Smokefree Portsmouth

Tobacco Control Strategy 2016-2020

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Foreword from Director of Public Health

Smoking continues to kill over 86,000 people in England, including over 300 people

in Portsmouth, every year. Smoking is the number one cause of preventable death in

the country. Tobacco use is also a powerful driver of health inequalities; there is a

significant difference in the risk of premature death and the burden of disease due to

smoking between social classes. Smoking is still one of the most significant public

health challenges we face today. Creating a smokefree generation is a key priority

for us and we will ensure that we focus on preventing young people from starting to

smoke to help achieve this.

As Director of Public Health for the city of Portsmouth I am conscious that these

inequalities are reflected in the population of our city which has an adult smoking

prevalence above the national average, and high rates of smoking among pregnant

women and young people.

I recognise the enormity of the challenge we face to promote a sustained reduction

in tobacco use. I support the vision and aims of this strategy which has been

developed collaboratively with local stakeholders and partners.

Our strategy focuses on prevention but we are also committed to providing the very

best services and support we can for those who wish to stop smoking. Whilst

working to reduce smoking prevalence through prevention and cessation activities,

we need to maintain our focus on protecting people, especially children, from the

harms caused by second-hand smoke.

We must maximise our collective impact on tobacco use by prioritising the full

tobacco control agenda and applying the latest evidence to influence our actions. If

we can prevent our young people from starting smoking we will see a whole new

generation of adults who will be free of the risk of poor health and premature death

relating to tobacco.

(insert signature)

Dr Janet Maxwell

Comment from Cabinet Member for Health and Social Care

As the Cabinet Member for Health and Social Care for Portsmouth City Council, I

welcome this strategy. I look forward to supporting the work of the Portsmouth

Tobacco Alliance and our partners to influence a reduction in the prevalence of

smoking in the city through preventing the uptake of smoking, particularly in young

people, and supporting existing smokers to quit.

(insert signature)

Cllr Luke Stubbs

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Contents

Foreword

Executive Summary Page 4

Introduction Page 5

National Picture Page 6

Local Picture Page 7

Our Strategy Page 9

Key Priorities Page 15

References Page 16

Appendix 1: Action Plan

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1. Executive Summary

The aim of the Smokefree Portsmouth: Tobacco Control Strategy 2016-2020 is to reduce ill health and preventable premature death by reducing the prevalence of smoking across the population of Portsmouth. The actions in the plan move Portsmouth towards best practice in tobacco control and are aligned with national recommendations. Our aim is to achieve a smokefree generation by 2025, ensuring that we focus on preventing young people from starting to smoke will help achieve this.

Smoking is the most important cause of preventable ill-health and premature death in England. Half of all regular smokers will be killed by their habit, and most of these deaths are due to cancers (particularly lung cancer), chronic obstructive pulmonary disease and circulatory disease. Every year in Portsmouth more than 300 people die from smoking-related illnesses. If the health of the people of Portsmouth is to be improved and health inequalities reduced, tobacco control must be a priority. Although Portsmouth has seen some notable achievements in tobacco control and cessation in recent years, Portsmouth continues to have an adult smoking prevalence above the national average and high rates of smoking in pregnancy and in young people.

The actions set out in this strategy consider the impact on those at risk of unequal health outcomes. In addition to the development of local interventions, we aim to enhance national activity and, where appropriate, collaborate with regional colleagues to increase the impact of our local actions.

We will focus on the three important areas of:

• Prevention – creating an environment where people choose not to smoke

• Protection – protecting everyone from second-hand smoke

• Cessation – helping people to quit smoking

Our key priorities for achieving a Smokefree Portsmouth are to:

1. Promote smokefree environments across the city 2. Provide leadership to create a smokefree city

3. Motivate every smoker to stop, assisting those that need help 4. Deliver effective communications and campaigns around the tobacco agenda 5. Develop a workforce confident and competent to help reduce the harms of

smoking 6. Improve health outcomes and reduce smoking related inequalities targeting

young people, pregnant women, adults in routine and manual occupations and adults with mental health disorders

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2. Introduction

This strategy promotes a tobacco control approach to create a tobacco-free generation by 2025 by helping children and young people not to take up smoking.

We will achieve this if we can reduce the smoking prevalence among young people aged 15 to 5% or lower.

Effective tobacco control is central to creating a tobacco-free generation. It recognises that people deserve to live in a city free from the harms caused by tobacco, where people choose not to smoke and enjoy longer, healthier lives. Creating a smokefree environment in homes, public spaces and the wider environment helps children and young people not to take up smoking themselves.

Portsmouth has seen some notable achievements in tobacco control and cessation in recent years including a reduction in the overall prevalence of smoking in the city from 29.6% in 2003/05 to 22.3% in 2013 and a reduction in smoking at the time of delivery from 21% in 2009/10 to 14.7% in 2014/15.

