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Smoking Cessation Programme

Details of saving proposals

Background

The public health aspiration is to continue to drive down the use of tobacco in the borough:

  • stopping people starting smoking
  • helping people quit smoking
  • protecting people from the harmful effects of second hand smoke.

Stopping smoking is amongst the most important measures that an individual can take to improve their health. Within a year, an individual's chance of heart disease is halved and in five years the risk of lung cancer is halved. Tower Hamlets has amongst the highest level of premature death from smoking related diseases in the country and this is why offering universal smoking cessation services has been such a priority. Services support 1500-2000 to stop smoking each year in Tower Hamlets.

Current investment

  • Smoking cessation services provided in pharmacies £330k
  • Enforcement of no smoking legislation in pubs and restaurants and public areas £263k
  • Specialised smoking cessation service - 1-1 and group intensive smoking cessation support for smokers with higher needs such as long term addiction, pregnant smokers, smokers with chest conditions £227k and Specialist service drug costs £45k
  • Targeted smoking cessation for black and minority ethnic(BME) groups - 1-1 and group tobacco and smoking cessation support for tobacco chewers and smokers from BME groups £213k
  • Smoking cessation in GP surgeries – support to quit smoking through GPs and GP practices  £200k
  • Peer education tobacco – educational programme for young people on the risks of smoking delivered in schools and youth centres £80k.

Proposed budget reductions 16/17 and 17/18

  • Smoking cessation in pharmacies (£330k) reduce by £117 in 16/17 and a further reduction of £17k (17/18)
  • Tobacco control (£263k) – reduce by £163k
  • Specialist smoking cessation service (£226k)  reduce by £5k in 16/17 and further reduction £5k (17/18)
  • Targeted smoking cessation  (£213k) BME groups reduce by £5k in 16/17  and further reduction £5k (17/18)
  • GP practice smoking cessation services (£200k) reduce by £20k in 16/17 and by a further £80k in 17/18
  • Peer Education tobacco (£80k)  reduce by £80k from 16/17.

Summary

From a base budget of £1,367,940 we are proposing a saving of £407,000 in 2016-17 and a full year saving of £512,000 in 2017-18.

Implications

Tower Hamlets residents continue to have higher rates of smoking than the national or regional averages with smoking especially prevalent in particular demographic groups. Supporting people to stop smoking is one of the most cost effective and health enhancing public health intervention that not only reduces mortality and morbidity but has a significant impact on reducing health inequalities.

As elsewhere, smoking prevalence has been falling steadily in Tower Hamlets over the past ten years. In 2005 prevalence was estimated at 29 per cent and the most recent estimate is 22 per cent. This fall is likely to have been driven by the smoking ban, e-cigarettes and changing societal attitudes. However, it is important to recognise that these falls have been less marked in more deprived groups and smoking therefore remains an important driver of heath inequalities. For these reasons, it has been the approach to reduce the provision of universal services (in line with the reduction in footfall) and to preserve the more specialised and targeted services.

Smoking cessation service in pharmacies (£330k) reduce by £117k and further reduction £17k (17/18)

We are proposing to make savings by reducing the length of the treatment programme provided by community pharmacies. Many smokers do not use the full amount of Nicotine Replacement Therapy (NRT) prescribed during a quit attempt either because four weeks combination supply is enough to last them six weeks, they quit but manage without using the full prescribed amount, or they chose to buy electronic cigarettes. This results in a surplus of NRT prescribed and therefore waste.

The specialist services treatment programme will not be reduced for smokers who are more heavily addicted to nicotine e.g. smokers with mental illness. The varenicline treatment programme (an alternative nicotine substitute product)  also remains the same. This means that the same number of smokers can be helped but at lower cost. We are exploring a payment mechanism that will ensure that pharmacies are only paid fees if there is a successful quit at the end of the programme.

Specialist smoking cessation service (£226k)  reduce by £5k from 16/17 and further reduction £5k (17/18), specialised service drug costs (£45k) reduce by £15k from 16/17 & Targeted smoking cessation  (£213k) BME groups reduce by £5k  and further reduction £5k (17/18)

The changes to the GP Network Improvement Service (NIS) will see an increased footfall, of approximately 2,000 smokers, into the specialist service stop smoking service and Black and Minority Ethnic (BME) tobacco project combined in 2016/17. 42 per cent of these smokers will come from BME groups. As the service provides a more effective and specialised service than GPs can offer the quit rate will increase from 22 per cent to over 50 per cent. This will reduce the cost per quitter. In addition there will be a reduction in prescribing costs due to the following:

  • pick up of some prescribing costs for those patients supported by the specialist service or BME tobacco project within GP practice settings
  • reduction in specialist treatment programme of Nicotine Replacement Therapy (NRT) (with the exception of pregnant smokers)
  • increased use of electronic cigarettes leading to a reduction in smokers offered NRT and/or varenicline programmes.

GP practice smoking cessation services (£200k) reduce by £20k in 16/17 and a further £80k in 17/18

As described above the smoking cessation support practice in GP practices in the borough will change so that smokers that need sustained support will be referred by GPs to the specialist services that will operate from the GP practices. This will reduce the cost per quitter and provide a higher quality level of support. The aim of the changed approach is to increase the number of smokers receiving support as some GP networks (not all) have not been very successful at providing support for smoking cessation.

Tobacco control – reduce by £163k from 16/17

The funding that is provided to the council`s Environmental  Health Consumer Team to undertake checks on illegal counterfeit cigarette sales, underage sales, smoke free premises and public vehicles, etc, can be reduced because the evidence is that there is generally a good level of compliance compared to three years ago. Some funding will still be available for these activities and appropriate checks on commercial premises will continue to be undertaken.

Peer Education tobacco (£80k) reduce by £80k

It is proposed to discontinue the peer education smoking cessation programme that is funded by Public Health as smoking awareness education is still provided through school PSHE activity,  the School Health programme and the Council`s Healthy Schools team.

Public Health is working with Youth Services through the Youth Service Review to develop a health-promoting youth service and mainstream this throughout the borough youth provision in order to maintain and improve the outputs of peer education programmes. Tobacco will be included as a key theme in this.

Impact on key local or national targets

The changes proposed are not anticipated to have a detrimental impact on local or national stop smoking targets and the effectiveness of the services are likely to increase as both the specialist and BME services have a higher  successful quit rates compared to the previous configuration of services in Primary Care.

It is also expected that there will be a Commissioning for Quality and Innovation (CQUIN) target for referrals implemented at the Royal London Hospital. CQUINS are additional targets that are set to provide incentives for services to undertake extra work to meet challenging targets. The CQUIN should significantly improve the identification and referral of smokers from the acute hospital and so increase the access and referrals of patients to cessation services.

It is also proposed to allocate some of the additional funding allocated to the borough`s Vanguard service integration programme (a government initiative) to put a stronger focus on smoking cessation in the whole range of services delivered by the borough`s main acute services provider, Barts Health.

You can review the smoking cessation programme equalities screening.


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