Analysis of the Wiltshire Stop Smoking Service:

Transcription

1 1 Analysis of the Wiltshire Stop Smoking Service: 2013/14 Data Report Document Prepared by James Attwood Public Health Analyst Wiltshire Public Health & Public Protection Nikki Murch Public Health Analyst Wiltshire Public Health & Public Protection Simon Hodsdon Public Health Analyst Wiltshire Public Health & Public Protection Date Published: 29 th December 2014

2 2 Contents Background and Purpose... 3 Summary of Key Findings... 4 Smoking Cessation Interventions... 6 Wiltshire Stop Smoking Service... 7 Wiltshire Summary 3 Year Comparative Analysis... 8 Analysis by Gender... 9 Analysis by Age Analysis by Age and Gender Analysis by Ethnic Origin Analysis by Occupation Analysis by Occupation and Gender Analysis by Intervention Type Analysis of Prescription Exemptions Geographical Community Area Analysis Analysis of Deprivation and Gender Analysis of Deprivation and Age Pharmacies Lost to Follow Up Analysis Pregnant Women and Breastfeeding Analysis of Pregnant Women using the Wiltshire Stop Smoking Service How Did You Hear of the Services? How Did You Hear of the Services by Channel Practice Level Summary GP Practice Stop Smoking Targets Three Year Trend Analysis New Service Users v Previous Service Users Breakdown of Service User Feedback Three Month Survey Results Website Activity: 54 Data Sources Definitions... 55

3 3 Background and Purpose Smoking is the primary cause of premature death in the UK and accounted for 80,000 deaths in 2011 in England alone. It is also associated with the development of long term conditions including Chronic Obstructive Pulmonary Disease (COPD), various forms of cancer as well as Cardiovascular Diseases (CVD) including coronary heart disease and stroke. Although the prevalence of smoking is declining in Wiltshire (16.7% of adults are smokers), it remains the biggest cause of premature death in the county with around 650 deaths from smoking related causes being recorded each year. Local smoking cessation interventions such as the Wiltshire Council Stop Smoking Service (freely available to any smoker living in Wiltshire wanting to give up) are therefore vital in improving the overall health of the population. Using data collected by the Wiltshire Stop Smoking Service, this report provides in depth analysis of annual numbers accessing the service in terms of age, gender and occupation in order to assess levels of service engagement. Analysis has also been provided according to intervention type and quit rate to identify any trends or issues that may warrant further investigation. Data The data used to inform this report is primarily drawn from the Wiltshire Council Stop Smoking Database and covers financial years 2009/ /14. Where appropriate, Wiltshire performance has been effectively benchmarked against 5 comparable Local Authorities as well as both South West and England averages. The 5 Local Authority areas selected for benchmarking are; 1) Bath and North East Somerset (BaNES) 2) Gloucestershire 3) Hampshire 4) Somerset 5) Swindon Further information can be found in the Data Sources section of this report

4 Summary of Key Findings 4,525 people used the Wiltshire Stop Smoking Service in 2013/14. This is 12.8% lower than in 2012/13. The quit rate of 54.4% in 2013/14 is lower than the 56.0% observed in 2012/13 but is consistent with that of 2011/12. Of those who successfully quit smoking in 2013/14, three quarters (75.4%) were confirmed through CO validation, slightly higher than 73.3% on the previous year. The proportion of service users who have not engaged for the full course of the Stop Smoking programme (known as the Lost to Follow Up rate) has increased from 11.2% in 2012/13 to 12.8% in 2013/14. 4 Gender The number of males setting a quit date in 2013/14 was 2,273. This is 12% lower than in 2012/13. The quit rate for males in 2013/14 was 55.2%. This is a decrease from the 57.3% in 2012/13 but higher than the 54.9% in 2011/12. The number of females setting a quit date in 2013/14 was 2,252. This is 13.4% lower than in 2012/13. The quit rate for females in 2013/14 was 53.7%, slightly lower than the 54.7% reported in 2012/13. Age The quit rate for under 18 year olds has increased to 22.7% in 2013/14 from 19.4% in 2012/13. The Lost to Follow Up Rate for this age group has also fallen to 28% in 2013/14 compared to 40.7% the previous year. The Lost to Follow Up rate has increased across all other age ranges in 2013/14 compared to the previous year with 60 years and over age category increasing to the greatest extent. Occupation A third of service users (1,483) who set a quit date were from the Routine and Manual occupation group. There was a significant increase in the Never Worked/ Long Term Unemployed group with 328 people from this occupation group setting a quit date in 2013/14 compared to only 158 in 2012/13. Quit rates were highest in the group Managerial / Professional with almost 2 in 3 (380 out of 594 people) clients quitting. The lowest quit rates, as in previous years, were seen in Full Time Students with less than a third (41 out of 130) successfully quitting.

5 5 Intervention Type One to One interventions are the most commonly used with 84.8% (3,839) service users opting for these compared with 80.2% the previous year. Quit rates are highest in drop in clinics and telephone support sessions, both reporting quit rates of approximately 72%. The lowest quit rates are observed in closed groups with just under half of clients (42 out of 96) quitting. Prescription Exemptions The proportion of people setting a quit date who were eligible for prescriptions was 56.3% (2,549) in 2013/14. This is up from 53.8% in both of the previous two years. The quit rate of those eligible for free prescriptions was 1 in 2 in 2013/14 with 1,309 of the 2,549 successfully quitting. Pharmaceutical More than half (55.8%) of clients setting a quit date received Nicotine Replacement Therapy whilst 40.9% received Champix (Stop Smoking Tablets). 61.7% of clients who received Champix successfully quit. This is higher than the quit rate for clients using Nicotine Replacement Therapy where only half (48.0%) successfully quit. 47% of service users using pharmacies successfully quit in 2013/14. This is a slight reduction from the 53% achieved in the previous year. Pregnant Women Of the 4,591 Wiltshire pregnant women in 2013/14, 12.7% (584) were smokers at time of delivery. The number of pregnant women setting a quit date in 2013/14 was 117, a reduction of 12.7% from 2012/13. In 2013/14, 49.6% of pregnant women that set a quit date did indeed successfully quit. This is a slight improvement from the previous two years where quit rates stood at approximately 47.0%. In 2013/14, the Lost to Follow Up rate for pregnant women who set a quit date reduced to 14.5% from 23.1% the previous year.