Despite these reductions Portsmouth continues to have an adult smoking prevalence above the national average, high rates of smoking in pregnancy and in young people.

Smoking is the biggest cause of health inequalities in the UK accounting for half the difference in life expectancy between richest and poorest, smoking rates in the most deprived communities in Portsmouth remain disproportionately high. The patterns of smoking prevalence rates are a direct cause of Portsmouth's continuing health inequalities. Therefore reducing smoking prevalence rates in the most deprived communities will make a significant contribution to reducing these health inequalities.

Our Vision

To improve the health of the people of Portsmouth by reducing inequalities caused by tobacco and by nurturing a tobacco-free generation.

Aim

This will be achieved through a reduction in the prevalence of smoking consistent with national targets and by addressing the wider tobacco control agenda. We aim to:

i. Reduce smoking prevalence in Portsmouth, both overall and in identified target groups

ii. Support local communities to create a tobacco-free culture for Portsmouth

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3. National Picture

Every day in England more than 200 people die from smoking-related illnesses. In 2013, around one in six (17 per cent) of all deaths among people aged 35 and over – around 79,700 people – were attributable to smoking1. Smoking causes more deaths every year than obesity, alcohol, road traffic accidents, illegal drugs and HIV combined2.

Smoking is the biggest cause of health inequalities in the UK accounting for half the difference in life expectancy between richest and poorest.

There is clear evidence3,4 that interventions such as the introduction of the smoking ban have led to a range of health benefits including reduced heart attack admissions to hospital, reduced childhood asthma admissions to hospital, and fewer premature births. However tobacco use remains one of the city's most significant public health challenges.

This strategy and the accompanying action plan take their shape from national legislation and guidance. On 1 October 2015 it became illegal:

for retailers to sell electronic cigarettes (e-cigarettes) or e-liquids to under 18s

for adults to buy (or try to buy) tobacco products or e-cigarettes for under 18s

to smoke in private vehicles that are carrying anyone under 18

'Healthy Lives, Healthy People: a tobacco control plan for England (2010-2015)'5 was

ambitious and progress over this period has been impressive - though some key

measures are yet to be implemented, including standardised packaging, and the EU

Tobacco Products Directive.

The Chief Medical Officer recognises that tobacco plays a role in perpetuating

poverty, deprivation and health inequalities. 'Fair Society, Healthy Lives: The Marmot

Review of Health (2010)'6 states that tobacco control is central to tackling health

inequalities as smoking accounts for approximately half of the difference in life

expectancy between the lowest and highest income groups.

The National Institute for Health and Care Excellence (NICE) provides national

guidance and advice to improve health and social care. It develops guidance,

standards and information on high quality health and social care, including those

around tobacco control. Guidance includes advice to the NHS, local authorities and

their partners on the range of services that should be available for everyone who

smokes or uses tobacco in any form. In particular, this includes pregnant women,

those aged under 20 years, manual workers and people who are on a low income or

income support.

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4. Local Picture

4.1 Health Impact

NB Updated local data from the Health and Lifestyle Survey about the prevalence of smoking among people aged 16+ years will be available in early 2016.

Smoking rates in the most deprived communities in Portsmouth remain disproportionately high. Half of all regular smokers will be killed by their habit, and most of these deaths are due to cancers (particularly lung cancer), chronic obstructive pulmonary disease and circulatory disease. Every year in Portsmouth more than 300 people die from smoking related illnesses.

Between 2003/05 to 2014/15, the prevalence of adults who smoke in Portsmouth declined from 29.6% to 22.3%.There has also been a reduction in smoking in pregnancy measured at the time of delivery from 21% in 2009/10 to 14.7% in 2014/15.

Despite these encouraging local trends, Portsmouth's Tobacco Control Profile7 shows that compared to England, Portsmouth has significantly higher rates of smoking prevalence and deaths from some smoking related diseases as in the table below:

Selected Tobacco Control Profile indicators with a significant (adverse) difference between Portsmouth and England

Portsmouth England

Smoking prevalence in adults - current smokers 2014 21.7% 18.0%

Smoking prevalence in adults - never smoked, 2014 42.9% 48.1%

Smoking prevalence in adults in routine and manual occupations - never smoked, 2014

34.7% 41.2%

Smoking prevalence at age 15 years - regular smokers, 2014/15

10.3% 8.7%

Smoking prevalence at age 15 years - current smokers, 2014/15

10.9% 8.2%

Deaths from chronic obstructive pulmonary disease, per (100,000 population), 2012-14

73.0 51.7

Deaths from lung cancer, per 100,000 population, 2012-14 69.4 59.5

(Public Health England, 2015)

Smoking rates remain much higher within more socio-economically deprived communities, and people who are long-term unemployed are significantly more likely to smoke. Smoking is about twice as common among people with mental health disorders, and more so in those with more severe disorders (estimates vary between 37% and 56%8).

