EMBARGOED UNTIL DATE OF MEETING Glasgow City CHP Item No. 8 CHP Committee Meeting Date: Tuesday 17 th February, 2015 Paper No 2015/004 Subject: Presented by: Recommendation(s) Summary/ Background Glasgow Tobacco Strategy Fiona Moss, Head of Health Improvement (CHP) Fiona Dunlop, Health Improvement Lead (Tobacco) GGC NHS Members are asked to endorse the new Tobacco Strategy (2015/17) for Glasgow City. The Glasgow Tobacco Strategy has been developed in response to the Scottish Tobacco Control Strategy which aspires to achieving a smoke free generation by 2034., Glasgow CHP and Glasgow City Council have been working together to jointly develop the local strategy. Achieving the national ambition in Glasgow will be extremely challenging as the city is still significantly above the 2011 target. However previous reports to Committee have outlined the range of prevention, cessation and protection work being undertaken and progress. The Strategy builds on this with further targeted action over the next two years. Policy/ Legislative Context Financial Implications Human Resources Implications Service User/Carer Engagement Equalities Implications Partnership Implications Response to the Scottish Tobacco Control Strategy, and the understanding of the contribution of tobacco to Glasgow s health inequalities. The Strategy also responds to the anticipated new target for protecting children from exposure to second hand smoke. Managed within available resources, some of which are awarded specifically by the Scottish Government for this purpose to GCHP. This builds on existing delivery arrangements. The key actions in the strategy build on a number of local programmes involving young people e.g. W-WEST (Why Waste Everything Smoking Tobacco), adults & families and implementation arrangements will continue to involve residents in their design and delivery. A full EqIA was carried out on the previous strategy. As this is a revision, a screening exercise has taken place to ensure no negative impact on those with protected characteristics. Glasgow Tobacco Strategy was approved by Glasgow City Council s Executive Committee on the 22 nd January, 2015; with implementation tracking through the related partnership structure e.g. ASSIST through the Education and Health Improvement Working Group.
EMBARGOED UNTIL DATE OF MEETING FoI/EIR Status tick If not to be made public, exemption (Section/Regulation) to be relied on under Public FoI/EIR legislation must be inserted below. Not Public Contains Personal Data DPA applies Date Report Prepared: 6 th February, 2015 2
Glasgow City Community Health Partnership Report To : Glasgow City CHP Committee Report By: Fiona Moss, Head of Health Improvement (GCHP) Fiona Dunlop, Health Improvement Lead (Tobacco) Date: 17 th February 2015 Subject: Glasgow Tobacco Strategy 1. Purpose of report 1.1 To inform the Glasgow City CHP Committee of the priorities contained within the new Glasgow Tobacco Strategy for 2014-17 which will assist in delivering the health improvement and inequalities priorities within the Strategic Plan for the HSCP within Glasgow City. 2. Introduction 2.1 A key action in the Scottish Government s Tobacco Control Strategy is the development of local tobacco control plans to drive forward actions within the national strategy at a local level. Local Authorities and NHS Boards are tasked to work with partners in the voluntary sector and local communities to develop these plans. 2.2, Glasgow CHP and Glasgow City Council have been working together to jointly develop a Glasgow Tobacco Strategy to meet this requirement. It has been aligned to Glasgow s Single Outcome Agreement (SOA) and will be the city s approach to delivering the Scottish Government s aspiration of achieving a tobacco-free generation by 2034. 2.3 This report outlines the background to the strategy, the key actions and indicators. 3. Background 3.1 The death toll in Scotland from smoking is approximately 13,000 deaths per annum, around a quarter of all deaths in Scotland each year. Although progress has been made, smoking continues to be the biggest single preventable cause of disease and premature death in Glasgow. Whilst smoking rates have fallen by 10% over the last 10 years to 27%, smoking rates in Glasgow are still 4% higher
than the Scottish average. There were 14,902 smoking attributable admissions to hospital and 4,039 smoking attributable deaths (over 30% of all deaths) in the Greater Glasgow and Clyde area in 2009. 3.2 A Glasgow Tobacco strategy has been in place since 2005, with the most recent document running from 2009 14. This tobacco strategy updates the previous tobacco strategy, incorporating new guidance and developments and it is intended that this will be in place until 2017 to bring the strategy development in line with the planning processes for the SOA and the Councils Strategic Plan. 3.3 The document has been presented at and approved by the GCC Health and Social Care PDC and will be presented to the Councils Executive Group at the end of December 2014. 4. Progress to Date: Outline of the Glasgow Tobacco Strategy 4.1 This plan has been aligned to the NHS and Council s strategic commitments and is consistent with other plans in the city and is in line with the proposals in the city to move to a neighbourhood approach to delivering health improvement. 4.2 Key actions associated with the delivery of this strategy are to identify and engage with the third sector and voluntary organisations, to delivery targeted action within the city s most deprived areas and to champion the relevance of tobacco control in reducing inequalities in health. A greater focus is required on reducing health inequalities, in capacity building, in effectively engaging with new and existing partners, and in working collaboratively with communities. 4.3 This document is an overarching tobacco control plan for the city and is complimented by the NHSGG&C Smokefree Policy 2014. It is proposed that each sector will develop a local tobacco action plan in collaboration with partners and the local community. 5. Priorities within the strategy Key actions with in the tobacco strategy are arranged under the headings of prevention, protection and cessation, in line with the national tobacco strategy. 5.1 Prevention Balance universal and targeted partnership approaches to support the effective delivery of tobacco prevention with young people particularly with those most in need. Key actions include 5.1.1 Universal measures: The ongoing delivery of effective schools based tobacco education programmes in both primary and secondary schools. Effective engagement with young people in programme development 2
