|
Meeting: |
Executive |
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Meeting date: |
09/05/2024 |
|
Report of: |
Peter Roderick, Director of Public Health |
|
Portfolio of: |
Cllr Jo Coles, Executive Member for Health, Wellbeing and Adult Social Care |
Decision Report: Building a
smokefree generation in York: approving use of the Local Stop
Smoking Services and Support Grant
Subject of
Report
1. This report will give an overview of how the council intends to utilise new resource from the Section 31 Local Stop Smoking Services and Support Grant 2024-2025 grant, where the city has been allocated an initial £196,000 from Department of Health and Social Care to be spent on reducing smoking in York in 2024/2025, with grant expected to continue each year until 2028/2029.
2. The grant will allow the Health Trainer service to engage more smokers from across the city, increase the number of people making a stop smoking quit attempt and increase the number of people who successfully quit smoking.
3.
Around 14,600 York residents still smoke, costing the economy an
estimated £120m in lost productivity and healthcare costs
(including an estimated social care cost of £3.1m), and
directly causing over 200 deaths a year.
Benefits and Challenges
5. Public Health will receive approx. £196,000 per year, over the next 5 years (from 24/25 to 28/29), via the section 31 Local Stop Smoking Services and Support Grant 2024-2025.
6. The grant funding provides an opportunity to enhance our local approach to tobacco control, including the current service offer provided by the City of York Council Health Trainer service, reaching into communities where smoking rates consistently above the York average. To do this, the service will have to adapt some ways in which it operates, to become more embedded within communities across York. There is a risk that moving from a proven delivery model to a more embedded community model may have an initial negative impact on upon the service’s current high success rate in supporting people to stop smoking.
Policy Basis for Decision
7. The proposed use
of the grant clearly aligns with the core council plan commitment
of Health and the priority of “a health generating city, for
children and adults”. Smoking is the leading preventable
cause of death and illness in York, with 8.7% of the York adult
population currently smoking – around 14,600
individuals.
8. This will also
be a key component of achieving one of the 10 big goals within the
Joint Health and Wellbeing Strategy 2022-2023. The changes to the
service will support the goal of “Bring smoking rates down
below 5% for all population groups”, with the revised focus
being on all population groups. At present there are large
differences in smoking prevalence in York, when comparing factors
such as employment type or housing tenure.
9. The council plan
2023-27 commits to ‘Support more people on their journey of
recovery from addiction, including through smoking cessation
services and our recovery-based drug and alcohol
model.’
10. This work will also support York’s Economic Strategy objective “York will be among the top 25% most productive local economies as measured by Gross Value Added (GVA) per hour worked, requiring a 3.8% increase in productivity.” Recent estimations are that £35.1m is lost to GVA due to expenditure on tobacco per year in York.
Financial Strategy Implications
11.
The council will receive £196,542 in 2024/2025. The
government has announced additional funding for local stop smoking
services and support over the next five financial years, starting
from 2024/2025 until 2028/2029. The grant has been confirmed for
the 2024/2025 year, with funding for subsequent years subject to
spending review settlements.
12.
The grant letter suggests funding will continue at the same level
as the 2024/2025 allocation throughout the five-year period. Any
revisions to the grant amount will need to be responded to
appropriately at that time.
13. The authority is required to maintain current spend on smoking cessation services in order to receive the additional funding.
14. The grant is ringfenced against a number of conditions set out to all Local Authorities in a government circular, and should be used ‘towards expenditure lawfully incurred or to be incurred by them in connection with the provision of local stop smoking services and support’
Recommendation and Reasons
15. Executive are asked to approve the use of the Local Stop Smoking Services and Support Grant 2024-2025 as outlined in this paper, including:
a) the expansion of the council’s stop smoking support
b) the expansion of treatments and the offer of additional stop smoking medications
c) additional community outreach to smokers, particularly those in disadvantaged groups in the city
d) additional communications activity to drive up smoking quit rates
16. Executive are asked to approve the use of the Local Stop Smoking Services and Support Grant in future years (subject to funding) in line with the approach outlined in this report.
Background
17. The Secretary of State for Health and Social Care has outlined that the grant will be used to:
· Invest in enhancing local authority commissioned stop smoking services and support, in addition to and while maintaining existing spend on these services and support from the public health grant. This should not replace other/existing programmes which support smokers to quit, for example the tobacco dependency programme delivered within the NHS Long Term Plan.
· Build capacity to deliver expanded local stop smoking services and support.
· Build demand for local stop smoking services and support.
·
Deliver increases in the number of people setting a quit date and 4
week quit outcomes, reporting outcomes in the Stop Smoking Services
Collection to NHS Digital
18.
The current Health Trainer service provides free, 1:1, stop smoking
support to residents of York. The service operates across community
venues in the city, alongside virtual and telephone based
appointments. As part of a quit attempt, the health trainers
provide behavioural support and advice alongside four weeks of
Nicotine Replacement Therapy [NRT] or an e-cigarette and four weeks
supply of e-liquids (12 weeks supply of NRT/e-cigarette for
pregnant women and their significant other).
19.
In 2022/2023, the service supported 245 residents to set a quit
date, of which 184 were counted as successfully quitting smoking
(those who have reported to not be smoking at all at 4-weeks post
their “quit date”), a 75% quit rate. This puts
York’s Health Trainer service as the fourth best performing
local authority stop smoking service in England (the average quit
rate across England is 54%).
20. Within York, the current smoking prevalence among adults is 8.7% (14,600 people). The 3 wards with the highest number of smokers are Westfield, Guildhall and Heworth, which combined account for approximately 7,000 of the smokers within the city. Across England smoking prevalence in the most deprived population decile is 21.9% versus 6.1% in the least deprived population decile.
21.
Smoking prevalence also varies significantly by occupation type
(6.7% in managerial and professional vs. 15.2% in routine and
manual) and by housing tenure (4.0% owns with a mortgage vs. 30.3%
in social rented). Smoking prevalence is also higher in other
specific population groups, such as adults with a long-term mental
health condition (20.9%), those seeking treatment for opiate
substance misuse (43.8%) and of Gypsy or Traveller ethnicity
(45.0%). These are examples of populations that are currently
underserved by the existing model of service delivery. The new
model of delivery will radically change the service, to make it as
accessible as possible for these population groups and
communities.
22.
To enable more people to successfully quit smoking there needs to
be an increase in two things. The first is the number of people who
are making a quit attempt, achieved through local and national
marketing and communications. This needs to highlight the harms of
smoking, the benefits to quitting and the ways in which people can
be supported to make a quit attempt.
23.
The second is driving more people into a specialist stop smoking
service, as this is repeatedly evidenced to be the most effective
quitting method (with a combination of pharmacotherapy and
behavioural support) compared to going cold turkey or using NRT
bought over the counter. At present, across England, the majority
of people making a quit attempt do so either on their own with no
support, or on their own using an e-cigarette, with only 2%
accessing a specialist stop smoking service.
24.
Working with the Health Trainer Service Manager, a new model for
the service has been developed. This has resulted in an additional
2.5FTE Health Trainers, the development of two new Senior Health
Trainer roles and an additional 0.5FTE project support role, all of
which will build the capacity to deliver stop smoking support in
York.
25.
The additional capacity within the service will allow for a much
greater presence within community locations, closer alignment with
council services (housing, social care, homelessness services etc.)
and external services (primary and secondary care, voluntary
community sector, large employers). It will enable the inequalities
in smoking rates referenced in para 22 to be tackled and take the
service ‘out of the clinic’ to reach those who would
not normally engage.
26. In order to further support people to stop smoking the following measures are being proposed:
• Extending the pharmacotherapy offer (NRT and e-cigarettes) to 10 weeks, above the current offer of 4 weeks. NICE guidance is that pharmacotherapy is offered for 8-12 weeks, to provide the best chance of remaining quit long term. Currently financial constraints have meant that the offer has been 4 weeks since 2018.
• Exploring the process for making Cytisine available to service users, a recently approved stop smoking medication. The service previously offered Varenicline (Champix), until it was withdrawn by the manufacturer in summer 2021. Both this and the above point align with the grant condition of “increasing spend for stop smoking aids for smokers to use in their quit attempts from the full range of products available as recommended by NCSCT and NICE guideline NG209”.
• Increasing the marketing and comms output of the service via dedicated comms officer time and an increased operational marketing budget. Part of the grant is suggested to be used on “Increased promotion of local stop smoking support - we encourage local authorities to invest in marketing and promoting local interventions to quit smoking.”