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4.2 Economic Impact

According to estimates generated by Action on Smoking and Health, smoking costs

society in Portsmouth approximately £57.1 million per year9.

Figures 2 and 3 show the impact on the local economy in direct financial terms,

including the cost of smoking related illnesses, the loss of working days, productivity,

NHS and social care costs and domestic fires.

Figure 2.Taxation and costs of smoking in Portsmouth. An estimate by ASH

Figure 3.The cost of smoking in Portsmouth. An estimate by ASH

£57.10

£35.08

0.00 10.00 20.00 30.00 40.00 50.00 60.00

Total local costof tobacco

Total local contributionin tobacco duty

£millions

Smoking costs vs taxation in your area (£millions) Portsmouth UA

£0.52 £0.77

£3.93 £5.21

£7.48

£14.68

£24.51

£0.0

£5.0

£10.0

£15.0

£20.0

£25.0

£30.0

Cost to society (£millions)

Estimated cost of smoking in your area (£millions)

Portsmouth UA

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5. Our Strategy

5.1 Target groups

Over the next decade, this strategy aims to increase actions to accelerate the rate of decline in smoking prevalence within Portsmouth by reducing smoking:

among 15-year-olds (regular smokers) to 9% per cent by 2020 and 2% by

2025

among pregnant women to 8% by 2020 and 5% by 2025

in the routine and manual socio-economic group to 21% by 2020 and 16% by 2025

in the adult population to 13% by 2020 and 9% by 2025

Smoking prevalence in 15 year olds

In England, it is estimated that one in eight children become regular smokers by the age of 15 years. Research from Cancer Research UK has shown that trying just one cigarette can make children more likely to start smoking later in life. Children who smoke are more likely to suffer immediate health consequences such as coughs, increased phlegm, wheezing and shortness of breath and also to take more time off school10.

The Portsmouth secondary school 'You Say' Survey 201511 reports that 80% of pupils have never tried tobacco (a slight decrease from 82% in 2014 and 83% in 2013), and that friends are the most common source of cigarettes/tobacco.

The best way to reduce smoking amongst young people is to reduce the visibility and culture of tobacco in the world around them12.

Smoking in pregnancy

Between 2013/14 and 2014/15, the percentage of the city's pregnant women still smoking at the time their babies were delivered decreased from 15.4% to 14.7%. However, the latter figure is still higher than the national average of 11.4%. The percentage of women whose smoking status was 'not known' at time of delivery has increased from 0% to 3% in the last two years.

Figure 4. Percentage of women smoking at time of delivery. Source: The Health and Social Care

Information Centre, Lifestyle Statistics / Omnibus

0

5

10

15

20

25

% S

mo

kin

g at

tim

e o

f d

eliv

ery

Percentage of Portsmouth women smoking at time of delivery compared to England (incorporating future local targets)

England

Portsmouth

Target

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Smoking prevalence in adults (over 18s)

Estimated prevalence for 2014 indicates that 21.7% of Portsmouth adults (aged 18 years and above) smoke - significantly higher than the estimated prevalence for the South East region (16.6%) and for England (18%). The prevalence of adult smoking in Portsmouth has decreased annually since 2010, but the decrease is not statistically significant.

Figure 5. Portsmouth smoking prevalence. Source: Integrated Household Survey via Local Tobacco

Control Profiles, Public Health England.

Our approach to creating a smokefree city is by addressing the following three key strands of activity:

• Prevention – creating an environment where people choose not to smoke

• Protection – protecting everyone from second-hand smoke

• Cessation – helping people to quit smoking

5.2 Prevention

There are many risk factors associated with increased likelihood of youth smoking

including whether a parent, carer or sibling smokes. Lower socio-economic status,

higher levels of truancy and substance misuse are all associated with higher rates of

youth smoking. The impact of interventions aimed at reducing smoking prevalence in

young people are considered more effective when delivered as a package of cross-

cutting tobacco control measures within schools and wider community settings13.

Children are more likely to take up smoking if they live with people who smoke. It is

estimated that two thirds of adult smokers start before the age of 18 years.

Children and young people have a right to access health-related information and

education, including in relation to harmful substances such as tobacco14. When

0

5

10

15

20

25

30

35

% A

du

lt s

mo

kin

g p

reva

len

ce

Smoking prevalence in Portsmouth adults (over 18s) compared to England (incorporating future local trends)

England

Portsmouth

Target

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communicating with young people about the impacts of tobacco, it is important that

information is delivered in a style and format that reflects the needs of the target

audience.

5.3 Protection

Second-hand Smoke

Exposure to other people's tobacco smoke is also a cause of ill health. Second-hand smoke has been shown to cause:

• Lung cancer and heart disease in adult non-smokers

• Increased sensitivity and reduced lung function in people with asthma

• Irritation of the eye, nose and throat

• Reduced lung function in adults who do not have chronic chest problems.

The harms to health from second-hand smoke can impact on the wider determinants of health including school attendance and sickness absence rates at work.