Encourage schools to address smoking as part of a broader programme addressing the uptake of risky health behaviours in young people. 5.1.2 Targeted measures: The delivery of the 3 year national pilot peer education programme (ASSIST) in identified Glasgow secondary schools A focused neighbourhood approach to youth prevention work in partnership with voluntary/third sector Develop a programme to reduce uptake of smoking as part of a wider programme to reduce risk taking behaviour with Looked After and Accommodated Children. Action to address high levels of smoking in 16-24 age group 5.2 Protection Smoke-free environments are effective in reducing non-smokers exposure to second-hand smoke, may contribute to the de-normalisation of smoking and support smokers efforts to quit. Key measures include: 5.2.1 Universal measures: Smoke-free grounds across local authority and NHS estates by 2015 Increase availability of outdoor smoke-free places and events in Glasgow Ensure high levels of compliance with smoke-free legislation 5.2.2 Targeted measures: Adoption of smoke-free policies in third sector youth organisations working with vulnerable young people. Work with low income communities to reduce the availability of and demand for illicit tobacco Outline how HMP Barlinnie will move to become smoke-free Deliver a programme to reduce exposure to second hand smoke in homes in the most deprived areas along side specific work within adoption, foster, kinship, early years and residential care services (LAAC and the elderly) 5.3 Cessation The strategy acknowledges the whole range of factors and wider life circumstances which influence someone s motivation and capacity to quit smoking including the increased usage of e-cigarettes. 5.3.1 Universal measures: Ensure the ongoing delivery of an integrated stop smoking service in Glasgow which is based on best practice for all smokers who want to stop smoking. This integrated service includes community pharmacy, community smokefree services, maternity, acute, mental health and youth services. 5.3.2 Targeted measures: Targeting of services to meet needs of most disadvantaged smokers and those smokers from specific communities, including extending pre and post quit, supporting tailored services for specific groups including prisons and BME. 3
Development of innovative ways of delivering stop smoking support in partnership with local communities to ensure services best meet their needs within the SOA neighbourhoods. Delivery of behaviour change training to those organisations working with vulnerable groups and with the potential to impact on health and well being. 6. Targets and indicators 6.1 The key measurable targets for the Glasgow Tobacco Strategy are: To reduce adult smoking prevalence in Scotland from 23% in 2011 to 5% by 2034. (17% by 2016, 12% by 2021, 9% by 2026, 6% by 2031). To reduce the proportion of children in Scotland exposed to second-hand smoke in the home from 12% to 6% by 2020 The NHS in Scotland to deliver 12,005 successful quits at 12 weeks post quit in the 40% most deprived within-board SIMD areas over the 1 year ending March 2015. 6.2 The key measurable outcome indicators for the Glasgow Tobacco Strategy are: Reduction in overall adult smoking prevalence in Glasgow (Scottish Household Survey, Health and Wellbeing Survey) Reduction in adult smoking prevalence in SIMD 1 and 2 in Glasgow (Scottish Household Survey, Health and Wellbeing Survey Reduction in smoking in young people in Glasgow (Glasgow Schools Survey and SALSUS) Reduction in exposure to second hand smoke in Glasgow (Glasgow Schools Survey, Scottish Health Survey, investigate the potential to include a question on second hand smoke within the local household survey) Percentage of compliance with tobacco control legislation (display ban, smokefree, age related sale) in Glasgow 7. Monitoring 7.1 The Strategy will be monitored by the Glasgow City Council Health Inequalities and Improvement Group. Performance monitoring will be incorporated into Service Annual Service Performance Improvement Reports (ASPIR) with a similar process sought in. The Health and Social Care Policy Development Committee will receive an annual progress report. 4
8. Recommendation 8.1 Effective tobacco control is a key means by which the NHS and Council s current activity to tackle health inequalities can be maximised. The strategy builds on previous work centred around prevention, protection and cessation activity but with a renewed focus on inequalities and vulnerable people, in line with national, CHP and City Council priorities. 8.2 The attached Glasgow Tobacco Strategy 2014-17 and Action Plan outlines Glasgow s approach in full. The Committee is asked to approve the Glasgow Tobacco Strategy. 5
GLASGOW TOBACCO STRATEGY Strategy and Action Plan 2015-17
FOREWORD In recent years, there has been significant progress in reducing the harm caused by tobacco in Glasgow. Local and national initiatives, supported by community projects and a continuing programme of health education in our schools have all contributed to a reduction in the number of adults and young children who smoke. Despite these successes, tobacco use in Glasgow remains higher than the Scottish average and remains the main preventable cause of death. In addition, as the gap in the prevalence of smoking increases between our most and least deprived communities, it is increasingly a contributor to the levels of health inequality we see within the city. This Glasgow Tobacco Strategy marks the latest joint collaboration between the Council and NHS Greater Glasgow & Clyde in driving forward the tobacco control agenda in this city. Our strategy is ambitious and represents the city s approach to achieving the Scottish Government s aspiration of achieving a tobacco-free generation by 2034. I want to see a real reduction in health inequalities in Glasgow, and I believe that decisive action on tobacco control is necessary for this to happen. Too many Glaswegians continue to be harmed by smoking. This strategy outlines the city s collective resolve to create a society where every Glaswegian has the right to the highest attainable standard of life and a city free from the harm caused by tobacco. Councillor Emma Gillan Spokesperson for Health Inequalities 2