6 6 Smoking Cessation Interventions Background Smoking was banned in nearly all enclosed workplaces and public spaces in The U.K. Government commissioned a review of how the ban was working in Most forms of tobacco advertising have been banned since 2003, and eye-catching displays were banned from supermarkets in April Healthy Lives, Healthy People: A Tobacco Control Plan for England sets out what the government plans to do between It includes details of plans on stopping tobacco promotion, making smoking less affordable, regulating tobacco products, helping smokers to quit and reducing exposure to second hand smoke. Source: National Stop Smoking Campaign There are still more than 8 million smokers in England. By the end of 2015, the U.K. Government want to reduce smoking rates to: 18.5% or less for adults (compared to 21.2% for April 2009 to March 2010) - meaning around 210,000 fewer smokers per year (Recent figures suggest this has been achieved) 12% or less for 15 year olds (compared to 15% in 2009) 11% or less for pregnant women, measured at the time of giving birth (compared to 14% over 2009 to 2010) Smokefree Campaigns Smokefree campaigns are being run to encourage people to change their behaviour. The campaigns are aimed at: Making people aware of the health dangers of smoking Stopping young people from taking up smoking Encouraging smokers to try and quit, and to do so in the most effective way Encouraging people to stop smoking in their homes and family cars - emphasising how it affects children Stoptober Stoptober is the 28-day national stop smoking challenge that has taken place every October since This campaign can effectively increase the number of clients accessing Stop Smoking services in October over and above previous seasonal levels.

7 Wiltshire Stop Smoking Service The Wiltshire Stop Smoking Service is available for any smoker living in Wiltshire wanting to stop smoking. People are encouraged to use the service as many times as they need in order to achieve their smoke free goal. People are 4 times more likely to stop successfully if they have support and use stop smoking medication, especially compared with going cold-turkey. What the Service Offers The Wiltshire Stop Smoking Service offers the following: Free, friendly, non-judgmental support and advice Over 100 locations across Wiltshire Trained stop smoking advisors at G.P. surgeries, pharmacies, walk-in quit clubs Individual appointments or group setting 12 weeks of stop smoking medication on prescription if registered at a Wiltshire GP Free carbon monoxide testing Specialist support for pregnant women and those with mental health conditions Continued support for as long as the client needs Help and advice to choose a suitable stop smoking medication Help developing an individually tailored quit plan Support in making behavioural changes Help with managing cravings and temptations Support with worries about weight gain and/or managing stress Developing strategies to become a content smoke-free person Medication The following medication is available to those using the Wiltshire Stop Smoking Service: Nicotine replacement therapy (N.R.T.) Champix (Varenicline) Zyban (Bupropion Hydrochloride) 7 Source:

8 8 Wiltshire Summary There were 4,525 people using the Wiltshire Stop Smoking Service in 2013/14, 12.8% lower than the 5,183 users in 2012/13. The quit rate of 54.4% in 2013/14 is below the quit rate of 56.0% observed in 2012/13 but is exactly the same quit rate as in 2011/12. The lost to follow up rate has increased from 11.2% in 2012/13 to 12.8% in 2013/14 although this is still significantly better than the lost to follow up rate of 17.1% observed in 2011/12. Of the successful quitters, three quarters (75.4%) were confirmed through CO validation, slightly higher than 73.3% on the previous year. Figure 1: Wiltshire Summary Number of clients 6,000 5,000 4,000 3,000 2,000 1, % 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% rate / / /14 Total setting a quit date 5,412 5,183 4,525 Number of successful quitters ,902 2,463 Number of confirmed quitters 2,205 2,127 1,858 Number of lost to follow up Quit rate 54.4% 56.0% 54.4% Lost to follow up rate 17.1% 11.2% 12.8% % Successful quitters confirmed through CO 74.8% 73.3% 75.4% 0.0%

9 9 Analysis by Gender Males The Wiltshire quit rate for males of 55.2% was similar to other comparative areas as well as both the South West and national averages. The Wiltshire lost to follow up rate for males of 13.0% was similar to both Gloucestershire (15.9%) and Swindon (11.5%). Somerset performed the best out of the comparative areas with a lost to follow up rate of 9.0%. Of those males that are recorded as quit, 3 in 4 (76.7%) were confirmed through C.O. validation. The Wiltshire rate of confirmed male quitters was similar to the other comparative areas and the South West as a whole. It was also better than the national average. Figure 2: Males Quit Rate 70% % by LA National % South West % 60% 50% 40% 30% 20% 55.16% 57.69% 63.05% 50.23% 44.77% 63.58% 10% 0% Wiltshire Council Bath And North East Somerset Council (Unitary) Gloucestershire County Council Hampshire County Council Somerset County Council Swindon Borough Council (Unitary) Figure 3: Males Lost to Follow Up Rate 35% % by LA National % South West % 30% 25% 20% 15% 30.70% 10% 5% 13.01% 19.82% 15.93% 9.01% 11.45% 0% Wiltshire Council Bath And North East Somerset Council (Unitary) Gloucestershire County Council Hampshire County Council Somerset County Council Swindon Borough Council (Unitary)

