Smoking in Haringey update with focus on smoking cessation and smokefree policy in the NHS. Haringey CCG Governing Body September 2017

Transcription

1 Smoking in Haringey update with focus on smoking cessation and smokefree policy in the NHS Haringey CCG Governing Body September 217 Sarah Hart [Senior Commissioner public health ]

2 Smoking remains an important risk factor for long term conditions Source: Haringey Annual Public Health Report 215, PHE 217

3 Smoking attributable hospital admissions, rate per 1, Smoking Attributable Hospital Admissions by NCL borough Smoking attributable hospital admissions in 215/16 were higher than the London and England averages in Islington and Haringey. Islington has a significantly higher rate than the rest of NCL. Directly standardised rate of Smoking Attributable Admissions in people aged 35 and over, 215/ London region England Barnet Camden Enfield Haringey Islington Source: Public Health England, Local Tobacco Control Profiles for England, 217

4 Smoking attributable hospital admissions, rate per 1, Smoking Attributable Hospital Admissions by NCL borough: trends When compared to other NCL boroughs, smoking attributable admissions in people aged 35+ are higher in Islington and Hariney between 29/1 and 215/ Directly standardised rate of Smoking Attributable Admissions in people aged 35 and over, 29/1 to 215/ Barnet Camden Enfield England Haringey Islington London region 5 29/1 21/11 211/12 212/13 213/14 214/15 215/16 Year Source: Public Health England, Local Tobacco Control Profiles for England, 217

5 Estimated deaths attributable to smoking per 1, population, aged 35+ Smoking attributable mortality by NCL borough In 213/15, deaths attributable to smoking in residents over 35 years were higher in Islington and lower in Haringey, compared to the London and England averages. 4 Estimated deaths attributable to smoking per 1, population, aged 35+, 213/ London region England 1 5 Barnet Camden Enfield Haringey Islington Source: Public Health England, Local Tobacco Control Profiles for England, 217

6 Proportion of smokers among the population Prevalence of smoking by NCL borough N C L Current smoking prevalence in each NCL borough is similar to prevalence in London or England, except in Haringey, where it is higher. Smoking Prevalence in adults 18+ (APS), England London Barnet Camden Enfield Haringey Islington Source: Public Health England, Fingertips, 217 3

7 Percentage of smokers aged 18+ Prevalence of smoking by NCL borough: trends Prevalence of smoking has shown a slight decrease in the last few years. Across NCL, prevalence remains between 1% and 2% of the adult population. Haringey remains the highest at 17.7% in Prevalence of smoking among persons 18 years and over, (APS) Barnet Camden Enfield England Haringey Islington London region Source: Public Health England, Local Tobacco Control Profiles for England, 217

8 Smoking and health inequalities Smoking rates are declining but stark inequalities remain Employment Employed = 15.9% Unemployed = 29.8% Mental Health Education Educated to degree level = 9.1% GCSE grade D-G /CSE = 22.8% General population = 15.5% Serious mental illness = 4.5% Income Type of work Managerial & Professional =1.9% Routine & Manual = 29.4 % 4,+ = 1.5% Up to 9,999 = 19%

9 Smoking Prevalence in adults - current smokers Smoking prevalence (%) Smoking and health inequalities Smoking remains a major cause of the life expectancy gap, accounting for up to 5% There is always a risk that our interventions may increase health inequalities Bisexual 1% higher than heterosexual in Smoking and Socioeconomic class, Smoking and sexual identity, Haringey London region England Haringey average Heterosexual/Straight Gay/Lesbian Bisexual Other

10 Smoking prevalence Smoking and inequality Focus on mental health - Mental Wellbeing Survey 216 There is a higher proportion of smokers in the most deprived areas of Haringey (24.2%), compared to the total area sample (2.1%) Smoking prevalence is the main contributor to health inequalities: Smoking has a significant relationship with mental wellbeing. 21.6% of current smokers have low mental wellbeing, compared to 14% for non-smokers and 6% for ex-smokers 1% 8% 6% 4% 2% % 77% 45% 37% In the more deprived east, current smokers are most likely to have low mental wellbeing (15.6%) Source: Haringey Council Mental Wellbeing Survey (216)

11 Rate of people setting a quit date per 1, smokers Rate of people setting a quit date per 1, smokers Rate of people setting a quit date per 1, smokers Rate of people setting a quit date per 1, smokers Rate of people setting a quit date per 1, smokers Rate of people setting a quit date per 1, smokers Service Use number setting a quit date and quitting in NCL N C L North Central London Sustainability and TransformationPlan Rate of smokers setting a quit date and quitting have declined in all NCL boroughs between 213/14 and 215/16, mirroring the national trend Rate of people setting a quit date and successful quitters at 4 weeks per 1, smokers, 213/14 to 215/16 Number setting a quit date Successful quitters at 4 weeks 12 1 Barnet Camden Enfield /14 214/15 215/16 213/14 214/15 215/16 213/14 214/15 215/ Haringey Islington 213/14 214/15 215/16 213/14 214/15 215/16 Source: Public Health England, Local Tobacco Control Profiles for England, England /14 214/15 215/16