Contents EXECUTIVE SUMMARY SECTION 1: BACKGROUND 1.1 Introduction 1.2 Background to tobacco control in Glasgow 1.3 National policy context 1.4 Progress to date SECTION 2: VISION, AIM AND PRINCIPLES 2.1 Vision and aim 2.2 Principles 2.3 Local strategy alignment 2.4 Delivery through partnership working SECTION 3: PRIORITY AREAS AND ACTIONS 3.1 Strategic tobacco control priorities 3.2 Prevention 3.3 Protection 3.4 Cessation SECTION 4: TARGETS, MONITORING AND FINANCIAL FRAMEWORK 4.1 Targets 4.2 Monitoring and reporting 4.3 EQIA 4.4 Financial framework APPENDIX 1 REFERENCES 3
EXECUTIVE SUMMARY 1. The Glasgow Tobacco Strategy sets the joint direction for tobacco work in Glasgow for 2015-17 between the Council and NHS Greater Glasgow & Clyde () and will be the city s approach to delivering the vision of a smoke-free Scotland by 2034. 2. Although progress has been made, smoking remains high in the city s most deprived areas and among specific groups, such as people with mental health conditions, those with a limiting long term disability, prisoners and older people. The gap in smoking prevalence between the poorest and most affluent in the city is increasing, leading to an increase in heath inequalities. 3. The key focus of the Strategy will be on reducing health inequalities, capacity building, effectively engaging with new and existing partners and working collaboratively with communities. 4. The Strategy acknowledges the need for universal services and programmes to reduce smoking prevalence in Glasgow. However, in line with the Council Strategic Plan 2012-17, the biennial report of the Joint Director of Public Health and the Single Outcome Agreement, this plan will focus the majority of actions on activity which targets the most vulnerable and disadvantaged in Glasgow. 5. Tobacco control is the cross cutting, internationally recognised, evidence based approach to tackling the harm caused by tobacco. Supporting people to stop smoking is the most well known tobacco control measure. Equally important however, are actions to prevent young people from starting to smoke and protecting people from the harm associated with smoking. 6. The Glasgow Tobacco Strategy outlines a range of measures to reduce tobacco related harm in Glasgow, including: Implement smoke-free grounds policy across estates by March 2015 and begin to implement a programme of smoke-free policies across Council grounds and events from 2015-2016. Priority areas for the Council include the entrances to Council buildings, smoke-free outdoor areas where children and families congregate (play areas) and smoke-free family outdoor events. A programme to reduce uptake of smoking amongst Looked After and Accommodated Children (LAAC) as part of a wider programme to reduce risk taking behaviour. Ensuring advice on creating a smoke-free home is a feature of all adoption, foster, kinship care and residential care services. Deliver the A Stop Smoking in Schools Trial (ASSIST) peer education programme in 10 secondary schools in the most deprived areas and with the highest smoking prevalence in Glasgow. Continuing to support trading standards officers to implement a more rigorous enforcement on existing tobacco sales laws. Identify and form new partnerships in order to expand opportunities for tobacco control interventions, with a particular focus on the third sector. 4
Summary of Glasgow Tobacco Strategy 2015-17 Priority Areas The key priority areas are grouped as follows: Strategic Planning Protection Identify new partnerships Sustain local leadership Implement smoke-free grounds Rigorous enforcement of tobacco laws Develop area based action plans Illicit Tobacco Advice on secondhand smoke vulnerable families Prevention Cessation ASSIST pilot in 10 Secondary Schools 16-24 year olds apprentice/ employment schemes Universal, evidence based stop smoking service Youth Justice Work with LAAC Meet the needs of specific communities BME, homeless, mental health issues Increased smoking cessation in the most deprived areas
SECTION 1: BACKGROUND 1.1 Introduction 1.1.1 The focus in this Glasgow Tobacco Strategy is the relationship between smoking and health inequalities. The strategy will build on work to date and the lessons learned from previous strategies in order to embed and standardise good practice and allow opportunities to learn from new approaches such as co-production and asset based work with communities. 1.1.2 Tobacco control is the cross cutting, internationally recognised, evidence based approach to tackling the harm caused by tobacco. Supporting people to stop smoking is the most well known tobacco control measure. Equally important, however, are actions to prevent young people from starting to smoke and protecting people from the harm associated with smoking. 1.1.3 Tobacco control brings together these different components under the broad headings of Prevention, Protection and Cessation and seeks to work through partnerships with public, private and voluntary groups in order to provide an effective mechanism for driving down smoking prevalence. Research has shown that no single measure will be successful in isolation and that integrated, partnership working is required. 1.1.4 The Scottish Government s Tobacco Control Strategy has placed responsibility on local authorities to drive forward the tobacco control agenda through the development of a local plan. Our plan which will be delivered jointly by Glasgow City Council and NHS Greater Glasgow and Clyde () will be a key element in reducing health inequalities in the city. 1.1.5 This is a three year tobacco plan (2015-17) to fit in with the timescales of the Council s Strategic Plan 2012-17 and is aligned to Priority 4 A City that looks after its Vulnerable People. There is a focus on partnership working targeted to disadvantaged groups and communities where smoking prevalence is greatest. A key priority within our three year programme is to further engage with a broader range of community planning partners (CPP), particularly the third sector. The strategy also links with the overarching vision of Glasgow s Single Outcome Agreement 2013 (SOA). 1.1.6 As well as a package of measures which will assist in meeting our aspiration of achieving a smoke-free Glasgow by 2034, there will be concerted action to shift social attitudes to protect young people in the city from behaviour and messages that promote smoking as a normal activity. 1.2 Background to tobacco control in Glasgow 1.2.1 The death toll in Scotland from smoking is approximately 13,000 deaths per annum 1, around a quarter of all deaths in Scotland each year. 1.2.2 Although progress has been made, smoking continues to be the biggest single preventable cause of disease and premature death in Glasgow. Whilst smoking rates 1 http://www.scotpho.org.uk/downloads/scotphoreports/scotpho120626_smokingreadyreckoner.pdf
