Transcript Document
Tobacco Control National Support Team visit to Cumbria, September 2007 Feedback To be covered today: • • • • • • • • • A Model of Integrated Tobacco Control Overall Strengths The Scale of the Challenge Strategic Themes, Recommendations:- Multi-agency partnership working - Planning and commissioning - Monitoring, evaluation and response - Normalising smoke-free lifestyles - Making it easier to Stop Smoking - Tackling illegal and underage availability - Communication Additional Requests for Department of Health Top Five Take-home Messages Summary of Support Offered Plenary Session Discussion NST Contact Details Planning and commissioning Making it easier to stop smoking Tackling illegal and underage availability Communication Multiagency partnership working Normalising smoke-free lifestyles Monitoring, evaluation and response Overall Strengths Partnership working • • • • • • • History of operational collaboration on Tobacco Control, particularly around planning for smoke-free workplaces. LSPs and CSP, with potential to take forward linked work on Tobacco Control. Recognition of further potential of a Tobacco Control Alliance to fulfil its potential. Active Health Scrutiny Panel with an interest in tackling smoking. Early inclusion of smoking stretch target in LAA and interest in developing this to add further value. Jointly-appointed DPH, with the associated opportunities for crossorganisational collaboration and joint target setting. ‘Locality-based commissioning’ concept offers potential to focus upon specific local needs. … Overall Strengths Environmental Health • • • History of local authority involvement in district-level and countywide action on smoke-free initiatives including support for national campaigns prior to implementation of Smoke-Free legislation Willingness demonstrated to collaborate with and provide practical support for Stop Smoking inputs, including supporting outreach activities to workplaces and community venues and events. Successful implementation of Smoke-Free legislation and incorporation of compliance checks into routine inspection activities. Trading Standards • • • • Demonstration of clear understanding of all aspects of tobacco control by Trading Standards. History and on-going programme of trading standards commitments to key tobacco control activities together with appropriate performance measures. Well organised trading standards structure with lead officers for district liaison, county wide policy lead officers and regional coordination roles. Plans for further region-wide collaboration re counterfeit/smuggled tobacco … Overall Strengths Cessation • • • • A history of delivery on cessation in predecessor PCTs. Committed Stop Smoking team members that have continued to provide services under challenging circumstances. Wider recognition of the importance of Stop Smoking intervention in reducing health inequalities. District level commissioning teams with local GP clinical involvement, which will be supported by commissioning and public health staff. … The scale of the challenge • • • • • • The impact of organisational change – PCT forming whilst coping with a financial deficit. Significant underperformance against PCT smoking cessation targets and LAA stretch target. Scale of waiting lists for addiction response. Need to develop effective commissioning framework. Need to develop effective performance management system. Geographical size and diversity; pockets of urban deprivation and rural populations that are not fully served. … Planning and commissioning Making it easier to stop smoking Tackling illegal and underage availability Communication Multiagency partnership working Normalising smoke-free lifestyles Monitoring, evaluation and response Recommendations Multi-agency partnership working Delivering on the full potential of Tobacco Control will require: – Active involvement of senior leadership across the local public sector; – Responsibility for Tobacco Control exercised by the CSP health group; – Co-ordinating links between CSP and LSPs (and LAAs). The support of elected members of local authorities in all relevant partnerships has potential to add significant value. Reviewing targeting for Tobacco Control as part of an LAA refresh would be useful. Regional Public Health Group & GONW could be approached to advise. In the context of a single PCT and a decision regarding local authority configuration, there is now an opportunity and a need to develop a Tobacco Control Alliance for Cumbria as a specialist multiagency partnership that will provide a targeted, evidence-based and prioritised strategic approach to Tobacco Control. … Recommendations Multi-agency partnership working The Tobacco Control Alliance should be prepared to inform and guide collaborative action, with board-level support by PCT and CSP/LSP, and utilising RTPM expertise in order to: – Ensure tobacco control evidence is translated into a strategic approach that prioritises local action. – Link strategic and operational activity in the medium-to-long term. – Include and co-ordinate the full range of tobacco control inputs. – Make the fullest local use of regional and national expertise and support. A review of membership, identification of a co-ordinating resource, and appointment of a suitably senior Chair will be central to improving the value and performance of this partnership. TCNST can offer tailored support to facilitate this process, including detailed input to develop the local model of Tobacco Control delivery. … Planning and commissioning Making it easier to stop smoking Tackling illegal and underage availability Communication Multiagency partnership working Normalising smoke-free