We need to ensure that pregnant women, wider family circles and communities are supported to reduce risks relating to smoking during pregnancy and the harms of second-hand smoke to pregnant women and unborn children.

Smokefree environments

Professionals within all partner agencies should feel confident and competent to ask

pupils, clients or patients about smoking and signpost individuals towards effective

support to cessation smoking.

Increasing the number of smokefree areas in Portsmouth will reduce children’s

exposure to smoking. Parents and other adults can act as positive role models to

demonstrate that smoking is not the ‘usual’ thing to do.

Not all smokefree areas will be eligible for enforcement; however setting up

smokefree play parks has been shown to be effective in eliciting voluntary

compliance from smokers.

Increasing the number of smokefree environments across the city will also help to reduce litter and associated issues whilst providing opportunities for community involvement and ownership.

5.4 Cessation

Smoking cessation service model in the city

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There are currently four providers of smoking cessation services in the city with additional services signposting and offering support to individuals. The mixed model of services includes:

the Wellbeing Service

General Practitioners

Pharmacies

Young Person's Service

The Wellbeing Service and key hubs across the city work with individuals and families to understand and support them with identifying and addressing lifestyle issues such as smoking, healthy weight, physical activity and alcohol as well as issues such as housing and financial needs..

Alongside this work, the Making Every Contact Count model will be implemented. This model seeks to equip the wider workforce with the knowledge, skills, and confidence to deliver brief advice and signposting for health improvement to the individuals they come into contact with.

MECC will be rolled out in a range of settings across the city including workplaces, children's centres, community centres, hospitals and healthcare settings, and retail environments.

5.5 Key Partners

Tobacco control is a key priority within the Joint Health & Well-being Strategy 2014-2017 to help reduce inequalities across the city.

Working in partnership with a wide range of partners across the city is key to creating a smokefree generation. The priorities of this strategy will be addressed by working with schools, local communities, the private sector, the NHS, the fire service, voluntary sector and a range of departments across the council.

The role of regulatory, environmental health and health services in supporting the tobacco control agenda are highlighted below.

Regulatory services:

ensure tobacco advertising complies with the restrictions on displays and

advertising in shops/pubs; this involves responding to complaints, providing

advice to relevant businesses and performing inspection of businesses

ensure tobacco products bear the required health warnings

prevent sales of tobacco and related products to persons under the age of 18

years by the provision of advice to businesses, test-purchasing using volunteers

and carrying out enforcement action when required

prevent the sale of non-duty- paid and counterfeit tobacco products by means of

inspections, responding to complaints, advice to businesses, and seizing illegal

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products; such products are often much cheaper than duty paid/genuine

cigarettes and frequently cause greater harm to health.

Environmental Health:

enforce smokefree legislation, which restricts smoking in many public places and

workplaces (including public transport and work vehicles)

ensure appropriate signage is displayed in premises which are required to be

smokefree and enforcement action can be taken against individuals smoking in

these premises

ensure compliance with the law. Compliance has been high in Portsmouth which

has had a positive impact on public health and supports those who wish to stop

smoking. However increasing visibility of smokers outside premises is an issue.

Health services:

are supporting actions to reduce smoking rates in pregnant women and in those

with mental health disorders

are working with us to develop smokefree NHS sites across the city which will

benefit staff, patients and visitors to these premises

5.6 Return on investment

It has been shown that for every £1 invested in smoking cessation £10 is saved in future health care costs and health gains15.

Reducing smoking prevalence by 1 percentage point a year over 10 years would prevent 69,000 premature deaths16.

ASH commissioned research has, for the first time, estimated the cost of smoking to the social care system. The research shows that smoking not only contributes to the social care bill but also has a significant impact on the wellbeing of smokers who need care on average nine years earlier than non-smokers. Costs are also estimated for each local authority based on the size of their over 50s smoking population9.

The total spending on social care for adults aged 50 and over during 2012-2013 in Portsmouth was approximately £3,723,857. This represents 2,975 individuals requiring additional social care9.

5.7 E-Cigarettes

The use of e-cigarettes in England has increased over the past two years from an estimated 700,000 users in 2012 to 2.6 million in 201517. Nearly two out of five users are ex-smokers and three out of five are current smokers18,19,20. E-cigarette use amongst those who have never- smoked remains negligible.

Figure 6 shows that whilst the percentage of smokers trying to stop is declining, the use of e-cigarettes is continuing to rise.

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Figure 6. Support used in quit attempts as reported by the Royal College of Physicians

E-cigarettes are not currently regulated as medicines. However, plans have been

announced to regulate e-cigarettes as medicines from May 2016 but until then, they

are only covered by general product safety legislation. Compared to tobacco

products, e-cigarettes are significantly safer21 however we do not yet know the

effects on the body of long term use. There are clinical trials in progress to test the

quality, safety and effectiveness of e-cigarettes, but until these are complete, the

government is not in a position to provide specific advice or recommend their use.