have fallen by 10% points over the last 10 years to 27%, smoking rates in Glasgow are still 4% points higher than the Scottish average and 10% points higher than in Edinburgh. There were 14,902 smoking attributable admissions to hospital and 4,039 smoking attributable deaths (over 30% of all deaths) in the Greater Glasgow and Clyde area in 2009. 1.2.3 Smoking levels remain highest in the city s most deprived areas and among specific groups, such as people with mental health conditions, those with a limiting long term disability, prisoners and older people. In 2012, 37% of adults in the most deprived areas of Glasgow smoked compared to 19% in the rest of Glasgow (Figure 1 below). The gap in smoking prevalence between the poorest and most affluent is increasing, leading to an increase in heath inequalities in the city. Figure 1: Adult smoking by Scottish City and deprivation 2012 (Understanding Glasgow) % of the adult population (16+ years) who currently smoke 100 90 80 70 60 50 40 30 20 10 0 Adult (16+) smoking, by Scottish city and deprivation, 2012 Source: Scottish Household Survey Glasgow Dundee Edinburgh Scotland 37 36 29 36 20% most deprived 80% least depirved Area Deprivation 19 25 16 20 1.2.4 The highest correlation evident in the profile of smokers and non-smokers is by socio-economic status and the deprivation index of the area in which people live. 1.2.5 Ethnicity does not appear to be a strong indicator of the prevalence of smoking, as most ethnic minorities have a lower incidence of smoking than the average for Glasgow as a whole. However, there is anecdotal evidence that smoking shisha is becoming increasingly popular within the Pakistani community in Glasgow where it is viewed as a form of socialising. As the shisha culture continues to grow, it has been suggested that shisha cafes are also now being used by a cross-section of the community 2. 1.2.6 Action on Smoking and Health (ASH) Scotland cites evidence that smoking rates are higher within the Lesbian, Gay, Bisexual and Transgender (LGBT) communities, with research suggesting that particularly among young people the daily stress of 2 Marisa de Andrade, NHS Greater Glasgow and Clyde, Black Minority Ethnic (BME) Feasibility and Ethnographic Study in the Southside of Glasgow, University of Stirling, 2014 7
homophobia and discrimination undermines a person s ability to avoid pressures to drink and smoke 3. 1.3 National Policy Context 1.3.1 There have been a number of national tobacco control initiatives, backed up with local enforcement, including the introduction of smoke-free legislation in 2006, increasing the age for tobacco sales from 16 to 18 in 2007, overhauling tobacco sale and display laws as well as ongoing investment in NHS smoking cessation services. 1.3.2 In 2013, the Scottish Government launched their new tobacco strategy for Scotland, Creating a Tobacco-Free Generation with the aspiration of creating a tobacco-free generation by 2034, defined as a smoking prevalence among the adult population of 5% or lower, and with a clear focus on those communities at greatest risk of unequal health outcomes. 1.3.3 In 2014, the Scottish Government launched a Consultation on Electronic Cigarettes and Strengthening Tobacco Control in Scotland. This calls for views on a range of measures to protect young people, including an age restriction on the sale and purchase of e-cigarettes; additional action to control the advertising and promotion of the devices; and legislation to prohibit smoking in vehicles with children on board. This consultation closes in January 2015. 1.4 Progress to Date 1.4.1 Glasgow can be proud of its long standing commitment to reducing the health impact of tobacco in the city through the work of Glasgow 2000, Glasgow Alliance Tobacco Strategy (2005-09) and the Glasgow Tobacco Strategy (2009-2014) which has helped contribute to a steady decline in smoking prevalence rates in adults and children. Successes in tobacco control include: A comprehensive tobacco control programme in place in the city since 1983 with the Council and jointly delivering a broad range of actions on cessation, protection and prevention. A steady decline in the proportion of adults who were current smokers in Glasgow City over the last 10 years from 35% in 2000 to 27% in 2012 (Scottish Household Survey) (Figure 2 below). A reduction in current smoking in Glasgow secondary school children from 10% in 2008 compared to 8% in 2010 (Glasgow Schools Survey). High achieving NHS stop smoking services, with services surpassing smoking cessation targets set for by Scottish Government since 2008. An effective tobacco training programme in place, including training on health related behaviour change, brief intervention, intensive support, second hand smoke and smoking and young people. Tobacco control programmes offered to all primary and secondary school children in Glasgow linked to the Curriculum for Excellence. Effective implementation of tobacco control legislation including the legislation on age restricted sales, smoke-free legislation, and the tobacco display ban. 3 http://www.ashscotland.org.uk/media/3858/lgbt.pdf 8