• Increased budget to support embedding the service in community locations. This may include basing the service in heart of communities on a permanent basis, such as within community centres, or on a temporary basis such as in care-homes and larger employers. It will work with already established and trusted community organisations, charities, and community peers. This supports the grant guidance of “providing access to specialist and non-specialist advisers in locations where smokers routinely attend, such as community venues, GP surgeries, mental health services and employers”.
Options Analysis and
Evidential Basis
27. The proposed changes to the service outlined above will allow the Health Trainer service to undertake the three priorities needed to increase the number of people who are able to successfully quit smoking
a) Increase the number of people making a quit attempt – the increased marketing activity of the service will allow local residents to know how and where they can seek support to stop smoking and the benefits of doing so. The Health Trainer service will also amplify regional (though the ICB Centre for Excellence in Tobacco Control) and national campaigns (Stoptober, No smoking day).
b) Increase the number of people accessing specialist stop smoking support – the growth in the service headcount will allow the Health Trainer support to be taken into communities that are currently underserved by the existing offer. The service will be re-designed to ensure it is as accessible as possible for all residents in the city – by being visible in communities, workplaces, care homes, temporary accommodation. The service will bring support in to communities and locations with higher smoking prevalence, ensuring that support is available in the most convenient way.
c) Increase the effectiveness of the stop smoking service – the expansion of the pharmacotherapy and e-cigarette offer will give all residents the best chance to successfully quit smoking for good. The behavioural support helps to treat the habit and behaviours associated with smoking, while the pharmacotherapy helps to treat the nicotine addiction.
Organisational
Impact and Implications
· Human Resources (HR): Appropriate HR process will need to be followed while undertaking any change to staff roles or structures.
·
Financial: Financial implications have been outlined earlier
in this report. Finance colleagues are aware of the proposed
spending plans and have factored into the current year’s
budget planning.
·
Legal: Provided the Council complies with the terms of the
grant it has discretion on how to deploy the funds received.
·
Procurement: While no new services are planned to be
procured at this time, usual council process will need to be
followed should the need arise to procure an external
supplier.
·
Environment and Climate action: expansion of the
Council’s stop smoking support has the potential to reduce
associated carbon emissions of the service by considering how staff
operate within the communities they serve, covering travel and
energy usage. Consideration could also be given to the carbon
impact of any procured materials and the disposal methods for stop
smoking aids. Cigarette butts are one of the most littered items in
the UK and do not biodegrade, so reducing smoking rates has
positive impacts in this area.
·
Affordability: Smoking is not a choice; many smokers have
been trapped by nicotine addiction since a young age. The cost of
smoking can put our most vulnerable residents in an even more
precarious position. Anything that we can do as a Council to
support residents to quit smoking is beneficial and will allow for
income to be spent on other priorities and/or support financial
recovery. Working within community settings with partners could
facilitate other support to assist with further financial
support.
·
Equalities and Human Rights: Following a discussion with the
Assistant Director for Customer, Communities and Inclusion, an
Equalities Impact Assessment [EIA] has been conducted alongside
this report.
·
Data Protection and Privacy As there is no personal data,
special categories of personal data or criminal offence data being
processed for the purposes of this report, there is no requirement
to complete a DPIA. This is evidenced by completion of DPIA
screening questions AD-04771. However, the relevant data protection
requirements for the current Stop Smoking service will be reviewed
and updated where necessary following this decision.
Risks and
Mitigations
28.
As with all government grants, they are subject to an annual
spending review. As far as is possible, the government have
committed to this funding for the next five years and planning has
been undertaken on this basis. If, for whatever reason, the grant
was not to be continued or reduced, then appropriate changes to the
service offer would be made to reflect this.
29. The grant must be spent within the financial year in which it is allocated, and this must be reported upon each year. Public Health and Finance colleagues have worked together to ensure that the appropriate financial controls are in place for the effective spending and reporting of the grant.
Wards Impacted
30. All wards are impacted by the implications within this report.
Contact details
For further information please contact the authors of this Decision Report.
Author
|
Name: |
Peter Roderick |
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Job Title: |
Director of Public Health |
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Service Area: |
Public Health |
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Telephone: |
07511 160283 |
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Report approved: |
Yes |
|
Date: |
25/04/2024 |
Co-author
|
Name: |
Phil Truby |
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Job Title: |
Public Health Specialist Practitioner Advanced |
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Service Area: |
Public Health |
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Telephone: |
01904 553959 |
|
Report approved: |
Yes |
|
Date: |
25/04/2024 |
Annexes
· Annex A: Equalities Impact Assessment (EIA)