10 10 Figure 4: Males Confirmed Quitters as % of all Quitters 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 76.74% 73.59% 72.65% Wiltshire Council Bath And North East Somerset Council (Unitary) % by LA National % South West % Gloucestershire County Council 77.30% Hampshire County Council 87.36% Somerset County Council 69.89% Swindon Borough Council (Unitary) Females The Wiltshire quit rate for females of 53.6% was similar to other comparative areas as well as both the South West and national averages. The Wiltshire lost to follow up rate for females of 12.8% was similar to both Gloucestershire (16.8%) and Somerset (10.5%). Swindon performed the best out of the comparative areas with a lost to follow up rate of 8.2%. Of those females that are recorded as quit, 3 in 4 (74.0%) were confirmed through C.O. validation. The Wiltshire rate of confirmed female quitters was similar to the other comparative areas and the South West as a whole. It was also better than the national average. Figure 5: Females Quit Rate 70% % by LA National % South West % 60% 50% 40% 30% 20% 53.55% 58.05% 59.90% 45.74% 42.73% 62.55% 10% 0% Wiltshire Council Bath And North East Somerset Council (Unitary) Gloucestershire County Council Hampshire County Council Somerset County Council Swindon Borough Council (Unitary)

11 11 Figure 6: Females Lost to Follow Up Rate Figure 7: Females Confirmed Quitters as % of all Quitters Table 1: Gender Comparison Gender Clients Quit (including confirmed) Confirmed by CO Lost Quit rate Confirmed as % of quitters Lost rate Female % 74.1% 12.7% Male % 76.7% 12.8% There were a similar number of males and females accessing the stop smoking service in 2013/14 with males having a slightly higher quit rate than females. Both genders had a similar lost to follow up rate. Males had a higher rate of confirmation by CO than females.

12 12 Analysis by Age 2013/14 Wiltshire Quit Rate by Age Band, Benchmarked Against Neighbouring Areas i) Figure 8: Grouped by Age Band ii) Figure 9: Grouped by Area

13 /14 Wiltshire Lost Rate by Age Band, Benchmarked Against Neighbouring Areas i) Figure 10: Grouped by Age Band ii) Figure 11: Grouped by Area

14 /14 Wiltshire Lost Rate by Age Band, Benchmarked Against Neighbouring Areas i) Figure 12: Grouped by Age Band ii) Figure 13: Grouped by Area

15 /14 Wiltshire Lost Rate by Age Band, Benchmarked Against Neighbouring Areas i) Figure 14: Grouped by Age Band ii) Figure 15: Grouped by Area

16 Under-18 Years Of the Wiltshire clients under the age of 18 who set a quit date, 1 in 4 (22.4%) successfully quit. This is similar to Hampshire (19.2%) and Somerset (23.5%) but significantly below Swindon (61.0%), BaNES (50.0%) and Gloucestershire (34.8%). It is also significantly below both the rate for the South West and the national rate for this age group. Almost 3 in 10 (29.0%) Wiltshire under-18 year old clients ended up as a lost to follow up. This is very similar to both BaNES (27.8%) and Gloucestershire (29.0%). It is also very similar to both the South West and national rates but significantly worse than the rates for both Somerset (15.7%) and Swindon (7.3%). 3 out of every 5 (58.8%) Wiltshire under-18 year old clients who are recorded as quit were confirmed through C.O. validation. This is on the whole lower than the other comparative areas as well as lower than the South West and national rates Year Olds Almost half (48.4%) of the Wiltshire clients aged between 18 and 34 who set a quit date did indeed successfully quit and this is similar to the South West and national rates for this age group. This is better than 2 of the other comparative areas but worse than 3. 1 in 5 (19.2%) Wiltshire clients aged 18 to 34 who set a quit date ended up as a lost to follow up. This is lower than the South West and national rates for this age group and does not compare too badly with other local areas of interest. 7 in 10 (70.1%) Wiltshire clients aged 18 to 34 who are recorded as quit were confirmed through C.O. validation. This is slightly better than most comparative areas and nationally Year Olds 6 in 10 (58.0%) Wiltshire clients aged 35 to 44 successfully quit. This is better than both the South West and nationally and is similar to the other comparative areas. Swindon had the highest quit rate of these areas with almost 7 in 10 (68.2%) clients successfully quitting. The Wiltshire lost to follow up rate for clients aged 35 to 44 was 1 in 9 (11.4%). This was better than the national and South West rates and performed well compared to the other comparative areas. Only Swindon (7.6%) and Somerset (8.9%) had lower lost to follow up rates. 3 in 4 (76.3%) Wiltshire clients aged 35 to 44, who are recorded as quit were confirmed through C.O. validation. This is better than the national rate and similar to the South West and the other comparative areas, although Somerset stands out with 9 in 10 (89.8%) of recorded quitters being confirmed by C.O. validation.

17 45-59 Year Olds 11 in 20 (56.4%) Wiltshire clients aged 45 to 59 who set a quit date successfully quit. This is similar to the comparative areas and slightly above both the national and South West rates. 1 in 10 Wiltshire clients aged 45 to 59 who set a quit date ended up as a lost to follow up. This is similar to 2 of the other comparative areas and better than 3 of them. It is also significantly better than the national and South West rates. Of the Wiltshire clients aged 45 to 59, who are recorded as quit, 3 in 4 (77.9%) were confirmed through C.O. validation. This is similar to the other comparative areas although Somerset stands out as highly performing with a rate of 9 in 10 (90.5%). The Wiltshire rate was slightly below the South West rate but slightly above the national rate. 17 Over 60 Years Almost 6 in 10 (59.0%) Wiltshire clients aged 60 and over who set a quit date did indeed quit. This is almost identical to both the South West and national rates. 3 comparative areas performed better whilst 2 performed poorer. 1 in 13 (7.7%) Wiltshire clients aged 60 and over who set a quit date ended up as a lost to follow up. This is better than 3 of the other comparative areas and on a par with Somerset. Only Swindon (4.5%) achieved a noticeably better result. Slightly more than 3 in 4 (78.2%) Wiltshire clients aged 60 and over, who are recorded as quit, were confirmed through C.O. validation. This is similar to the other comparative areas although Somerset stands out with a rate of 91.6%. The Wiltshire rate was slightly above the national rate but slightly below the rate for the South West.