The use of e-cigarettes remains a contentious tobacco control issue and we await

the updated findings of the Medicines and Healthcare Products Regulatory Agency

(MHRA) and NICE guidance before considering what further advice or action is

required locally regarding e-cigarettes.

5.8 Monitoring and evaluation

Portsmouth's Public Health Team will lead the implementation of the tobacco control plan for the city via the Tobacco Control Alliance; this is in partnership with stakeholders and partners who will be accountable for specific elements.

Delivery will be monitored by a small group of executive leads to provide strategic

leadership and direction for the implementation of the plan. Members may be co‐opted to the group according to work streams. Quarterly monitoring of the Action Plan will be the responsibility of this core group.

An annual review of progress will take place at the end of each year, providing the focus for the action plan for subsequent years. There will also be timely reports to Portsmouth Health and Wellbeing Board.

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Effective monitoring and evaluation across agencies will be key to ensuring that we can assess the breadth, impact and ongoing priorities for action.

6. Key Priorities

The priorities for achieving a Smokefree Portsmouth will be taken forward by working

with our key partners and implementing the Action Plan (Appendix 1).

Our Vision

To improve the health of the people of Portsmouth by reducing inequalities caused

by tobacco and by nurturing a tobacco-free generation.

Aim

This will be achieved through a reduction in the prevalence of smoking consistent

with national targets and by addressing the wider tobacco control agenda. We aim

to:

i. Reduce smoking prevalence in Portsmouth, both overall and in identified

target groups

ii. Support local communities to create a tobacco-free culture for Portsmouth

Our key priorities are to:

1. Promote smokefree environments across the city 2. Provide leadership to create a smokefree city

3. Motivate every smoker to stop, assisting those that need help

4. Deliver effective communications and campaigns around the tobacco agenda 5. Develop a workforce confident and competent to help reduce the harms of

smoking 6. Improve health outcomes and reduce smoking related inequalities targeting

young people, pregnant women, adults in routine and manual occupations and adults with mental health disorders

We will build on national, regional and local best practice to further develop local

actions and interventions. We aim to contribute and help shape national policy and

strategies where appropriate and collaborate with regional colleagues to increase the

impact of our local actions.

Success will not be achieved through any one measure. That is why this strategy

builds on a multi-faceted approach, balancing a range of national and local actions

that complement and reinforce each other.

We will work with local communities to seek commitment for creating a tobacco-free

generation and aim to take an asset based approach by identify and building on local

assets to help achieve our aims.

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7. References

1. Statistics on smoking: England (2014) Health and Social Care Information Centre, 2015.

2. ASH Fact Sheet (2014) Smoking statistics: Illness and death 3. Pell, Jill P., et al. "Smoke-free legislation and hospitalizations for acute coronary

syndrome." New England Journal of Medicine 359.5 (2008): 482-491. 4. Mackay, Daniel, et al. "Smoke-free legislation and hospitalizations for childhood

asthma." New England Journal of Medicine 363.12 (2010): 1139-1145. 5. Department of Health (2011) Healthy lives, Healthy People: A Tobacco Control

Plan for England 6. The Marmot Review (2010). ‘Fair Society, Healthy Lives’. 7. Public Health England (2015). Tobacco control profile.www.tobaccoprofiles.info/ 8. RCP and RCPsych (2013) Smoking and Mental Health 9. ASH Ready Reckoner (2014) Local Cost of Smoking

www.ash.org.uk/information/ash-local-toolkit 10. Cancer Research UK (2013) More than 200,000 UK children start smoking

every year

11. Portsmouth City Council (2015). You say survey of secondary school

pupils.https://hampshirehub-files.s3.amazonaws.com/5900755f-04bb-4e53-

9ca6-710244348464/20150703SubstanceMisuseSurveySchools2015FINAL.pdf

12. US Department of Health and Human Services. "Preventing tobacco use among youth and young adults: A report of the Surgeon General." Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health 3 (2012).

13. Public Health England (2015) Tobacco Control: JSNA support pack

www.gov.uk/government/publications/the‐tobacco‐control‐plan‐for‐england 14. UN Committee on the Rights of the Child (CRC). General comment No. 4

(2003): Adolescent Health and Development in the Context of the Convention on the Rights of the Child

15. Local Government Association (2013) Money Well Spent? Assessing the cost effectiveness and return of investment of public health interventions

16. Public Health England (2015) Comprehensive local tobacco control: why invest 17. ASH Fact Sheet (2015) Use of electronic cigarettes (vapourisers) among adults

in Great Britain 18. West, R. Electronic cigarettes in England: latest trends. Smoking Toolkit Study.

April 2014. http://www.smokinginengland.info/latest-statistics 19. Brown J, Beard E, Kotz D, Michie S & West R. Real-world effectiveness of e-

cigarettes when used to aid smoking cessation: a cross-sectional population study. Published online May 2014.

