Transcript Document

The decline in numbers
accessing stop smoking services:
challenges and opportunities
Martyn Willmore – Fresh
Ailsa Rutter – Fresh
Dave Jones – Public Health England
Overview of workshop
What we hope to achieve from this session...
- A re-affirmation of the vital role of Stop Smoking Services
within Tobacco Control
- A shared understanding of recent changes in SSS activity levels
- Discussion of potential factors behind this fall in throughput
- Discussion of potential SSS provision in the future
Context
• Since 1999, we have seen over 7.7 million smokers accessing
Stop Smoking Services across England alone
• Nearly half have been recorded as successfully quit by week 4
• We know the case for effectiveness and cost effectiveness of
our SSS
• Robert West article estimated that by end of 2010/11, over
145,000 long term quits were directly attributable to SSS*
*West, R. et al. Performance of English stop smoking services in first 10 years: analysis of
service monitoring data. BMJ 2013;347:f4921 doi: 10.1136/bmj.f4921
Number of smokers using
English SSS (2000-2012)
Number of smokers using
English SSS (2000-2014)
Group discussion 1
From your experience, what factors are
contributing to the recent decline in
footfall through Stop Smoking Services?
10 minutes. Each group to feedback 2
headline issues
Factors impacting on throughput
• Electronic cigarettes
• Public Health reorganisation?
• Primary Care disengagement?
• Fewer smokers to engage? Less overt marketing of SSS?
• More challenging smokers to recruit? Less motivated to quit?
Electronic cigarettes
• Huge growth in market coincides with
drop in SSS throughput
• Limited relationship between SSS and
electronic cigarettes and their users??
• Awaiting MHRA process of medicinal
regulation. Game-changing??
• Mixed opinions from Tobacco Control
community. Can SSS sit on the fence??
• In relation to SSS, are e-cigs any more
than a distraction?
Prevalence of nicotine products in
recent ex-smokers
Increase in use of e-cigarettes
has offset a reduction in NRT
use that began earlier
N=702 adults who stopped in the past year; increase p<0.001 for e-cigs;
decrease p<0.001 for NRT
www.smokinginengland.info/latest-statistics
Public Health reorganisation
• How many localities have seen a major review of their SSS
provider over the last two years?
• What does your SSS look like? Has it changed? Who hosts it?
• New PH commissioners from April 2013. Time spent remaking the case for SSS/Tobacco Control?
• Competing topics for funding. Ring-fencing of budgets
• Increasing focus on more joined-up “lifestyle services”?
Primary Care disengagement?
• What proportion of your quit attempts come from Primary Care
settings? Has this changed recently?
Proportion of quit dates set by setting
2009/10
2010/11
2011/12
2012/13
Primary Care
Stop Smoking Service
Pharmacy
44.8%
43.1%
40.7%
39.2%
29.9%
31.4%
31.4%
32.6%
18.4%
18.5%
20.0%
20.6%
• Are referral pathways from Primary Care working?
•
Competing GP interests?
Primary Care disengagement?
Number of quit dates set by setting (2009-2013)
Fewer smokers? More options
for quitting?
• Prevalence continuing to fall
• But adult population growing
(+3 million between 2002-2012).
8 million smokers across England
• More Apps/online tools to help
smokers quit
• National TV campaigns promote
quitting, but not necessarily SSS
More challenging smokers to
engage? Motivation levels?
• Anecdotal feedback from NE SSS that majority of remaining
smokers have complex issues. E.g.
• Chaotic lifestyles
• Multiple public health challenges (drugs, alcohol)
• Mental health issues
• Learning difficulties
• Perception that “low-hanging fruit” are now quit
• Yet data suggests increasing numbers trying to quit….
Quit attempts
There has been a small increase in quit attempts
N=14,024 adults who smoke or who stopped in the past 3 months; increase p=0.005
www.smokinginengland.info/latest-statistics
15
Does the decline in the number
of smokers accessing SSS
necessarily matter?
YES
NO
Local 4-week quitter targets
Less national focus on 4-week quits now
they`re not nationally mandated
Continued justification of service to
commissioners/HWB boards
The intervention is proven to be cost effective
Payment by results
Potential to re-frame any payments around
most disadvantaged smokers
Impact on prevalence
SSS not a prevalence reduction service. But
can contribute to reducing health inequalities
What is the purpose of a SSS?
“Smoking Kills” White Paper in 1998
set out intention to set up national
smoking cessation services.
Specifically, it highlighted,
“Our priority will be the need to help
the least well off smokers. Smoking is
disproportionately high among the
more disadvantaged. If we are to
reduce smoking overall, and reduce
health inequalities, we must start with
the groups who smoke the most”.
What is the purpose of a SSS?
“In Britain today, more than 120,000
people are going to die over the next
year from illnesses directly related to
smoking. And the year after that, and
the year after that. Unless we all do
something.”
The Rt Hon Tony Blair MP Prime Minister, Smoking Kills, 1998
What different approaches to
SSS are emerging?
Rotherham & Doncaster - Triaging clients
More generic lifestyles approach
Leicester – more e-cigarette friendly
SoTW – non-specialist model
Group discussion 2
Looking ahead 2-3 years, what are the
key factors that you think would make
a successful SSS?
oWhat would the SSS look like?
oWhat support would it be offering?
oWho would be the key target groups?
oHow would it be delivering support?
oWhat outcomes would it be measured on?
Future of SSS…??
• Does the fall in activity offer a unique opportunity to look again
at what the SSS can offer, to whom, and how?
-
More focus on those smokers with “greatest need”
Triaging clients based on expected level of support needed
SSS quality assurance hub, but with many outlets?
Better integration with clinical care pathways
General lifestyle services Vs. “specialist” advisors?
Role around harm reduction?
Online support? Telephone support?
Less focus on overall target, and more on the added value
Final thoughts…..
• We need to continue making the case for effective SSS within a
broader tobacco control structure
• But as smokers have more options on ways to quit, does this
mean that SSS can re-position themselves in the market?
• Is this a discussion we`d like to see taken forward? How, and
who needs to be involved?
Contact details….
[email protected]
[email protected]
0191 333 7145
www.freshne.com
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