18 18 Analysis by Age and Gender For both genders the age groups and had the most clients using the service. The greatest proportion setting a quit date in females was in the age group and in males it was in the age group For both males and females the quit rates were extremely low for the younger ages especially in the age group whose quit rate is 24% for males and 21% for females. Males aged 60 and over have the highest quit rate at 63%. Figure 16: 2013/14 Smoking Cessation by Age and Gender Number of clients Female Male clients quitters quit rate this gender 21% 48% 59% 56% 55% 24% 49% 57% 57% 63% this age quit rate this gender all ages 54% 54% 54% 54% 54% 55% 55% 55% 55% 55% 70% 60% 50% 40% 30% 20% 10% 0% % successful quitters

19 Analysis by Ethnic Origin Analysis by ethnic origin is not particularly useful except to say that the majority, 93.3%, of all clients are White British and a further 3.9% are White Other. The number of clients in the other ethnic categories total 31 or less; too few for meaningful statistical analysis. Figure 17: 2013/14 Smoking Cessation by Ethnic Origin % number of people % 54% 54% 53% 53% 52% 52% % quit rate 0 White - British Other clients quitters quit rate 55% 52% Wiltshire quit rate 54% 54% 51%

20 20 Analysis by Occupation The highest number of clients is from the occupation category Routine and manual and that makes up almost a third of all clients. Prisoners make up the lowest number of clients, closely followed by Full time students with both less than 3% of all clients. There are a large number of clients in the occupation category Unable to code. It would be prudent to investigate this further to see if it is possible to categorise this data next year if at all possible. The highest quit rates are of the order of 2 in 3 clients in the occupation categories Managerial/Professional (64.0%) and Retired (61.5%). The lowest quit rates are of the order of 1 in 3 clients in Never Worked/Long Term Unemployment (32.3%) and Full Time Students (31.5%). Figure 18: 2013/14 Smoking Cessation by Occupation Group clients quitters quit rate Wiltshire quit rate quit rate 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% Routine and manual Managerial/professional Retired Unable to code Home carer Intermediate Sick/disabled and unable to work Job Seeker Never worked / long term unemployed Full time student Prisoner ,000 1,200 1,400 1,600 Number of people

21 21 Analysis by Occupation and Gender The highest number of clients come from the occupation category Routine and Manual for both males and females, although the number of males in this category is 73% higher than the number for females (941 v 542 respectively). The distribution of occupation is very similar when comparing males to females with just one point of difference; the levels of Home Carer being much higher in females than males. The highest quit rate for females is 2 in 3 (65%) in Managerial/Professional and for males 2 in 3 (65%) in Retired. The lowest quit rate for both genders is Full Time Students of between 1 in 4 and 1 in 3. Figure 19: 2013/14 Smoking Cessation by Occupation and Gender clients quitters quit rate Wiltshire quit rate quit rate 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% Routine and manual Managerial/professional Retired Unable to code Intermediate Female Male Sick/disabled and unable to work Prisoner Job Seeker Never worked / long term unemployed Full time student Home carer Routine and manual Home carer Managerial/professional Unable to code Retired Intermediate Sick/disabled and unable to work Full time student Never worked / long term unemployed Job Seeker Prisoner number of people

22 22 Analysis by Intervention Type One to One dominates the intervention type with 17 in 20 (84.8%) clients using this method. Open (Rolling) is the next most popular with 7.4% of clients using this method. The quit rate for One to One is similar to the overall quit rate average and this is unsurprising since it is by far the most common intervention type. The highest quit rates are of the order of 7 in 10 and are observed in Drop in Clinics (71.9%) and Telephone Support (72.1%). Closed Groups have the lowest quit rate of around 5 in 11 (43.8%). Figure 20: 2013/14 Smoking Cessation by Intervention Please note that text message has been excluded due to having less than 5 people. Clients/quitters One to One Support Open (Rolling) Drop in Clinic Closed Group Telepho ne Support Couple or Family Support clients quitters quit rate 54.0% 52.2% 71.9% 43.8% 72.1% 57.7% 66.7% Wiltshire quit rate 54.4% 54.4% 54.4% 54.4% 54.4% 54.4% 54.4% 80% 70% 60% 50% 40% 30% 20% 10% 0% % quitters

23 23 Analysis of Prescription Exemptions Of the 4,525 clients setting a quit date in 2013/14, 6 in 11 (56.3%) were exempt from prescriptions. Perhaps surprisingly the quit rate of just above half (51.4%) was lower in those clients exempt from prescriptions compared to those that were not exempt (58.4% quit rate). One might assume that clients who do not have the barrier of cost might have a higher persistency with the medication and therefore have a greater chance of quitting. We might interpret this that people who are willing to pay will have more personal investment in quitting. Figure 21: 2013/14 Smoking Cessation by Those Exempt from Prescriptions % % number of people % 40% 30% 20% % quitters % 0 Not Exempt Exempt clients quitters quit rate 58.4% 51.4% Wiltshire quit rate 54.4% 54.4% proportion 43.7% 56.3% 0%

24 Geographical Community Area Analysis Heat Map 1: Rate of Clients per 1,000 Population 24

25 Heat Map 2: Quit Rate per 1,000 Population 25

26 Heat Map 3: Lost Rate per 1,000 Population 26

27 27 Trowbridge Community Area has the most clients accessing the stop smoking service with 493 and Wilton has the fewest with just 24. High lost to follow up rates will have an effect on lowering the quit rate. This is because none of the lost to follow up clients will count towards the number of quitters, despite the fact that a proportion of this cohort are likely to have, in fact, quit. Marlborough and Warminster have the 2 highest quit rates with both having quit rates of 2 in 3 (66%). Mere and Malmesbury have the lowest quit rates with around less than half of those who set a quit date successfully quitting. Figure 22: 2013/14 Stop Smoking Activity and Quit Rate by Area Board clients quitters Area quit rate Wiltshire quit rate Warminster Community Area Marlborough Community Area Bradford on Avon Community Area Melksham Community Area Amesbury Community Area "No Area Board Found" Pewsey Community Area Wilton Community Area Westbury Community Area Southern Wiltshire Community Area Corsham Community Area Tidworth Community Area Chippenham Community Area Trowbridge Community Area Tisbury Community Area Devizes Community Area Wootton Bassett Community Area Salisbury Community Area Calne Community Area Malmesbury Community Area Mere Community Area quit rate 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% number of people