Figure Two: Adult smoking trends by Scottish City 2000 2012 (Understanding Glasgow) 1.4.2 Glasgow City Council and have made a clear and continued commitment to improve health and tackle the health inequalities that exist within the city. Health is a cross cutting issue that impacts significantly across all aspects of the Council Strategic Plan. Glasgow s Single Outcome Agreement prioritises tackling inequalities within specific neighbourhoods, through a thriving places approach. The NHS Corporate plan 2013 16 and combined equalities review and action plan, A Fairer NHS Greater Glasgow and Clyde both emphasise the importance of tackling inequalities in health. 1.4.3 Steps have already been taken to tackle the root causes of poor health, such as poverty and income, through the creation of a Poverty Leadership Panel and the Healthier Wealthier Children programme as well as focused action on the wider environmental causes such as the quality of housing, employment opportunities and education. 1.4.4 Tobacco control was identified in the Marmot review on health inequalities as central to any strategy to tackle health inequalities. The life expectancy and health of Glasgow citizens can be improved through decisive action on smoking. 1.4.5 The effect of place on health is well established. People living in poverty are more likely to maintain risk behaviours because of inequality of opportunity, constrained choice of consumption patterns, psychosocial stress and cultural norms. The Council recognises its key role in creating good public spaces that promote people s health, happiness and wellbeing. 1.4.6 It is recognised that by addressing health inequalities by tackling the wider determinants of health there will be a positive impact on smoking prevalence. In Glasgow this will be complemented by targeted action on tobacco, prioritising the needs of certain disadvantaged groups. The Glasgow Tobacco Strategy prioritises certain population groups identified in the Director of Public Health Report 2013-15 including looked after and accommodated young people, the prison population and youth health. 9
SECTION 2: VISION, AIM AND PRINCIPLES OF THE GLASGOW TOBACCO STRATEGY 2015-17 2.1 Vision and Aim 2.1.1 The new Glasgow Tobacco Strategy 2015-17 is a crucial step in supporting the vision of a Smoke-free Scotland by 2034. 2.1.2 Our vision replicates that of the SOA in seeking to ensure that: Glasgow is a thriving, inclusive and resilient city; a city where all citizens can enjoy the best possible health and well-being and have the best opportunity to meet their potential. 2.1.3 Our aim of reducing the impact of tobacco in Glasgow, particularly targeting areas and populations of greatest need is a clear way of working towards achieving the vision of the SOA. 2.1.4 The objectives of the strategy are threefold and are aimed at: Prevention: Creating an environment in Glasgow where young people choose not to smoke. Protection: Protecting people from second-hand smoke. Cessation; Helping people to quit smoking. 2.1.5 These objectives are more fully developed in the priority areas described below. 2.2 Principles 2.2.1 The following principles underpin the development and implementation of this strategy: 2.2.2 A population approach - focus on improving the overall health status of the community, delivering sustained, effective and comprehensive programs that promote and support healthy living for all. 2.2.3 Reducing inequity address the differences in health status in the community by recognising and responding to the special needs of groups whose health is poorest, ensuring scale and intensity of programmes proportionate to level of disadvantage. 2.2.4 Working in partnership recognise that many factors that influence health are outside the direct control of the Council/NHS and developing strategic partnerships across government, industry, business, unions, voluntary and third sector organisations, research institutions, youth groups and communities as required. 2.2.5 Capacity building focus on organisational change, workforce development, resource allocation and leadership that incorporates advocacy and relies on partnerships. By working across sectors, there is potential to build individual skills, strengthen community action and empower organisations to promote sustainable health behaviours and support healthy environments. 10
2.2.6 Engaging communities engage with people where they live, work and play and informing, enabling and supporting people to make healthy choices. Relevant settings may include home, work, school, youth centres, workplaces and community. 2.2.7 Ensuring effective implementation provide a strong infrastructure that supports individuals and communities in making and sustaining healthy choices and measures progress in achieving targets. 2.3 Local Strategy Alignment 2.3.1 The Council is already committed to a number of strategies which seek to tackle the social determinants of poor health in Glasgow, as well as measures to promote healthy lifestyles of the population at both a universal and targeted level. The Council will ensure the direction and actions are consistent with other plans in the city including: GCC Strategic Plan 2012-17 (Vulnerable People Theme) Glasgow s Single Outcome Agreement 2013 (Vulnerable People Theme) Glasgow s Integrated Children s Services Plan 2013-15 Poverty Leadership Panel Glasgow s Action Plan for Change 2013 Strategic Direction for the Glasgow CHP Health Improvement Workforce 2013 Building Momentum for Change, Biennial report on population health in NHS Greater Glasgow and Clyde 2013-15 2.4 Delivery Through Partnership Working 2.4.1 Key actions associated with the delivery of this strategy are to identify and engage with new partners, focussing on third sector and voluntary organisations, targeted action within the city s most deprived areas and champion the relevance of tobacco control in reducing inequalities in health. 2.4.2 As the strategy progresses there will be further communication with Community Planning at a citywide and local level to agree their role and to increase engagement with local communities. 2.4.3 The achievement of the ambitious target of a Smoke-free Scotland by 2034 and the associated challenging 5 year milestones will require renewed efforts in implementing Glasgow s tobacco control programme. A greater focus is required on reducing health inequalities, in capacity building, in effectively engaging with new and existing partners and in working collaboratively with communities. 2.4.4 The Strategy acknowledges the need for universal services and programmes to reduce smoking prevalence in Glasgow. However, in line with the Council Strategic Plan and the SOA, this plan will focus the majority of actions on activity which targets the most vulnerable and disadvantaged in Glasgow. 11
SECTION 3: PRIORITY AREAS AND ACTIONS 3.1 Strategic Tobacco Control Priorities 3.1.1 In order to deliver effective actions in prevention, protection and cessation at a community level, it is important that the right partnerships are in place at the outset and are considered in relation to ongoing health and social care integration. 3.1.2 Area based action plans will be developed detailing local delivery of the strategy by Glasgow Community Health Partnership (GCHP) staff and through appropriate engagement. 3.2 Prevention 3.2.1 Research indicates that effective youth smoking prevention requires a comprehensive approach. Sustained and integrated effort is required as short-term and one-off or limited focus interventions targeting young people are unlikely to have lasting results. Actions balance universal and targeted partnership approaches to support the effective delivery of tobacco prevention with young people particularly with those most in need. 3.2.2 Universal measures: Ensure the ongoing delivery of effective schools based tobacco education programmes in both primary and secondary schools. Increase capacity within schools to deliver the tobacco element of health improvement programmes, as part of the Health and Wellbeing in the Curriculum for Excellence. Engagement of young people in the development of tobacco programmes. Encourage schools to address smoking as part of a broader programme addressing the uptake of risky health behaviours in young people. (Scottish Government (SG) Action 11) Ensure high levels of legislative compliance (age restricted sale, display ban). 3.2.3 Targeted measures: Support the delivery of the 3 year national pilot peer education programme (ASSIST) in identified Glasgow secondary schools and dependant on outcomes, consider the future for the programme. (SG Action 12) In partnership with young people and relevant organisations develop a more targeted neighbourhood approach to delivering prevention work with young people. Build on previous tobacco work and research with Looked After and Accommodated Children to develop a programme to reduce uptake of smoking as part of a wider programme to reduce risk taking behaviour in this group. (SG Action 11) 12
Undertake actions at a local level to address high levels of smoking in 16-24 age group, including working with social work, local tertiary education establishments, apprentice/training schemes and youth service providers. 3.3 Protection 3.3.1 Smoke-free environments are effective in reducing non-smokers exposure to second-hand smoke and it is argued that they contribute to the de-normalisation of tobacco smoking. Smoke-free environments are also beneficial for smokers by supporting their efforts to quit and reducing the consumption of cigarettes as smokefree environments provide fewer opportunities to smoke. 3.3.2 Universal measures: Implement smoke-free grounds across all NHS estates by 2015. Using a partnership approach to share learning and experiences of policy development. (SG Action 34), the Council will begin a rolling programme of introducing smokefree grounds and events from 2015-2016 taking a planned approach and making best use of existing resources. Priority areas for the Council include the entrances to Council buildings, smokefree outdoor areas where children and families congregate (play areas) and smoke-free family outdoor events. Glasgow Life has already introduced smoke free family events and Land & Environmental Services (LES) has implemented a number of smoke free play areas. Ensure high levels of compliance with smoke-free legislation (SG Action 19/21) 3.3.3 Targeted measures: Drive the adoption of smoke-free policies in third sector youth organisations working with vulnerable young people, using the recently produced guidance from NHSGGC and ASH Scotland. Using a co-production model, working with local communities to develop an approach to reduce the availability of and demand for illicit tobacco based on the recent local illicit tobacco research. (SG Action 19) Develop a plan that outlines how HMP Barlinnie will move to become smoke-free building on current work by with the prison. Deliver a targeted programme to reduce exposure to second hand smoke in the homes of those in the most deprived areas as well as specific work within adoption, foster, kinship, early years and residential care services (LAAC and the elderly). (SG Action 26) 3.4 Cessation 3.4.1 The strategy acknowledges the whole range of factors and wider life circumstances which influence someone s motivation and capacity to quit smoking. It is important that a whole range of services that impact on a person s health and wellbeing offer support and encouragement to stop smoking. 3.4.2 Universal measures: 13
Ensure the ongoing delivery of an integrated stop smoking service in Glasgow is based on best practice for all smokers who want to stop smoking. 3.4.3 Targeted measures: Tailor services to meet needs of most disadvantaged smokers and smokers from specific communities, including extending pre and post quit support, tailored services for specific groups including prisons and BME. Develop innovative ways of delivering smoking cessation support in partnership with local communities to ensure services best meet their needs. Deliver behaviour change training to those organisations working with vulnerable groups and with the potential to impact on health and well being including Social Work Services, Financial Inclusion, NHS and GCC Credit Unions, Housing Associations and third sector organisations. (SG Action 11) SECTION 4: TARGETS, MONITORING AND FINANCIAL FRAMEWORK 4.1 Targets 4.1.1 The Council and NHSGGC are committed to creating a smoke-free Glasgow by 2034 which supports the Scottish Government s aspiration for a tobacco-free Scotland by 2034 (an adult smoking prevalence of 5% or lower). The target is to reduce adult smoking prevalence from 23% in 2011 to 5% by 2034. (Intermediary targets: 17% by 2016, 12% by 2021, 9% by 2026, 6% by 2031). 4.1.2 Given the clear inequalities dimension to smoking prevalence rates, the Scottish Government have also included 5-year milestones setting out how prevalence needs to reduce by SIMD quintile to achieve the 2034 target (Table 1). 4.1.3 In 2014, the Scottish Government introduced a new target to reduce the proportion of children in Scotland exposed to second-hand smoke in the home from 12 per cent to six per cent by 2020. This is the first target of its kind anywhere in the world. 4.1.4 The NHS in Scotland has been set a target to deliver 12,005 successful quits at 12 weeks post quit in the 40% most deprived within-board SIMD areas over the 1 year ending March 2015. 4.1.5 The key measurable outcome indicators for the Glasgow Tobacco Strategy are: 14
