4 week quit rate Objective 4: Reduce exposure to second hand smoke Action Notes Who Timescale Update 4.1 Promote Fresh Start Wales Campaign Source materials and training Professionals who have access to parents of young children Promoted to Early years setting- 25 packs

30 4.2 Promote step outside to smoke campaign Source materials and training 4.3 Promote Smoke free cars scheme Source materials and training 4.4 Update Powys thb Smoke Free policy Identify any gaps in current policy Seek best practice from other LHB areas. Identify any funding streams e.g. WG Launch new policy Professionals who have access to parents of young children Professionals who have access to parents of young children Quality & Safety. Well Being at Work team Kate Heneghan to support given at training event Discussed with Health Visitors at 1 st meeting Follow up in May Discussed with Health Visitors at 1 st meeting Follow up in May To be discussed through Well Being at Work meeting Spring 2013

31 References 1. World Health Organisation (2003) Framework Convention on Tobacco control. Geneva: World Health Organisation (WHO) 2. Public Health Wales. Public Health Strategic Framework 2011/ /13 3. Public Health Wales Observatory Tobacco and health in Wales (2012) Available at [Accessed 24th December 2012] 4. Welsh Assembly Government. (2010) Welsh Health Survey Cardiff: Welsh Assembly Government. Available at [ Accessed 12 January 2012] 5. Dolman, R., Gibbon R, Roberts C.(2007) Smoking in Wales current facts. Cardiff: Wales Centre for Health 6. Department of Health. A Smokefree Future(2010) Available at licyandguidance/dh_ [Accessed 24 th December 2012] 7. Phillips, C.J. and Bloodworth, A. (2009) Cost of smoking to the NHS in Wales. Cardiff: ASH Wales. 8. Public Health Wales NHS Trust (2011).Trends in mortality and life expectancy in Wales. 9. Welsh Assembly Government. Our Healthy Future (2009). Available at: [Accessed 24 th December 2012] 10. Welsh Assembly Government (2011) Draft Tobacco control Action Plan for Wales 11. The information centre for health and social care (2011) Infant feeding survey 2010:early results [online]. Available at: arly_results/infant_feeding_survey_2010_headline_report2.pdf Accessed on 8 November 2012

32 12. NICE public health Guidance 26 (2010) How to stop smoking in pregnancy and following childbirth [Online] Available at: Accessed 8 th November Royal College of Physicians. Passive Smoking and Children [Online] Available at: Accessed 8 th November Action on Smoking and Health (ASH) (2011). ASH Factsheets Smoking and mental Health.[Online] Available at : pdf Accessed 8 th November NICE Public health intervention guidance 5 (2007). Workplace health promotion: how to help employees to stop smoking [Online] Available at ALTH=Smoking+and+tobacco#/search/?reload Accessed 31 st January 2013.

33 Appendix A: Suggested group membership Local Authority Trading standards Environmental Health Corporate Health Education Leisure Services Youth services Youth and family information worker Oral health promotion lead Housing officers Fire service Licensing CAIS Voluntary Sector PAVO Local Health Board Medicines Management Nursing Midwifery School Health Nurses Physiotherapists and other therapists Public Health Healthy Schools Healthy pre-schools Local Tobacco Control lead Private landlords and Housing Associations FOR APPROVAL/DISCUSSION/INFORMATION [delete as appropriate] Powys Tobacco Control Strategic Planning Page 33 of 34 Agenda Item 4.2

34 FOR APPROVAL/DISCUSSION/INFORMATION [delete as appropriate] Appendix 2 Powys Tobacco Control Strategic Planning Page 34 of 34 Agenda Item 4.2