28 28 Analysis of Deprivation and Gender Deprivation analysis is based on the within Wiltshire deprivation quintile index with deprivation quintile 1 being the most deprived and deprivation quintile 5 being the least deprived. For both males and females the highest proportion of clients, by far, are from the most deprived areas. The lowest proportion of male clients is in the 4 th quintile and for females it is the least deprived 5 th quintile. For male clients there is a clear correlation between the quit rate and the deprivation area with the lowest quit rate (49.5%) observed in the most deprived area and the quit rate increasing as the deprivation reduces. In the least deprived area the quit rate for males is 61.1%. For females the quit rate does not follow the same pattern as for males. For the female clients the highest quit rates, 57.1% and 55.1%, are in deprivation quintiles 2 and 3 respectively. Deprivation areas 1, 4 and 5 have the lowest quit rates of between 51.1% and 52.0%. Figure 23: 2013/14 Smoking Cessation by Deprivation and Gender clients quitters quit rate this gender & deprivation quit rate this gender all deprivations Proportion by deprivation % 60% 50% 40% 30% 20% 10% % quitters 0 0% 1 Most Deprived least Deprived 1 Most Deprived least Deprived Number of clients Female Male

29 29 Analysis of Deprivation and Age The highest number of clients using the service are from the most deprived areas and are in age groups and The lowest number of clients comes from the 60 and over age group in the least deprived areas. Excluding the age group 0-17, the lowest quit rate is in age group in deprivation area 4 with 2 in 5 (43%) clients quitting and the highest quit rate is in age group in deprivation area 4 and age 60 and over in deprivation area 5 with both having quit rates of 2 in 3 (63%) clients quitting. There are very few clients in the 0-17 age group therefore quit rates can be volatile and are not as statistically significant in this age group. Figure 24: 2013/14 Smoking Cessation by Deprivation, Ages Years number of people Most Deprived Least Deprived clients quitters quit rate, this age, this area 44% 49% 53% 43% 52% quit rate, this age, all areas 48% 48% 48% 48% 48% quit rate, all ages, all areas 54% 54% 54% 54% 54% 60% 50% 40% 30% 20% 10% 0% % quitters Figure 25: 2013/14 Smoking Cessation by Deprivation, Ages Years number of people Most Deprived Least Deprived clients quitters quit rate, this age, this area 54% 59% 57% 63% 62% quit rate, this age, all areas 58% 58% 58% 58% 58% quit rate, all ages, all areas 54% 54% 54% 54% 54% 64% 62% 60% 58% 56% 54% 52% 50% % quitters

30 30 Figure 26: 2013/14 Smoking Cessation by Deprivation, Ages Years number of people Most Deprived Least Deprived clients quitters quit rate, this age, this area 53% 56% 60% 58% 56% quit rate, this age, all areas 56% 56% 56% 56% 56% quit rate, all ages, all areas 54% 54% 54% 54% 54% 61% 60% 59% 58% 57% 56% 55% 54% 53% 52% 51% 50% % quitters Figure 27: 2013/14 Smoking Cessation by Deprivation, Ages 60 and Over number of people Most Deprived Least Deprived clients quitters quit rate, this age, this area 60% 62% 54% 58% 63% quit rate, this age, all areas 59% 59% 59% 59% 59% quit rate, all ages, all areas 54% 54% 54% 54% 54% 64% 62% 60% 58% 56% 54% 52% 50% 48% % quitters

31 31 Pharmacies In 2013/14 there were 40 pharmacies that provided the Stop Smoking Service, seeing 445 clients, 208 of whom successfully quit. This equates to nearly 1 in 2 (46.7%) clients at pharmacies successfully quitting in 2013/14. The pharmacy quit rate of 46.7% for 2013/14 was lower than the 2012/13 pharmacy quit rate of 53% but higher than the 43% achieved in 2011/12. Figure 28: Pharmacy Quit Rate, 5 Year Trend 60% 50% quit rate % 40% 30% 20% 10% 0% 2009/ / / / /14 Quit Rate 39% 46% 43% 53% 47% Year

32 32 Lost to Follow Up Analysis Lost to Follow Up by Year Lost to follow up is the term used to describe those service users who have not engaged for the full course of the Stop Smoking programme and are subsequently contacted by members of the Wiltshire Council Stop Smoking Team to determine whether any additional support can be provided. The lost to follow up rate in 2013/14 was 1 in 8 (12.8%) clients compared to nearly 1 in 9 (10.9%) in 2012/13 and 1 in 6 (17.1%) in 2011/12. Whereas the lost to follow up rate is significantly better than two years ago it has declined slightly since last year. As this is a key metric it is important that we try to isolate any particular areas that are responsible for this increase in lost rate. To do this we look at various cohorts of clients to ascertain their particular lost to follow up rate. Figure 29: Lost to Follow Up by Year Number of clients 6,000 5,000 4,000 3,000 2,000 1, / / /14 Total Clients 5,461 5,225 4,525 Number of lost to follow up Lost to follow up rate 17.3% 10.9% 12.8% 20.0% 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Lost Rate