lifestyles Monitoring, evaluation and response Recommendations Planning and/ commissioning Commissioners need input from public health / behaviour change expertise to focus on addressing health inequalities. The commissioning process should include: – – A short term performance improvement project to meet immediate performance targets; A comprehensive review of Cumbria’s stop smoking approach TCNST/RTPM can advise further and/or signpost to expert support; – Robust SLA and performance management systems; TCNST supports the intention to routinely monitor at Board level the performance of the service and key indicators such as 4 week quit target, smoking in pregnancy rates and the % of patients with smoking recorded by GPs In order to be effective, revised stop smoking provision should be based on best practice i.e. a “Hub and Spoke” model … Planning and commissioning Making it easier to stop smoking Tackling illegal and underage availability Communication Multiagency partnership working Normalising smoke-free lifestyles Monitoring, evaluation and response Recommendations There is an immediate need for an effective data collection/central clinic booking system, to improve client access because: – – – Monitoring, evaluation & response Current software appears not to be meeting operational needs and is resulting in considerable inefficiency; Different systems are being used across the County; Specialist Stop Smoking Advisors appear to be undertaking significant data entry duties, amounting to the loss of the equivalent of one clinic per week per Advisor. Given the importance of tackling health inequalities, placing a higher priority upon monitoring delivery upon LDP/LAA targets would appear to be appropriate. … Planning and commissioning Making it easier to stop smoking Tackling illegal and underage availability Communication Multiagency partnership working Normalising smoke-free lifestyles Monitoring, evaluation and response Recommendations Normalising smoke-free lifestyles Cross-service agreements (and proper authorisation) between trading standards, environmental health, and others, on observation, intervention and reporting arrangements for smoke-free compliance could add value by maximising the benefits of local authority regulatory functions. Cross-service agreements between environmental health and stop smoking providers on promotion of stop smoking services and other resources for self-help and reducing prevalence are worth exploring, with a view to reaping the fullest benefits from smoke-free workplace regulations. Consideration of Level 1 training for local authority officers who can encourage stop smoking as part of their work activities. … Recommendations Normalising smoke-free lifestyles Changing social attitudes to tobacco use is a crucial element of a comprehensive tobacco control approach for Cumbria and the Tobacco Control Alliance’s planning and communication will need to reflect this. TCNST/CIEH can offer/broker tailored training A review of compliance with smoke-free policies would be timely, in particular: – Mental health – develop policy and practice to achieve smoke-free mental health units by July 2008. – Effectiveness of smoke-free hospitals policies – Progress re Prison Service smoke-free directive There would be benefit in reviewing the current policies governing home visits for staff visiting service users at home to ensure consistency in broad terms across all organisations. TCNST could signpost to transferable good practice. Smoke-free public areas – encouraging adoption of corporate smokefree policy in large open public areas, e.g. stadiums and arenas – is an appropriate focus for Tobacco Control Alliance communications and advocacy. Planning and commissioning Making it easier to stop smoking Tackling illegal and underage availability Communication Multiagency partnership working Normalising smoke-free lifestyles Monitoring, evaluation and response Recommendations Making it easier to stop smoking Approach A two-stage approach is recommended: – Short Term – immediate focussing of resources on the deployment of well-evidenced, high impact interventions in areas of high smoking prevalence is necessary. TCNST can advise further. – Medium Term – a comprehensive review of stop smoking methodology is clearly vital. TCNST endorses the PCT’s intention to provide this. TCNST/RTPM can support this process through signposting to successful comparable services and detailed input into refreshed Service planning. Recommendations Making it easier to stop smoking Development of Hub and Spoke model of delivery A “Hub and Spoke” delivery model would offer real advantages for Cumbria. This would provide a unified central team of specialists supporting a network of trained multi-disciplinary community based Level 2 advisors, delivering services as contractors, through SLAs or similar agreements. There are likely to be considerable benefits in delivering Level 2 stop smoking services through GP Practices and Pharmacies, enhancing and capturing existing stop smoking work already being undertaken in these sectors. Recommendations Making it easier to stop smoking Issues for action The revised approach should offer cessation support to all smokers, but with a focus on low-income and pregnant smokers, and to develop links with local community groups to ensure the needs of hard to reach populations are catered for. Develop integrated stop smoking pathways as part of chronic disease management, consistently in primary and secondary care (e.g. “Stop Before The Op”) Increase referral and involvement of GPs and other members of primary care teams Explore approaches used by other comparable services TCNST can signpost