20. McRobbie H, Bullen C, Hartmann-Boyce J, Hajek P. Electronic cigarettes for smoking cessation and reduction. The Cochrane Library, Dec. 2014. DOI: 10.1002/14651858.CD010216.pub2

21. McNeill A et al. E-cigarettes: an evidence update. A report commissioned by Public Health England. PHE, 2015

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Bibliography

Action on Smoking and Health (ASH) (2013a). Smoking and disease. http://www.ash.org.uk/files/documents/ASH_94.pdf.

ASH (2013b). Smoking and mental health. http://www.ash.org.uk/files/documents/ASH_120.pdf

ASH. (2014). Smoking Statistics. http://www.ash.org.uk/files/documents/ASH_93.pdf

Department of Health (DH). (2011). Healthy lives, healthy people. A tobacco control plan for England. London. DH. https://www.gov.uk/government/publications/the-tobacco-control-plan-for-england

DH. (2013b). NHS Outcomes Framework 2014-2015. London: DH. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/256456/NHS_outcomes.pdf

Local Government Association. (LGA), (2012). Tackling tobacco. Local government's new public health role http://www.local.gov.uk/web/guest/publications//journal_content/56/10180/3811960/PUBLICATION

Lowry, C. and Scammell, K. (2013) (eds). Smoking in pregnancy; a call to action. London. ASH/

National Centre for Smoking Cessation and Training (NCST) (2012). Streamlined secondary care system project report. http://www.ncsct.co.uk/usr/pub/ncsct-streamlined-secondary-care-final-report.pdf

National Institute for Health and Clinical Excellence (NICE). (2012). Smokeless tobacco cessation - South Asian communities: guidance. http://guidance.nice.org.uk/PH39/Guidance/pdf/English

NHS commissioning board. (2012) Commissioning fact sheet for clinical commissioning groups. http://www.england.nhs.uk/wp-content/uploads/2012/09/fs-ccg-respon.pdf

NHS England (2014a). CCG outcomes indicator set- at a glance. http://www.england.nhs.uk/wp-content/uploads/2013/12/ccg-ois-1415-at-a-glance.pdf

NICE. (2013a). Smoking cessation - acute, maternity and mental health services: guidance. http://guidance.nice.org.uk/PH48/Guidance/pdf/English

NICE. (2013b). Tobacco - harm-reduction approaches to smoking: guidance. http://guidance.nice.org.uk/PH45/Guidance/pdf/English

Smokefree Action Coalition (2013). Local Declaration for Tobacco Control. http://www.smokefreeaction.org.uk/declaration.

Portsmouth Health and Wellbeing Board (2014). Joint Health and Wellbeing Strategy, 2014-2017 https://www.portsmouth.gov.uk/ext/documents-external/hlth-jhwellbeingstrategy2014-17.pdf

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Appendix 1: Action Plan

Portsmouth Tobacco Control Action Plan 2016-2020 Outcome Measures:

Young People

PHOF Outcomes

Portsmouth 2014/2015

England 2014/2015

Portsmouth Target 2015/2016

Portsmouth Target 2020

Portsmouth Target 2025

2.09i Smoking prevalence at age 15- current smoker

10.9% 8.2% 10% 9% 2%

2.09ii Smoking prevalence at age 15- regular smoker

10.3% 8.7% 10% 9% 2%

2.09iii Smoking prevalence at age 15- occasional smokers

4.2% 3.9% 3.5% 3% 2%

PH Young Persons Outcomes: 2013/2014 2014/2015 2015/2016 Target 2020 Target 2025 Target

5a % of schools engaged in programme

50 50 80 100 100

5b Number of new young people engaged with service (one to one)

99 36 100 100 100

5c Number of under 18s setting a quit date

75 30 50 50 50

19

Pregnancy, at time of delivery & within 12 months after child birth

PHOF Outcome Portsmouth 2014/15 England 2014/2015

Portsmouth Target 2015/2016

Portsmouth Target 2020

Portsmouth Target 2025

2.03 Smoking status at time of delivery

14.7% 11.4% 12% 8% 5%

2.1 Low birth weight of term babies

3% 2.9%

4.1 Infant mortality (per 1,000 live births)

2 (2011-13) 4 (2011-13)

Prevalence

PHOF Outcome Portsmouth 2014 England 2014

Portsmouth Target 2016

Portsmouth Target 2020

Portsmouth Target 2025

2.14 Smoking Prevalence 21.7%

18% 18% 13% 9%

Routine & Manual Workers

PHOF Outcome Portsmouth 2014 England 2014

Portsmouth Target 2016

Portsmouth Target 2020

Portsmouth Target 2025

2.14 Smoking Prevalence- routine & manual

27.2% 26.4% 26% 21% 16%

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Ref. Objective Actions Targets Timescale

Lead

Progress

Aim 1. To reduce smoking prevalence in Portsmouth, both overall and in identified target groups