33 33 Lost to Follow Up Rate by Exact Age and 5 Year Age Band There is a clear trend in that the lost to follow up rate is high for younger ages and decreases the older the client (with a few exceptions). This would suggest that having a better strategy to manage to the lost to follow up rate for younger ages (<35) would be prudent in order to lower the overall lost to follow up rate in 2014/15. The proviso to this is that overall numbers of clients in the very young ages is so low that improving the lost rate for this cohort may not affect the overall lost rate significantly. Figure 30: Lost to Follow Up Rate by Exact Age and 5 Year Age Band Number of clients exact age

34 34 Lost to Follow Up by Deprivation with 3 Year Trend There are a number of records on the system that it is not possible to link to a deprivation quintile because the postcode given does not match the deprivation lookup. We have excluded these clients from the deprivation analysis below. This does mean that the overall lost to follow up rate of 1 in 8 (12.8%) changes to 12.9% for the clients included in the deprivation analysis in this section. The highest lost to follow up rates are seen in clients from the least deprived areas where it is 1 in 6 (15.9%) compared to the average over all areas of 1 in 8 (12.9%). Figure 31: 2013/14 Smoking Cessation Lost to Follow Up Rate by Deprivation % % number of people % 10% lost rate % % 0 1 most deprived least deprived clients Lost Wiltshire lost rate 2013/ % 12.9% 12.9% 12.9% 12.9% Lost rate 2013/ % 11.7% 12.4% 12.3% 15.9% Lost rate 2012/ % 9.4% 12.6% 9.4% 11.9% Lost rate 2011/ % 14.5% 16.7% 19.2% 18.9% 0%

35 35 Lost to Follow Up Rate by Deprivation and Age Band It is clear that for ages 0-17 years the lost to follow up rate is very high, however overall numbers of clients in this age group are very low. Focusing efforts on improving the lost to follow up rate in this age group would have very little effect on the overall rate across all clients. The key age group of all have a higher lost to follow up rate in all deprivation areas than the average. It would be prudent to focus on improving the rates in this group of clients. The worst lost to follow up rate for this age group is in the least deprived areas. Figure 32: Lost to Follow Up Rate by Deprivation and Age Group Total Clients Lost to follow up Lost % all clients Lost % % number of people % 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% lost rate 0 0.0% 1 most deprived least deprived 1 most deprived least deprived 1 most deprived least deprived 1 most deprived least deprived 1 most deprived least deprived

36 36 Lost to Follow up by Occupation By far the worst lost to follow up rates are seen in Full time students and Prisoners, however these occupations have a relatively low number of clients. Clients with an occupation of Routine and manual are by far the most dominant in terms of number of clients into the service. Figure 33: 2013/14 Lost to Follow Up Rate by Occupation Total Clients Lost to follow up 2013/14 Lost % 2013/14 Lost % all clients 2011/12 Lost % 2012/13 Lost % Number of clients % 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% lost rate %

37 37 Lost to follow up by Community Area There are a number of community areas that have a high lost to follow up rate. Malmesbury, Mere and Tidworth rank as having the worst rates that are all above 1 in 4 clients. It is also worth mentioning the high lost rate of 2 in 11 (17.8%) at Devizes since there are a large number of clients from this area so it affects the overall lost rate more. Figure 34: 2013/14 Lost to Follow Up Rate by Area Board Total Clients Lost to follow up Lost % Lost % all clients % % Number of clients % 15% 10% Lost rate % 100 5% 0 0%

38 38 Lost to Follow Up by Practice More than 1 in 3 (37.9%) clients that set a quit date at Barcroft Medical Centre resulted in being lost to follow up. This was higher than at any other practice. There were 6 other practices where the lost to follow up rate was 1 in 4 clients or higher and these practices were: Malmesbury P. C.C. (31.8%), Markey Lavington Surgery (28.6%), Rowden Surgery (27.3%), Salisbury Medical Practice (26.2%), Burbage Surgery (25.0%) and Hathaway Medical Centre (25.0%). Lovemead Practice achieved the best lost to follow up rate with 0 clients being lost to follow up out of 110 in total. Other practices had a lost to follow up rate of 0 but these had very few clients. Figure 35: 2013/14 Lost to Follow Up Rate by Practice Total Clients Lost to follow up Lost % Lost % Average (practices only) Number of clients BARCROFT MED CENTRE MALMESBURY P C C MARKET LAVINGTON SURGERY ROWDEN SURGERY SALISBURY MEDICAL PRACTICE BURBAGE SURGERY HATHAWAY MEDICAL CENTRE MERE SURGERY NORTHLANDS SURGERY CRICKLADE SURGERY SOUTHBROOM SURGERY PORCH SURGERY WIDBROOK MED PRACTICE PATFORD HOUSE SURGERY TISBURY SURGERY BRADFORD ROAD MED CENTRE JUBILEE FIELD SURGERY WHITEPARISH SURGERY SPA MEDICAL CENTRE SMALLBROOK SURGERY THREE SWANS SURGERY BOURNE VALLEY PRACTICE BEMERTON HEATH SURGERY ORCHARD PARTNERSHIP ST ANN STREET SURGERY WILTON HEALTH CENTRE BEVERSBROOK MED CENTRE RAMSBURY SURGERY ST JAMES SURGERY WHITE HORSE HEALTH CENTRE HINDON SURGERY DOWNTON SURGERY PEWSEY SURGERY AVON VALLEY PRACTICE GIFFORDS P C C SILTON SURGERY HARCOURT MEDICAL CENTRE MILLSTREAM MEDICAL CENTRE ST MELOR HOUSE SURGERY TOLSEY SURGERY MARLBOROUGH SURGERY TINKERS LANE SURGERY LANSDOWNE SURGERY CASTLE PRACTICE LODGE SURGERY NEW COURT SURGERY OLD SCHOOL HOUSE SURGERY AVENUE SURGERY BOA HEALTH CENTRE BOX SURGERY COURTYARD SURGERY CROSS PLAINS SURGERY ENDLESS STREET SURGERY LOVEMEAD GROUP PRACTICE PURTON SURGERY 40% 35% 30% 25% 20% 15% 10% 5% 0%