Review the role of other professionals in SSS particularly Health Visitors Using the High Impact Changes to Reduce Smoking in Pregnancy document is recommended. Planning and commissioning Making it easier to stop smoking Tackling illegal and underage availability Communication Multiagency partnership working Normalising smoke-free lifestyles Monitoring, evaluation and response Recommendations Tackling illegal and underage availability The officers and the activities of the Cumbria Trading Standards Service have a key role to play in a multi-agency partnership approach and should be a core component of a refreshed Tobacco Control Alliance. Smuggled tobacco products are likely to be a growing threat to Tobacco Control measures in Cumbria (as they are nationally); measures to assess this, and ensure proactive intelligence sharing between local and regional law enforcement agencies, are important. RTPM/TSI/LACORS can advise. To make the fullest use of the National Intelligence Model, other local agencies could usefully examine what intelligence they may be able to share/collate via the Trading Standards Service. Exploring this should be a project for the developing Tobacco Control Alliance. TCNST endorses the proposal to carry out planned test purchasing for underage sales of tobacco following the 1 October age raise. … Planning and commissioning Making it easier to stop smoking Tackling illegal and underage availability Communication Multiagency partnership working Normalising smoke-free lifestyles Monitoring, evaluation and response Recommendations Communication Reconvening the Cumbria Communications Officer Group may be a means of ensuring consistency of Tobacco Control messages. There would be benefit in this group participating in a strategic approach, led by the Tobacco Control Alliance. As part of a strategic approach to Tobacco Control, there would be value in developing a specific communications strand, which incorporates; – a strong message and image based on shared aspirations which highlights that Tobacco Control is everyone’s business. – developing knowledge in social marketing principles to underpin Tobacco Control messages for specific target audiences. TCNST can advise further. – fully exploiting national campaigns at a local level and establishing links with regional support. TCNST/RTPM can assist with access to materials and advise on their use. – embed the importance of smoking cessation messages at all levels of PCT, provider services and both district and county level local authorities. … Top 5 Take-home Messages for Cumbria… 1. There is now an opportunity and a need to develop an effective, strategically linked (to CSP), multi-agency Tobacco Control Alliance. 2. Urgent action is required to turn around current Stop Smoking performance. 3. A Stop Smoking approach should then be commissioned to a ‘hub and spoke’ model with clear leadership and scope to address health inequalities. 4. There would be benefit in capitalising upon the momentum and good practice from the joint work on smoke-free workplaces to work towards normalising smoke-free lifestyles. 5. Joint planning is required to tackle the threat of smuggled and counterfeit tobacco. Additional Requests for DH Strengths • Evaluating what has worked well in Tobacco Control is now crucial to identify transferable learning. • National guidance on tackling smuggled and counterfeit supply would be useful. • Low levels of fines for detected underage sales hinder the effectiveness of enforcement activity; Tobacco licensing would be a useful aid. • Overall national intelligence gathering needs to include greater consideration of counterfeit and smuggled tobacco products (and availability of Customs officers is a limiting factor). … Additional Requests for DH Strengths • Regional support for Tobacco Control is invaluable, and local stakeholders should be encouraged to use it. • Discouraging diversion of public health funding is helpful, as is encouraging behavioural change. • A period of NHS stability would aid delivery. • Align funding with expectations. • Be aware that targets alone don’t change people’s lives. • Don’t just throw money at the problem, give us permission to get it right. … Summary of support offered Regional Public Health Group & GONW could be approached to advise on LAA refresh TCNST can offer tailored support to develop the Tobacco Control Alliance TCNST/RTPM can advise further and/or signpost to expert support on review of stop smoking approach TCNST could signpost to transferable good practice re smoke-free home visits TCNST/CIEH can offer/broker tailored training on next steps in normalising smoke-free lifestyles TCNST/RTPM can support the two-stage process to review and reform the stop smoking approach TCNST can signpost to comparable stop smoking service models RTPM/TSI/LACORS can advise on proactive intelligence sharing regarding illegal sales TCNST/RTPM can assist with access to campaign materials and advise on their use TCNST can advise on social marketing principles Plenary session discussion • PCT, LA, stakeholder comments • Questions to clarify feedback points • Comments on feedback • Any comments on TCNST process • Next steps Contact details Name Title Email Telephone Cathy Hamlyn Director of National Support Team Development [email protected] 020 7210 5124 Keith Burnett Delivery Manager (North) [email protected] 07786 125356 Andy Graham Associate Delivery Manager (North) [email protected] 07776 244435 Tracy Fraser Project Officer (North) [email protected] 020 7972 1328 NST Office address :Rm 220 Director’s Office address Room G18 Wellington House Richmond House 133-155 Waterloo Road Whitehall London S£1 8UG London SW1A 2NS