Smokefree NHS. Thursday 18 th October. RCGP/CRUK Cascade Event. Ailsa Rutter OBE Director of Fresh

Transcription

1 Smokefree NHS Thursday 18 th October RCGP/CRUK Cascade Event Ailsa Rutter OBE Director of Fresh

2 Summary Progress to date- locally together approach works 5% by 2025 vision- how? Why is smoking still an issue? Role of Smokefree NHS Role of primary care- what works? What can front line HCPs do? More information

3 Big picture context- build on progress Change in regional smoking prevalence : 29% down to 16.2% 0% -5% -10% -15% -20% -25% -30% -35% -40% -45% -50% -44% -33% -32% -37% -35% -38% -34% -38% 5% by 2025 vision. Gateshead and Newcastle HWBs. -45% -38%

4 Policy to help to achieve 5% by 2025 Increasing quit rates and reducing Increase real cost of tobacco uptake Implementation Amplifying tax increases with further action around illicit tobacco Run regional mass media campaigns Implement VBA in 1 care Introduce Stop- Smoking+ model of support, and extend 2 care provision Reduce access to tobacco Amplifying national campaigns and running region-specific campaigns Offer support to 45% of smokers Specialist community stop smoking support for priority groups, much better secondary care initiation of smoking cessation, pragmatic approach around less harmful nicotine products Restricting outlets, extending smoke-free, raising age of sale to 21, levy on tobacco industry Prof Robert West UCL slide

5 30 seconds to save a life

6 Key points Smoking still kills thousands of people each year, despite good progress in the NE Most smokers want to stop, millions have quit for good All NHS staff should be able to ASK: all patients if they smoke ADVISE: the best way to stop ACT: by providing referral to local stop smoking services

7 15 North Easterners will die from smoking TODAY: for every 1 death: 20 will be suffering

8 Health inequalities impact Smokers lose 10 years of life on average Smoking is the biggest cause of health inequalities. Responsible for half the life expectancy gap between the highest and lowest socio-economic groups In the North East around 34% of the 300,000 households with a smoker, fall below poverty line. If they quit, around 34k households would be lifted out of poverty

9 It s not a lifestyle issue/choice People smoke because they re dependent. CHRONIC RELAPSING LONG TERM CONDITION, usually starts in childhood and is familial. Nicotine is the addictive product within cigarettes. Not the nicotine that kills smokers though.tobacco smoke contains over 5,000 chemicals - over 70 known to cause cancer. E-cigarettes significantly less harmful (PHE, RCP, BMA, RCGP, CRUK )

10 Hiding in Plain Sight Summary The principle of autonomy requires that patients who smoke and who are in contact with health services have their smoking ascertained, and information and treatment offered, to enable autonomous decisions on future smoking. The principle of justice requires that we offer smokers help to quit smoking; failure to so implies that smokers health is less important than that of other patients. Failing to provide help to quit smoking while delivering other similarly or less cost-effective interventions to smokers represents distributive injustice which both perpetuates and exacerbates health inequalities. > Opt-out models of treatment help to sustain autonomy and justice in treating smoking, and should be the norm. It is at least as important to address smoking in patients using secondary care as those in primary care. Treating the physical health of patients is also no less important than treating mental health. Treating smoking improves both.

11 Hiding in Plain Sight Summary Since most people would prefer to avoid being ill than to go through illness and treatment, prevention should be given a proper place in the allocation of health service resources. Proper use of health service resources also requires that more cost-effective treatments are used in preference to less cost-effective treatments. Smoke-free NHS estates protect the health of patients and staff, signals that smoking is a crucial health issue, and supports smokers who are trying to quit. Heath service commissioners and practitioners have a responsibility to ensure that cost-effective smoking interventions are provided and properly implemented. Failure to identify and treat smokers is no less negligent than failure to identify and treat patients with cancer. Systems failure is no less negligent in this respect than individual failure. Smoking cessation should be incorporated, as a priority, as a systematic and opt-out component of all NHS services as a complement to local authority services, and delivered in smokefree settings. It is unethical to do otherwise.