Reduction in overall adult smoking prevalence in Glasgow (Scottish Household Survey, Health and Wellbeing Survey) Reduction in adult smoking prevalence in SIMD 1 and 2 in Glasgow (Scottish Household Survey, Health and Wellbeing Survey). Reduction in smoking in young people in Glasgow (Glasgow Schools Survey and Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS)). Reduction in exposure to second-hand smoke in Glasgow (Glasgow Schools Survey, Scottish Health Survey, investigate the potential to include a question on second-hand smoke within the local household survey). Percentage of compliance with tobacco control legislation (display ban, smokefree, age related sale) in Glasgow. 4.2 Monitoring and reporting 4.2.1 The Health Inequalities and Improvement Group (HIIG), chaired by Councillor Gillan reporting to the Health and Social Care Policy Development Committee will take the lead in coordinating and monitoring the implementation of the Strategy across Glasgow. A review of progress towards the targets and implementation of actions will be undertaken in 2016, including reporting on population level indicators of smoking prevalence and other key indicators from the Strategy. 4.2.2 Within the Council, progress will be reported as part of the Annual Service Plan and Improvement Report (ASPIR) process. The intention is that this will reduce the requirement for separate reporting on activity, with Tobacco Strategy actions fully mainstreamed into existing service performance reporting systems. Progress reports from the NHS will be provided within the same timeframes. 4.2.3 The Tobacco Strategy sets out long term goals and outcomes. It is expected that the Council and progress between 2015-2017 will reflect the early work to realise these long term goals. 4.3 EQIA 4.3.1 An initial equalities screening exercise has been undertaken to identify areas where there is a clear equalities dimension in relation to the delivery of this strategy. This found that the main correlations of smoking prevalence were in relation to deprivation, older people, mental health and long term limiting illness. There is also anecdotal evidence to suggest that smoking may be more prevalent among the LGBT community. 4.3.2 Further research and individual Equality Impact Assessments will be undertaken as required throughout the implementation of this strategy. 4.4 Financial Framework 4.4.1 Tobacco control funding, allocated to annually, is contained within a broad Effective Prevention budget, where funding for a number of specific programmes including tobacco control is aggregated into one budget. Health Boards can use this flexibly to deliver the programme outcomes as agreed with Scottish Government within the scope of the budget. The bulk of the funding is used to support the 15
delivery of NHS stop smoking services. However it is also used for other specific programmes and a funding proposal for specific tobacco work with Looked After and Accommodated Children has recently been approved by the Tobacco Planning and Implementation Group. 4.4.2 Tobacco control funding supports Boards to take safe, effective, person-centred action to reduce the level of tobacco-related deaths and preventable illness, help people stop smoking and prevent uptake of smoking. 4.4.3 Scottish Government also funds 4 tobacco control officers based in Land and Environmental Services within the Council, who have responsibility for ensuring compliance with tobacco control legislation. 4.4.4 To meet existing and future challenges, improved efficiency and effective partnership working will be required to ensure the most efficient use of available resources. Therefore, any investment stated or implied within this document will be met within existing resources. 16
APPENDIX 1 ACTION PLANS 2015-17 The actions identified to meet the outcomes of the Strategy have been grouped into the priority areas identified earlier in the document. Objective 1: Strategic Planning (Building partnerships and developing localised action plans) Objective Action What will we do? Output measures/indicators What will we monitor to show that we have done this? Strategic Planning Outcome measures/indicators What will this achieve and what will we monitor to demonstrate this? Lead and partners Identify and form new partnerships in order to expand opportunities for tobacco control interventions within a range of settings Engage more effectively with Third Sector through the Third Sector Forum Better linkage with Community Planning structures in the city Partnerships and joint working developed between relevant agencies by December 2016 Number of tobacco training sessions delivered Number of tobacco control interventions piloted within organisation Glasgow City Council (GCC) Chief Executive s Office Glasgow Community Health Partnership (GCHP)sectors NHS Greater Glasgow and Clyde () Agree a mechanism within each sector as to how strategy will be implemented Strategy is adopted by the Strategic Plan of the Integrated Health and Social Care Partnership Develop a localised action plan and agree a mechanism within each Community Health Partnership (CHP) sector as to how strategy will be implemented Work with Shadow Integration Board to ensure strategy is adopted by the Health and Social Care Partnership Strategic Plan. Production of a localised action plan within each CHP sector Work with Integrated Joint Board as they develop Strategic Plan. A clear programme of tobacco control activity within each sector Glasgow Tobacco Strategy adopted by the Integrated Health and Social Care Partnership Strategic Plan. Community Planning Partnership (CPP) GCHP sectors Integrated Health and Social Care Partnership GCC Chief Executive s Office