1.1 Reduce tobacco uptake and use, in young people (under 18s)

Implement the Young Persons Peer Support Programme across schools in Portsmouth

all secondary schools to be engaged and set to deliver a peer education programme

Sept 2016 Andy Caldow 2 schools currently engaged with programme

1 primary school to pilot the programme

Sept 2016 Andy Caldow

Provide appropriate training, support and resources to both primary & secondary schools

2 sessions to be delivered city wide with representation from each secondary school

Sept 2016 Andy Caldow

Use effective marketing and communications campaigns aimed at young people

all college sites to run no smoking day and stoptober campaigns

Oct 2016 Andy Caldow & Cheryl Morgan

Anti-smoking activities aimed to develop decision-making skills and include strategies for enhancing self-esteem. Parents and carers should be encouraged to get involved

1 secondary school to pilot whole family support programme

Sept 2016 Andy Caldow & Gethin Jones

Work with educational establishments to design, deliver, monitor and evaluate smoking prevention activities and policy

PH young person's smoking cessation and prevention team to support smoking agenda work as part of the new Public Health Schools & College Programme

Pilot to run sept 2016-July

Andy Ames

21

Ref. Objective Actions Targets Timescale

Lead

Progress

Deliver and evaluate an effective service to support young people to quit smoking

Targets: Number of new young people engaged with service= 100 Number of under 18s setting a quit date= 50% of those engaged

Sept 2015- August 2016

Andy Caldow

Training and support offer to wider children's workforce

Develop and deliver training for newly established multi agency teams

Sept 2016 Andy Caldow

Develop and deliver new MECC bolt-on course specific to tobacco control agenda

March 2016 Andy Caldow

Carry out You Say survey across the city to all year 8 and year 10 students

Additional question added on e-cigarettes

Feb-Oct 2016

Andy Ames

Research with young people to shape a prevention and cessation service suitable to their needs

Research action plan to be agreed

April 2016 Sam Hibberd

Continuation of the proxy sales reporting scheme 'Proxywatch'

Trading standards to biannually update Tobacco Control Lead on enforcement and actions

June 2016 Peter Emmett

1.2 Reduce prevalence of smoking in

Work in partnership with maternity services and other stakeholders to

Maternity representation at the Tobacco Control Alliance

Ongoing Jane Parker-Wisdom

22

Ref. Objective Actions Targets Timescale

Lead

Progress

pregnancy, at time of delivery and within 12 months after child birth

ensure compliance with "Smoking in pregnancy; a call to action' (2013)

& Smokefree Committee meetings

Identify opportunities for improving support to reduce smoking rates in pregnant women

Agree and confirm suitable community/ hospital venues for wellbeing clinics to run from (to be delivered by the integrated wellbeing service)

April 2016 Gethin Jones

Use effective marketing and communications campaigns aimed at pregnant women

Work with hospital communications team to deliver joint campaigns

First campaign by March 2016

Cheryl Morgan & Gill Walton

Identifying pregnant women who smoke and referring them to the appropriate service:

GP

Pharmacy

Integrated Wellbeing Service

All midwives to CO test all pregnant women and refer all women who smoke

Ongoing Gill Walton

Pregnant women who have quit smoking in the last two weeks to be referred to the wellbeing service

Ongoing Gill Walton

Monitor and evaluate the implementation of Carbon Monoxide monitoring for all pregnant women and compliance with national recommendations

Feb 2016 the ongoing

Gill Walton

Identify partners of pregnant women and others in the household who smoke

All maternity and integrated wellbeing staff to have completed smokefree home

August 2016

Gill Walton

23

Ref. Objective Actions Targets Timescale

Lead

Progress

and smokefree cars online training

Consultation with pregnant women to help shape future support

Consultation action plan to be agreed

March 2016 Sam Hibberd & Hannah Byrne

Establish feasibility of training a cohort of midwives to have a specialist stop-smoking advisor role

Dates set for training and implementation

May 2016 Sam Hibberd & Gill Walton

Identifying pregnant women who smoke and referring them to appropriate service– action for others in the public, community and voluntary sectors (including: GPs, practice nurses, health visitors and family nurses.

MECC training offered city wide, with additional tobacco bolt on

Ongoing Lee Loveless

24

Ref. Objective Actions Targets Timescale

Lead

Progress

Obstetricians, paediatricians, sonographers and other members of the maternity team (apart from midwives). Those working in youth and teenage pregnancy services, children's centres and social services. Those working in fertility clinics, dental practices, community pharmacies and voluntary and community organisations.)