12 This is strategically important for the region STP Prevention Board #1 priority: Regional Smokefree NHS/Treating Tobacco Dependency Taskforce Joint chair DPH and Northern Cancer Alliance Mandate given Priority- target April 2019 all FTs to implement NICE Guidance PH48 7 meetings in and various pieces of work: SSS mapping, FT mapping, Maternity mapping, K Hub, T&F groups CQUIN (NHS England): first time, 2 year scheme (2017/18 community focus, 2018/19 acute focus). Potentially to be extended. 5YFW National tobacco plan for England NICE guidance PH48

13 North East picture? Good progress was made around maternal smoking: Baby Clear and results 210 grams, doubled quit rates Mapping December 2017: mixed picture. Implementation needs to be sustained. LMS event 15 th October. Exemplary leadership around mental health from TEWV: We can t allow this health inequality to continue, we have a duty of care to our service users and by going smokefree we aim to significantly increase the life expectancy for people with mental health problems across our Trust areas.» Dr Nick Land, medical director and chair of the Trust Nicotine Management Project» Toolkit widely available

14 North East picture? Secondary care: All trusts mapped 2014/15. Pockets good practise. Nowhere implementing fully NICE guidance but emerging drive around this in some FTs. Mapping again Spring Some FT s made rapid progress - Northumbria. Consultant in Public Health. 4/8 have signed the NHS Smokefree Pledge mokefree-nhs/nhs-smokefreepledge/ Primary care: Need to build a clearer picture around VBA in particular - concerns around prescribing. First meeting Nicotine Management Regional Policy. Only one CCG has signed the pledge

15 Benefits of stopping smoking Stopping smoking before age 30 reduces mortality risk to that of a non-smoker. Stopping smoking at any age gives extra years of life. Stopping smoking slows decline in lung function. Health benefits of stopping smoking start immediately. Reference: Doll (1994) Mortality in relation to smoking [British Doctors Study]. BMJ

16 Effectiveness of smoking cessation Support = specialist individual behavioural support Reference: West R, Owen L (2012) Estimates of 52-week continuous abstinence rates following selected smoking cessation interventions in England. Version 2

17 Harm reduction Harm reduction a way to reduce the negative consequence of substance use by substituting a less harmful alternative NICE advocates harm reduction for those who: May not be able (or want to) stop smoking in one step May want to stop smoking, without giving up nicotine May not be ready to stop, but want to reduce the amount of smoking Fresh clear position statement on Electronic Cigarettes:

18 Skills Identifying all smokers Delivering brief opportunistic smoking cessation advice to all smokers Assessment of a patient s commitment to quit Referring to local stop smoking services

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20 Attitudes Non-judgemental approach to smokers Acknowledge role of addiction and importance of support Most smokers do not choose to smoke but do so because they are addicted to nicotine Most smokers will not be able to give up without support Smokers have equal rights to best available treatments

21 Tony: Maggie:

22 Summary Health care professionals should understand that most smokers smoke because of addiction to nicotine and not out of choice Most smokers would like to quit, but the majority will not be able to do so without help Strong evidence base, this is cheap too All health care professionals should use the 3 A s: ASK: all patients if they smoke ADVISE: the best way to stop ACT: by providing referral to local stop smoking services and/or drug treatment

23 Increasing Quit Attempts Intensity of advice or how convincing advice is, is probably not that important 99% of time, the clinician will never see the effect of the advice; thus, advising is an act of faith Repeating the advice at intervals (e.g. every 3 months) important

24 Effect of Not Mentioning Smoking When clinicians do not mention smoking, smokers conclude Clinician thinks smoking is not that problematic (41%) Clinician does not think I can change (46%)

25 Making a million opportunities count Tobacco use Sx s Death Dx & Rx 25 [Dr Sanjay Agrawal / British Thoracic Society]

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27 More information about Smokefree NHS Taskforce, our Smokefree NHS group on Knowledge Hub, to get in touch with others, online training Loads of good information and online training: