London Smoking Cessation Transformation Programme

Transcription

1 ADPH London London Smoking Cessation Transformation Programme Supporting Londoners to Quit Smoking LSCTP Journey and Ambition 1

2 About this slide set This slide set has been developed to provide stakeholders with further information on the London Smoking Cessation Transformation Programme (LSCTP). This document covers the following key points: Why the Programme was established in 2016 Original Programme aims and vision What the Programme has achieved between 2016 and early 2018 Review of the Programme pilot (phase 1) and results of its evaluation The LSCTP plans and aspirations for 2018/2019 (phase 2) 2

3 Contents London Public Health Context for Smoking Cessation Background: 2015 Sector led improvement review 2016 Literature review Establishing the LSCTP initial aims and scope What has been delivered in the Pilot (Phase 1) 2017/18 Review of LSCTP Pilot Feb to March 2018 Key Learning and Recommendations from the review of the Pilot Current work (Phase 2): Aims and Approach 2018/19 LSCTP Activity 3

4 London Public Health Context for Smoking Cessation Smoking causes 17% of all deaths in people aged 35 and over (1). One study estimates that local councils face a demand pressure of 760 million a year on domiciliary (home) care services, as a result of smoking-related health conditions (2). Nearly one million (991,025) smokers reside in London (3).This equates to over 15% of all of England's smokers. In Great Britain, 60.8% of people aged 16 years and above who currently smoke said they wanted to quit (3). Based upon this Great Britain average, as a proxy, almost 600,000 people would want to quit smoking in London. However, between April 2016 and March 2017, a total of only 51,945 Londoners were reported to have set a quit date with a Stop Smoking Service (4). 4

5 Background: SLI review Sector Led Improvement (SLI) Review (2015) During 2015, London Directors of Public Health and their teams undertook a Sector-Led Improvement (SLI) to consider their approaches to smoking cessation and tobacco control. This sought to provide confidence to stakeholders as well as the public and to demonstrate continuous improvement to public health practice and improved health outcomes. 32 London local authorities participated. The peer review identified a common concern about falling numbers of quitters, particularly those who sought to quit with the support of a Stop Smoking Service. It also identified that a number of London boroughs were experiencing challenges providing services across highly mobile populations. As many smokers take a few attempts to quit, it became clear that many people who move between boroughs are likely to have different experiences of quit services at each attempt. This highlighted the potential to develop more consistent and person-centred services which could be accessed even when a smoker moved to another borough. This was viewed as an ideal opportunity to explore new and innovative approaches to service delivery in order to help London smokers access Stop Smoking Services and ultimately quit smoking. 5

6 Background: Rapid Literature Review Literature review Following the Sector Led Improvement exercise in 2015, a rapid literature review on Stop Smoking Services was undertaken between January and February The review sought to seek evidence on the efficacy and cost effectiveness of Stop Smoking Services delivered through telephone, online and digital apps. The literature review found that: Effective smoking cessation counselling may be provided via telephone, text or internet based services and that text and internet/applications are likely to be very cost effective. Telephone support (both reactive and proactive) can be effective, with some studies reporting a 2-3% increase in quit rate. Further, telephone support offered in addition to counselling or pharmacological therapy could be an added benefit to people seeking to quit smoking. International examples highlighted a range of alternative delivery models for Stop Smoking Services that have been successful in a range of digital capacities. However, information on efficacy and cost effectiveness was limited. Therefore the review concluded that the implementation of such models within a London context would need to sit within the existing health service landscape and be supported by a full evaluation in order to gather more evidence of effectiveness in practice. 6

7 Establishing the LSCTP The sector-led improvement work and the literature review identified significant potential and interest amongst boroughs to work together to explore new innovative approaches to help smokers access services or to help smokers to quit. Following scoping work between March and August 2016, London Directors of Public Health agreed in September 2016 to establish the London Smoking Cessation Transformation Programme (LSCTP). At its outset in 2016, the Programme aim was: To support London boroughs to transform and improve the way their residents accessed stop smoking support, with the potential to deliver savings to participating local authorities and improved outcomes for their residents. The scope of the Programme was to seek to offer boroughs innovative service options in alternative channels (digital, online, telephone) and which could be delivered once across London, to complement locally-determined services such as face to face models. The Programme presented an opportunity to learn together at scale and pace what works, and to jointly commission where it made sense to do so. 7

8 LSCTP Programme Governance Thirty one London boroughs jointly commission and participate in the LSCTP which is now part of a broader stop smoking and tobacco control landscape that includes education, regulation and enforcement. The Programme is overseen by a Programme Board with representation including Directors of Public Health or their deputies from each of the five London subregions. The Programme and its administrative office is hosted by Public Health, London Borough of Tower Hamlets. A Reference Group acts as the advisory and sounding board for delivery of the Stop Smoking London offer. The Joint Advisory Group was established by Professor West to oversee evaluation of the Programme. 8

9 What happened during the Pilot? (Phase 1) When it was established in September 2016, the Programmes aims were: To support London boroughs to transform and improve the way their residents accessed stop smoking support, with the potential to deliver savings to participating local authorities and improved outcomes for their residents. To meet these aims, the Programme launched a marketing and communications campaign launched to direct smokers to a new pilot London wide Stop Smoking helpline. 9

10 LSCTP Pilot (Phase 1) The LSCTP pilot used the conceptual framework of Stop Smoking+, based on a model developed by Professor Robert West. Specialist support of top quality for smokers who need it and are willing to make the necessary commitment. Brief support and a stop-smoking medicine for those who want help but are not willing to commit to a specialist course. Self support for those who want to stop but do not want professional support. Text and imagery provided by Professor Robert West, UCL 10

11 LSCTP Pilot (Phase 1) The LSCTP pilot, based on the conceptual framework of Stop Smoking+, was comprised of a: Telephone helpline: A ten month pilot of an enhanced telephone behavioural support offer for Londoners calling the National NHS Smokefree helpline and a dedicated Stop Smoking London Helpline (SSL), which commenced after a soft launch in May Web Portal: In the summer of 2017 the Programme agreed to work alongside Professor Robert West and utilise an existing London Stop Smoking Portal. This website provides information on local and regional Stop Smoking Services as well as apps and resources. Communication and Marketing: Phased implementation of a public facing marketing and advertising campaign launched in September This included radio, public realm and online advertising of both the web Portal and helpline and utilised existing national campaign opportunities, including Stoptober and No Smoking Day. The pilot (phase 1) completed on time and as planned in March

12 12 Examples of Stop Smoking London Service branding and promotional resources

13 Stop Smoking London Service Touchpoints Public Realm Campaigns Web Ads Search Advertising Professional Referral Local Campaigns Radio Word of Mouth Social Ads PR Service Awareness Direct search Click through Address Call NHS Smokefree Portal landing pages Search London helpline Ldn pilot Opt-In Consideration Search Apps and Websites Call London Helpline Search NRT and Pharmacotherapy Search local SSS Triage to Tier 1 and Tier 2 Advisors London Service Signposting to local SSS GP letter of recommendation for Champix Outbound behaviour /motivatio nal support Service User calls helpline back Scheduled outbound calls from helpline to quitter London Service Loyalty Stop Smoking London Service User Journey 2016-March 2018

14 LSCTP 2015 to Mar 2018 Timeline Rapid Literature Review LSCTP Established Phase 1: Stoptober Phase 2: Men s health month and Lung cancer awareness month Phase 3: New year s resolutions Phase 4: World Cancer Day 2015 Jan 16 Sep 16 Nov 16 May 17 Jun Jul 17 Sep 17 Oct 17 Nov 17 Dec 17 Jan 18 Feb 18 Mar 18 Sector Led Improvement Review LSCTP PID Developed Soft Launch of London Helpline Introduction of London Stop Smoking Portal Phase 5: No Smoking Day Soft launch of London service LSCTP Review 14

15 Review of LSCTP Pilot (Phase 1) Data from the Stop Smoking London advertising campaign showed that while successful in reach and visits to the Portal, calls to the helpline were consistently low. At the end of the pilot the LSCTP Board commissioned an independent review. The Board sought to answer the following questions: 1. How did the different facets of the Stop Smoking London Services interact during the pilot? 2. What effect did the promotional campaign play during the pilot? 3. What was the performance of the helpline and what contributions were made by the London Stop Smoking Portal during the pilot? 4. What where the views from stakeholders of the pilot? 5. Moving forward what learning could we take from the pilot and from other public health initiatives? 15

16 Review Findings Campaign Extensive promotional campaigning through digital marketing, mainstream media and stakeholder work, effectively amassed two million impressions and in excess of 43,000 click-throughs to the London Portal up to and including March

17 Review Findings Portal Between September 2017 and March 2018: Nearly 500 people registered their address to receive updates on Stop Smoking London. Half of the total visitors to the Portal landing pages chose to explore local service options and sought further information via the Portal. 66 people who visited the Portal decided to call the Stop Smoking London Helpline. The remaining visitors undertook no further action on the Portal following their arrival on the Portal landing page. 17

18 Review Findings Helpline Results Over 400 direct calls were made to the London helpline between September 2017 and March Not all callers were eligible for the service.i.e. pregnant, not a London resident etc. (365 out of 472 London callers were eligible). Data showed that the number of people calling the helpline increased with marketing activity. 76 people of 365 agreed to be part of the proactive 4 week behavioural support pilot. 59 people were lost to follow up at 4 weeks. Of those engaged with the London helpline pilot who were contactable at 4 weeks 76.5% (13 out of 17 contactable pilot participants) self-reported they had abstained from smoking at 4 weeks. 18

19 Review Findings Helpline Borough Activity Borough No. Of Eligible Contacts No. Of Ineligible Contacts No. Of Eligible Contacts Consented Secro helpline data week commencing 22 nd May 2017 to 31 st March Values of 5 and under have been masked. No. Of Eligible Contacts Declined Croydon Enfield Waltham Forest 41 * 9 32 Bromley Havering 24 * * 21 Haringey 19 6 * 18 Newham 12 * * 9 Southwark 12 * * 11 Redbridge 11 * * 11 Barnet 9 * * 9 Sutton 9 * * 7 Merton 8 * * 6 Tower Hamlets 8 * * * Wandsworth 8 * * 7 Camden 6 * * * Ealing 6 * * * Hackney 6 * * * Barking and Dagenham * * * * Brent * * * * Greenwich * * * * Hammersmith and Fulham * 6 * * Hounslow * * * * Islington * * * * Lewisham * * * * Lambeth * * * * Richmond Upon Thames * * * * Kensington and Chelsea * * * * Kingston Upon Thames * * * * City of Westminster * * * * Bexley * * * * Harrow* * 9 * * Hillingdon* * * * * City of London * * * * Total

20 Stop Smoking London Helpline: A Caller s Story A London male called the helpline in April to receive support to stop smoking. He was newly-wed and his wife was a non-smoker. He advised that his motivation was to stop for both their health. He planned to use patches and oral NRT but would discuss with the pharmacist. He was highly motivated and determined, although, nervous as this was his first quit attempt. His quit date was set for late April. At the pre-quit call the customer was still intending to get patches and an oral product. He was still very motivated but worried that he d be quick to snap when not smoking. Determined at this stage to quit for his wife. Quit day was a brief call with customer and he advised he had quit and had NRT. Wife supportive and he was looking forward to discussing his progress further into his journey. One day post quit and the customer was finding it difficult. He had one cigarette but was using gum incorrectly. Discussed proper use and how to manage cravings. Not feeling confident at this stage but he advised he would call if he was struggling. Emphasised Not one puff. One week post quit and customer was using gum and patches although he had had one cigarette, he had not smoked when he was drinking. Discussed triggers and how to manage/prepare for them. There was no further contact with the customer until his 2 month post quit call, when the customer advised he was still smoke free and had found the Programme helpful. 20

21 Review Findings Stakeholders STRENGTHS CONCERNS Exciting because of joinedup work. Mixed messages locally Good to raise profile of smoking cessation support across London Some Boroughs disinvested from the start Interesting to try working at regional levels. Incredibly complicated decision making process 21

22 LSCTP Review Systems Flow Created by Aidan Loughran, Serval Improvements, on behalf of the LSCTP Board 22

23 What did we learn from the Pilot? The number of visits to the landing pages of the web Portal translated in to few calls to the helpline. Marketing supported the web Portal but again not the uptake of the helpline. This may be because we did not target the right people in the right place or the right way. Once smokers were engaged with the stop smoking helpline 4 week proactive behavioural support and are contactable, we saw a quit rate of 76.5 per cent. This is in keeping with the Russell Standard (Clinical), which states the self-reported 4 week success rate should generally be over 50 per cent (5). Hearing about the service, largely through digital realms, to an intimate and personal conversation with a remote health advisor; may have been too great a channel shift for service users and contributed to the lower than anticipated take-up. Confusion around the roles of the website and the phone service and perceived competition with local services may have contributed to differences in the way the London telephone helpline service and web Portal were publicised locally. It is possible that continuing to focus attention solely on a telephone helpline, website and supporting communications programme would be too prescriptive in scope. There is relevant learning to be had from other initiatives around the UK and we should join up and share information going forward. There was and continues to be energy and good will across London stakeholders for a coherent smoking cessation offer. 23

24 Recommendations from the Independent Review The independent review conducted by the consultant included the following four recommendations : 1. The LSCTP need to adopt a test, learn and adapt approach to the Programme. 2. The LSCTP need to develop and enhance our understanding of London smokers attitudes to smoking and quitting, lifestyles and service preferences. 3. The LSCTP need to develop a robust monitoring and evaluation framework for the entire service. 4. The LSCTP need to adopt a joined up working approach to similar Programmes around England. 24

25 ADPH London LSCTP Aims and Approach From 2018/19 Supporting Londoners to Quit Smoking 25

26 The LSCTP from 2018/19 (Phase 2) In light of the independent review, the Board and London DsPH agree in 2018/19 the LSCTP will: 1. Remain focused on reducing the prevalence of smoking in London. 2. Continue to improve public awareness, access to and therefore uptake of all Stop Smoking Services. 3. Continue to build upon the Programme s asset base and innovate services, creating greater synergy between regional and local Stop Smoking Services. 4. Develop and provide an evidence based Stop Smoking London Service reflecting the needs and lifestyles of London smokers. 5. Create a Stop Smoking social movement across London that supports smokers to quit permanently. 26

27 LSCTP Approach from 2018/19 (Phase 2) To achieve these aspirations, the Programme will adopt a more overt test, learn, adapt approach. A wider range of interventions and service developments will be introduced alongside the telephone helpline service and web Portal but with faster feedback-loops, enabling the Programme to make quicker decisions about where to scale-up efforts (where things are working) or to pivot and change approach (where the interventions are not having the intended impact). As we build our knowledge of the service and crucially how people engage with the service, the strategy will be refined and adapted. 27

28 Phase 2 Deliverables 2018/19 Insight building: Gathering research and insight from key population groups and stakeholders across London. This will improve understanding of the LSCTP s target audience, their motivations for smoking, their motivations for giving up smoking, and how we might design and deliver a behaviour change campaign that encourages the target audience to seek and use London wide Stop Smoking Services. Understanding local landscape: Undertaking a survey exercise to obtain a comprehensive and up to date understanding of Stop Smoking Service delivery and activity across London as well as local authority commissioning for 2018/19. Evidence base: An ongoing literature search process in to effective stop smoking cessation initiatives around the world, evidence to be collated and where applicable incorporated in to the service design and delivery. Service Development: Commissioning of an evolving service offer that includes a one stop Portal that triages the user in to the best support to meet their needs at their initial decision to stop smoking. The service will also provide continued motivational and behavioural support to the user on their journey via local services or a dedicated remote service including a telephone helpline (based on user choice). 28

29 Phase 2 Deliverables 2018/19 cont. Awareness raising: London wide advertising campaign to promote Stop Smoking London to all London smokers. Stakeholder collaboration: Forge partnerships with, for example, STP Leads and Acute Trusts in order to pilot the promotion of the service among identified key audiences.i.e. smokers in social housing, hospital patients who smoke at time of admission etc. Stakeholder engagement and research: Cross-cutting stakeholder engagement across academia, central and local government administrations, local commissioning leads and Stop Smoking Service providers. Research and Evaluation: Developing and implementing a robust monitoring and evaluation framework for all of the above mentioned to ascertain the effectiveness and impact of the Programme. 29

30 Stop Smoking London System Pathway September

31 Phase 2 Activity 2018/19 July The DsPH approved the direction of the Programme and the new approach. July The review of the existing web Portal was undertaken with local commissioners, local providers of Stop Smoking Services and a user website developer (an expert in making websites more relevant to the target audience). This was undertaken to identify what currently works well and what could be improved. July/August 2018 Marketing and Communications supplier was commissioned to design, deliver, analyse and report findings from the smokers insight research. This insight will now be used to kick start the refresh of the branding and campaign resources to ensure it resonates with London smokers. August 2018 A tender exercise for the refresh and ongoing maintenance of the web Portal has been undertaken and a new provider has been appointed. August/September A commissioning survey of local stop smoking and tobacco control services in London, is underway and is being conducted in partnership with ASH to prevent duplication of work and to ensure we fully understand the local landscape that the service operates in. Autumn Promotion and marketing of the Portal will commence from autumn 2018, to coincide with the beginning of the national stop smoking campaign, Stoptober. 31

32 References (1) Health matters: smoking and quitting in England Published 15 September 2015 (2) Costs of social care analysis conducted by Action on Smoking and Health. Available at: (viewed June 2017) (3) Office for National Statistics Adult smoking habits in the UK: 2017 (4) (5) Robert West (2005) Assessing smoking cessation performance in NHS Stop Smoking Services: The Russell Standard (Version 2) 32

33 ADPH London For further questions: Meroe Bleasdille, LSCTP Programme Manager Carla Naidoo, LSCTP Stakeholder Communications 33