Objective 2: Prevention (Creating an environment in Glasgow where young people choose not to smoke) Objective Action What will we do? Output measures/indicators What will we monitor to show that we have done this? Prevention (Universal) Outcome measures/indicators What will this achieve and what will we monitor to demonstrate this? Lead and partners Increase capacity in schools to deliver the tobacco element of health improvement programmes within Curriculum for Excellence Encourage schools to address smoking as part of a broader programme dealing with the uptake of risky health behaviours in young people Create environments within schools, tertiary organisations and youth settings to discourage young people from taking up smoking focusing on areas of deprivation Evidence based curricular linked tobacco education programme available for all primary, secondary and special education needs (SEN) schools in Glasgow, supported by resources and training Promote programmes In partnership, develop a streamlined, co-ordinated plan to address risk taking behaviours (alcohol, drug and tobacco use) in schools Review outcomes of Social, Emotional and Education Development (SEED) pilot project Implement tailored and negotiated No Smoking Policies within schools, tertiary organisations and youth settings, in partnership with young people Explore potential areas for partnership working with Glasgow Life Appropriate resources and training available to all schools to support programme delivery Uptake of programmes Plan in place Evidence of alignment of substance misuse policies Substance misuse toolkit Review undertaken of SEED Number of youth facilities and organisations with tailored smoke-free policies Reduction in prevalence of smoking in Children (Glasgow Schools Survey/Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) local reports) Reduction in prevalence of smoking in Children (Glasgow Schools Survey/SALSUS local reports) Reduction in prevalence of smoking in Children (Glasgow Schools Survey/SALSUS local reports) GCC Education Services Glasgow CHP GCC Education Services Young people CHP sectors Ensure appropriate engagement of young people in the development of tobacco programmes. Health Summits Develop means of effective engagement with young people in Glasgow on tobacco issues Evidence of mechanisms for youth engagement Reduction in prevalence of smoking in Children (Glasgow Schools Survey/SALSUS local reports) Education Services GCHP sectors 18
Prevention (Targeted) Manage the implementation of national pilot of the ASSIST peer education programme in Glasgow Implement a programme to reduce uptake of smoking amongst Looked After and Accommodated Children (LAAC) as part of a wider programme to reduce risk taking behaviour In partnership with young people and relevant organisations develop a targeted, neighbourhood approach to delivering prevention work with young people Address high levels of smoking in 16-24 age group particularly those from most deprived backgrounds Develop and implement strategies for young people in custody or within the youth justice system Ensure the effective implementation of the Enhanced Tobacco Sales Enforcement Programme 19 Over 3 years deliver the ASSIST programme in 10 secondary schools in most deprived areas and with the highest smoking prevalence in Glasgow In line with existing plans develop and implement a tobacco control plan for LAAC (and kinship care, foster care, adoption and residential services), linked to wider risk taking behaviours Increase capacity of SWS to 10 schools participating in the programme Plans in place Training delivered Negotiated SF policies in place specific to individual units Reduction in prevalence of smoking in Glasgow school children Outcome of national evaluation Creation of an exemplar smoke-free residential uniy Smoking prevalence within LAAC&YP (under development) contribute to tobacco control work Options being developed with CHP Options being developed with CHP Reduction in prevalence of smoking in Children (Glasgow Schools Survey/SALSUS local reports) Through apprentice/employment agencies ensure a structured tobacco control component to youth training programmes Develop effective tobacco control programmes within tertiary education Identify relevant third sector partners and develop relationships Develop a programme of work with Intensive and Youth Justice Services Explore potential to link with proposals in relation to alcohol brief interventions with those on Community Payback Orders Maintain enhanced test purchase programme for tobacco Ongoing partnership with HMRC in intelligence led joint operations. Training and resources provided and tobacco control component being delivered Training and resources provided and tobacco control component being delivered Maintain 20% test purchase visits Reduction in prevalence of smoking in 16-24 group Reduction in prevalence of smoking in 16-24 group Increase in levels of compliance with age restricted sale legislation GCC Education Service GCC Social Work GCHP GCHP sectors GCC DRS. Jobs and Business Glasgow GCHP sectors GCC SWS GCC LES Police Scotland HMRC
Compliance with e cig restrictions Objective 3: Protection (Protecting people from second-hand smoke) Objective Action What will we do? Output measures/indicators What will we monitor to show that we have done this? Protection (Universal) Outcome measures/indicators What will this achieve and what will we monitor to demonstrate this? Lead and partners Implement smoke-free grounds across all NHS estates by 2015, and begin to implement appropriate smoke-free policies across Council grounds and events. Maintain the enforcement of smoke-free legislation Glasgow City Council Develop new Health and Safety Management Standard for Tobacco Focus on smoke-free entrances Increase the provisions of smoke-free outdoor areas (play parks). Ensure smoke-free policies link to new Park Management Rules Identify, implement and promote smoke free family outdoor events Maintain programme of enforcement and promotion to ensure compliance with smoke-free grounds by March 2015 Enforcement programme for smokefree legislation Develop programme of work with Shisha café owners New H&S Management Standards developed, endorsed and implemented Number of smoke-free events Compliance with the requirement for smoke-free grounds Number of enforcement visits Programme in place with Shisha café owners Reduction in adult smoking prevalence in Glasgow % compliance with smokefree legislation Land and Environmental Services Community Safety Glasgow GCC Chief Executive s Office Land and Environmental Services Police Scotland 20