39 39 Pregnant Women and Breastfeeding Smoking at Time of Delivery (S.A.T.O.D.) Please note that there was an error with the submission of the Wiltshire S.A.T.O.D. data for Quarter /14 to the HSCIC. Originally this gave a very high S.A.T.O.D. rate both for Quarter 4 and the full year. Correct figures have since been obtained from the Central Southern Commissioning Support Unit and these corrected figures have been used in this document however these will now differ from the official HSCIC data for this reason. HSCIC have been notified of the error. Of the 4,591 Wiltshire pregnant women in 2013/14, 584 were smokers at time of delivery and this equates to 1 in 8 (12.7%) pregnant women. Less than 5 of these 4,591 women had an unknown smoking status at time of delivery. Table 2:2013/14 Wiltshire S.A.T.O.D. Summary Number of Wiltshire maternities in 2013/14 4,591 Number of women smoking at time of delivery 584 Percentage of women smoking at time of delivery 12.7% Number of women not smoking at time of delivery 4,004 Percentage of women not smoking at time of delivery 87.2% Annual Result (Benchmarked) In 2013/14 1 in 8 (12.7%) mothers in Wiltshire CCG were known to be smoking at time of delivery. This rate is similar to the other comparative areas but is slightly higher than both the current national average (12.0%) and the national ambition (11.0%). Figure 36: Percentage of mothers known to be smoking at time of delivery by clinical commissioning group in England % NHS Wiltshire NHS Bath and North East Somerset NHS Gloucestershire NHS Swindon NHS Somerset The 2013/14 annual rate is shown and compared to both the national average and the national ambition of 11%.

40 40 Analysis of Pregnant Women using the Wiltshire Stop Smoking Service The table below gives a summary of the 2013/14 activity in the Wiltshire stop smoking service for pregnant women. Nearly 1 in 2 (49.6%) pregnant women who used the Wiltshire stop smoking service in 2013/14 did indeed quit, however this is lower than the quit rate for the service as a whole (54.4%). This would initially appear to be a low quit rate for this cohort of people. One might think that pregnant women who smoke would have a stronger determination to quit than the average stop smoking service user. One explanation of this is that there are a number of categories of pregnant smoker. The first group finds it easier to quit and does not seek support from the stop smoking service. The second group finds it more difficult to quit and may seek support from the stop smoking service in order to give it a try. Effectively the pregnant women that use the service are those smokers who are less likely to quit, with the other pregnant smokers who have quite bypassing the service altogether. Table 3: 2013/14 Wiltshire Stop Smoking Service Summary, Pregnant Women Pregnant women using the Wiltshire stop smoking service Total 2013/14 Number setting a quit date 117 Number of successful quitters 58 Number who had not quit 42 Number not known/lost to follow 17 up Number who had successfully quit, 14 confirmed by CO validation Quit rate 49.6% Lost rate 14.5% Confirmed as % all clients 12.0% Confirmed as % quitters 24.1%

41 Pregnant Women: Quit Rate (Benchmarked) In Wiltshire nearly 1 in 2 (49.6%) pregnant women who use the stop smoking service successfully quit smoking. This is slightly better than both the rate for the South West (45.6%) as a whole and the national rate (47.3%). When measured against comparative local areas the Wiltshire quit rate for pregnant women is on a par with Gloucestershire and above the rates for both Hampshire (1 in 3) and Somerset (2 in 5). Swindon and BaNES have high quit rates for pregnant women with 2 out of 3 pregnant women successfully quitting. Figure 38: Pregnant Women Quit Rate 41 Pregnant Women Lost to Follow Up The Wiltshire lost to follow up rate for pregnant women is approximately 3 in 20 (14.53%) pregnant women. This is better than both the national rate of 1 in 4 (23.3%) and the South West rate of 1 in 5 (19.4%). Both Gloucestershire (9.7%) and Swindon (3.1%) had a lower lost to follow up rate for pregnant women than Wiltshire. The Wiltshire lost to follow up rate for pregnant women was much lower than the rates for BaNES, Hampshire and Somerset. Figure 39: Pregnant Women: Lost to Follow Up Rate (Benchmarked)

42 42 Pregnant Women: Confirmation by C.O. Validation (Benchmarked) C.O. validation should be attempted on all clients who are recorded as having quit at the 4 week follow-up, except for those who were followed up by telephone. C.O. validation may not be available to all quitters for a number of reasons. For example, telephone consultation or availability of equipment. A face to face setting is required for a CO validation to be done and in Wiltshire a large proportion of follow ups for pregnant women are done by telephone rather than face to face. This is due to a combination of large geographical spread and the resources available. In contrast the midwives in both BaNES and Swindon make it part of their routine to see the pregnant mother face to face and it is at this point that they are performing the CO validation. Other ways of encouraging service users to engage with the face to face CO validation are currently being explored by Wiltshire Public Health. This is the reason that the number of confirmed quitters by C.O. validation for Wiltshire is extremely low. Every 1 in 4 pregnant women who were recorded as successful quitters were confirmed as quitters through C.O. validation. Figure 40: Pregnant Women Confirmed Quitters as a % of All Quitters

43 43 How Did You Hear of the Services? How Did You Hear of the Services by Channel 1,666 clients heard about the Wiltshire Stop Smoking service from a GP. This represents just over a third (36.8%) of the client base. The following channels all generated less than 20 clients in total between them; Leaflet mail drop, School Booklet, Newspaper & Radio. This raises an interesting question of whether to persist with some of the distribution channels or evaluate if the right strategy is being adopted to make the best use of them. In addition one would assume Newspaper, Radio and Leaflet drop may be comparatively expensive and that would make their population health improvement v monetary investment an extremely low return for this service. Conversely many of the other more productive channels may be much cheaper or even free. E.g. GP, Past Client etc. Figure 41: How the client heard about the Stop Smoking Service plotted with outcome. Options that were used by less than 5 people have been removed from the graph below. How client heard Quit % Lost % Quit Average Lost Average % 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% GP Other Health Professional Past Client Friend/relative Pharmacy Not known Hospital National TV Advertising Poster Follow Up Letter Workplace PR Promotion (F to F) Internet Leaflet Mail Drop ,000 1,200 1,400 1,600 1,800 number of people