12 Breakdown of quit attempts by setting Most quit attempts happen in GP practices in Barnet, Islington, and Enfield. In Camden, most quit attempts happen in pharmacies, while in Haringey most happen in a community setting. N C L North Central London Sustainability and TransformationPlan Barnet Camden Islington Enfield Haringey

13 Number of women Maternity data by NCL borough N C L North Central London Sustainability and TransformationPlan Very few pregnant women accessed stop smoking services in NCL between April and December 216. Of those who did, the majority did not quit or were lost to follow up, with only 13 quitters. 18 Pregnant women setting a quit date and outcome by NCL borough between April and December Not known / lost to follow up Not quit Successful quitters (self-reported) Total number setting a quit date 4 2 Barnet Camden Enfield Haringey Islington

14 The stop smoking service consultation completed in 214 found that across the survey and focus groups: Barriers to quit smoking were predominantly stress, drinking and socialising, living with current smokers and having friends/family who smoked. Respondents were worried about gaining weight when they gave up smoking. 29% said they would go to their GPs for information about how to stop smoking (29%), 23% internet (23%), and chemists 15% seek support through adverts on the street, mobile phone apps and 6% friends/family A number of people suggested that incentives like gym passes would help to keep them feeling healthier and manage their weight - though people with mental health issues said they might lack motivation to use them

15 E Cigarettes 5.6% of respondents stated in 216 survey1 they were current e- cigarette users, which equates to approximately 2.9 million of the population. Of those using 5.1% current and 48.2% ex-smokers stated their main reason for using e-cigarettes was as an aid to stop smoking. The second most common reason for both groups was that they perceived e-cigarettes to be less harmful than cigarettes, 1. Smoking habits in Great Britain using data from the Opinions and Lifestyle Survey, 1974 to 216 (adults aged 16 and over)

16 Our prevent approach to smoking cessation Smoking clinics with COPD services Tertiary Prevention CQUIN smoking St Mungo s smoking pilot Healthchecks with GPs and smoking cessation referral Secondary Prevention Stoptober London phone service pilot Well London Homes for Haringey Health Hubs One You Haringey Community Pharmacy 1:1 smoking cessation support MECC and brief advice Primary Prevention Smoking cessation maternity Population Health Community Health Personal Health

17 Activity in BEHMHT and acute trusts It s so important that we help anyone who has contact with our services to reduce smoking, and hopefully help them to quit. We have a great opportunity to have a major impact on their lives not only in terms of their mental health but their physical health too. Maria Kane, Chief Executive of BEH National CQUIN Indicator Indicator weighting (% of CQUIN scheme available) CQUIN to be introduced in aim to reducing health inequalities, encourage collaboration across different providers and improve the working lives of NHS staff CQUIN 9 - Tobacco CQUIN 9 Alcohol 9a Tobacco screening 9b Tobacco brief advice 9c Tobacco referral and medication offer 5% of.25% (.125%) 2% of.25% (.5%) 25% of.25% (.625%) 9d Alcohol screening 25% of.25% (.625%) 9e Alcohol brief advice or referral 25% of.25% (.625%)

18 Key challenges highlighted in discussion for the NCL STP prevention programme N C L Cuts to the public health grant Falling footfall into all community cessation services Inconsistent and incomplete capture of smoking status within clinical encounters Lack of systematic implementation of identification and brief advice /ask, assist, advise embedded in all clinical settings and pathways Lack of established referral pathways into community services Variable use of CO monitors in maternity Variable approaches to going smokefree

19 Key opportunities highlighted in discussion for the NCL STP prevention programme Opportunities Review smoking pathways in maternity across NCL: Best practice learning from other parts of London e.g. implemented BabyClear Gaps in CO monitor provision in maternity Work together to overcome professional and organisational barriers to ask, assist, advise and refer/ IBA and make the links to making every contact counts Facilitate sharing of learning and toolkits between trusts to go smokefree and support staff who want to quit. Using CHINs to reach into targeted groups

20 Discussion What is the best way to support access into smoking cessation services? How can we embed smoking cessation in CHINs? Are there any specific group of patients to focus on, i.e. stop before the op? Which primary care staff need to be involved and what skills do they need? How best can we ensure that the CQUINs in acute services actually lead to maintained smoking cessation activity?

21 Get involved in this years Stoptober Champaign from 21 st September