44 44 How did You Hear of the Services by Deprivation Access routes into the service where below 5 people in a given quintile were recorded have been excluded from the graph below Figure 42: 2013/14 How the Client Heard about the Service, by Deprivation 1 most deprived least deprived 100% 90% 80% 70% % of clients 60% 50% 40% 30% 20% 10% 0% GP Other Health Profession al Past Client Friend/relat ive Pharmacy Not known Hospital National TV Advertising 5 least deprived most deprived

45 Practice Level Summary Map 4: Locations of Wiltshire GP Practices and Community Areas 45

46 46 GP Practice Stop Smoking Targets Each practice had a 2013/14 target for the number of quitters to achieve. Out of 55 practices only 2 in 5 (22 practices) achieved or exceeded their target with 33 practices not achieving their target. The combined target of all 55 practices was to achieve 1,869 quitters. The actual number achieved was 1,692. This is 90.5% of target and 177 fewer quitters than had been planned. Burbage and Courtyard had low targets, 13 and 11 respectively, but only achieved 1 quitter each. Endless Street Surgery, Jubilee Field Surgery, Lansdowne Surgery, Purton Surgery and Widbrook Medical Practice all achieved less than 50% of their target number of quitters. At the other end of the scale Southbroom Surgery, St Melor House Surgery and Smallbrook Surgery all achieved greater than 160% of target. Figure 43: 2013/14 Number of Quits per Practice as % of Annual Target

47 GP Practice Stop Smoking Targets by Locality NEW Of the 19 N.E.W. practices, only 7 achieved their target for the number of quitters however both Old School House Surgery and Ramsbury Surgery did very well against their targets. Excluding practices with low number of clients, New Court Surgery had the lowest quit rate with only 2 in 5 (40.8%) clients who set a quit date actually quitting. On the positive side; Marlborough Surgery and Box Surgery have high quit rates, with around 4 in 5 clients quitting Figure 44: 2013/14 N.E.W. GP Practices: Number of Quits per Practice as % of Annual Target: Quit and Lost to Follow Up Rates /14 number of quits as a % by practice of annual target Target Quit rate Lost rate % of annual target 180% 160% 140% 120% 100% 80% 60% 40% 20% 0% 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% quit rate & lost rate BURBAGE SURGERY PURTON SURGERY PORCH SURGERY HATHAWAY MEDICAL CENTRE ROWDEN SURGERY BOX SURGERY MARLBOROUGH SURGERY TOLSEY SURGERY TINKERS LANE SURGERY MALMESBURY P C C NEW COURT SURGERY PATFORD HOUSE SURGERY NORTHLANDS SURGERY LODGE SURGERY PEWSEY SURGERY CRICKLADE SURGERY BEVERSBROOK MEDICAL CENTRE RAMSBURY SURGERY OLD SCHOOL HOUSE SURGERY Sarum Of the 21 Sarum practices, 10 achieved their target for the number of clients quitting, with St Melor House Surgery achieving the best result against target for this locality (167% of target). Bemerton Heath Surgery has the lowest quit rate with just over a third of clients (36.0%) quitting. St Ann Street Surgery, Castle Practice and Millstream Medical Centre have the highest quit rates with around 4 in 5 clients quitting.

48 48 Figure 45: 2013/14 Sarum GP Practices: Number of Quits per Practice as % of Annual Target: Quit and Lost to Follow Up Rates 2013/14 number of quits as a % by practice of annual target Target Quit rate Lost rate 180% 160% 140% 120% 100% 80% 60% 40% 20% 0% 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% quit rate & lost rate ENDLESS STREET SURGERY BARCROFT MEDICAL CENTRE DOWNTON SURGERY MILLSTREAM MEDICAL CENTRE WHITEPARISH SURGERY SALISBURY MEDICAL PRACTICE BEMERTON HEATH SURGERY ORCHARD PARTNERSHIP WILTON HEALTH CENTRE CROSS PLAINS SURGERY HARCOURT MEDICAL CENTRE SILTON SURGERY ST ANN STREET SURGERY CASTLE PRACTICE % of annual target TISBURY SURGERY HINDON SURGERY BOURNE VALLEY PRACTICE THREE SWANS SURGERY AVON VALLEY PRACTICE MERE SURGERY ST MELOR HOUSE SURGERY WWYKD Of the 15 WWYKD practices, only 5 achieved their target for number of quitters. White Horse Health Centre, Southbroom Surgery and Smallbrook Surgery performed exceptionally well against their respective targets. All achieved >150% of their target for number of quitters. Widbrook Medical practice Surgery has the lowest quit rate with nearly a quarter (24.5%) of all clients having successfully quit. The highest (statically meaningful) quit rate was Lovemead group practice with a quit rate of over 3 in 4 clients (76.4%). Figure 46: 2013/14 WWYKD GP Practices: Number of Quits per Practice as % of Annual Target: Quit and Lost to Follow Up Rates % of annual target 180% 160% 140% 120% 100% 80% 60% 40% 20% 0% 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% quit rate & lost rate COURTYARD SURGERY JUBILEE FIELD SURGERY LANSDOWNE SURGERY WIDBROOK MEDICAL PRACTICE MARKET LAVINGTON SURGERY GIFFORDS P C C ST JAMES SURGERY BOA HEALTH CENTRE BRADFORD ROAD MEDICAL CTR SPA MEDICAL CENTRE LOVEMEAD GROUP PRACTICE AVENUE SURGERY WHITE HORSE HEALTH CENTRE SOUTHBROOM SURGERY SMALLBROOK SURGERY