Promote free NCSCT online training:

Smokefree homes

Smokefree cars

Very Brief Advice

Sam Hibberd

1.3 Provide effective leadership of the local tobacco agenda

Finalise Portsmouth Tobacco Control Strategy and Action Plan

Strategy to be sign off by Health & Wellbeing Board

Feb 2016 Sam Hibberd Draft complete

Quarterly action plan monitoring

Progress reports produces for DMT/ OMT

April 2016 July 2016 Oct 2016 Jan 2017

Sam Hibberd

1.4 Motivate & assist every smoker to stop

Develop a workforce confident and competent to help reduce the harms of smoking

MECC training offered city wide, with additional tobacco bolt on

Ongoing Lee Loveless

Promote free NCSCT online training on hospital ESR system:

(TBC)

25

Ref. Objective Actions Targets Timescale

Lead

Progress

• Smokefree homes • Smokefree cars • Very Brief Advice

Dental Academy to train all students to be able to deliver smoking very brief advice supported by the integrated wellbeing service

Jo-Anne Taylor & Gethin Jones

Explore services models to accommodate smokers who choose to use e-cigarettes as their choice of nicotine replacement while quitting.

Evidence based review of services and approaches to supporting e-cigarette users

Sept 2016 Dan Williams

Commission and monitor effective behavioural change services which will support smokers to quit

Evaluation of current integrated wellbeing service

Jan 2017 Mary Shek

Implement local target setting and the promotion of 12 week quit programmes, place a greater emphasis on reducing prevalence rather than the proxy measure of numbers of four week quitters

Integrated wellbeing service to follow 12 week quit recommendation

April 2016 Gethin Jones

Re-commission Locally Commissioned Services, including

GP

Pharmacies

New contracts in place by 1st July 2016

July 2016 Barry Dickinson Service specification currently being amended

Ensure quality assurance and consistency of smoking cessation

Quarterly monitoring reports April 2016 (TBC)

26

Ref. Objective Actions Targets Timescale

Lead

Progress

support across the city

Evaluate the role and use of stop smoking champions within QA Hospital

Evaluation to be completed and plan of further implementation

April 2016 (TBC)

Develop and share a pathway for smoking services showing point of access into different services

Pathway to be completed and distributed

May 2016 Sam Hibberd

1.5 Improve health outcomes & reduce smoking related inequalities for the following targeted groups: -Adults with mental health disorders -Families living in poverty -BME communities

Use local intelligence to target interventions within vulnerable groups to achieve maximum population benefit

Evidence based review of cost effective interventions aimed at targeted groups

July 2016 Dan Williams

Consultation with BME communities to identify need, data collect methods and support preferences

Consultation action plan to be agreed

March 2016 Sam Hibberd

Improve health outcomes & reduce smoking related inequalities for the following targeted groups: •Adults in routine & manual occupations

Utilise Workplace Health agenda to target routine and manual employment sites across Portsmouth

Gain commitment from 12 local businesses to sign up to the Workplace Health Charter

March 2016 Holly Easlick 8 businesses currently committed

27

Ref. Objective Actions Targets Timescale

Lead

Progress

Aim 2 To support local communities to create a tobacco-free culture for Portsmouth

2.1 Promote smokefree environments across Portsmouth

Complete Public Health England CLEAR Assessment to identify any gaps in current Tobacco Control programme

Internal and external assessment complete

May 2016 Sam Hibberd Internal assessment underway

Consider launch of smokefree play parks across Portsmouth

Consultation to be carried out in relation to smokefree sites across Portsmouth, including smokefree play parks

July 2016 Sam Hibberd & Cheryl Morgan

Launch NHS Smokefree grounds at all sites in Portsmouth

Start of Solent NHS Smoke-free sites to launch by 1st October 2016

Oct 2016 (TBC)

Launch smokefree Portsmouth City Council sites

Collaboratively work with internal Workplace Health

Dec 2016 Sam Hibberd & (TBC)

Work with Environmental Health to ensure there is compliance with smokefree legislation

Environmental Health representation at the Tobacco Control Alliance

Ongoing Sam Hibberd

Tackling illegal tobacco by linking regionally to work in partnership with local authorities (including trading standards and public health), the police and HM Revenue and Customs (HMRC) to develop a co-ordinated approach

Trading standards to biannually update Tobacco Control Lead on enforcement and legislation actions

Ongoing Peter Emmett

Reducing exposure to second hand Promotion of smokefree Ongoing Sam Hibberd

28

Ref. Objective Actions Targets Timescale

Lead

Progress

smoke (protecting families and communities) through partnership working with wider alliance partners including services for children and families, maternity services, education, housing, businesses.

homes, smokefree cars and workplace health opportunities

2.2 Use local and national evidence to inform the development of local smokefree programmes & campaigns

Link to regional and national networks and respond to tobacco related consultations to influence policy based on local need

Contribute via Ongoing Sam Hibberd

Cascade key findings and provide regular updates on best practise in relation to tobacco control and smoking- including e-cigarettes

E-cigarettes to be a rolling agenda item of the Tobacco Control Alliance. Updates will be cascaded as appropriate

Ongoing Sam Hibberd

2.3 Work in partnership to influence national, regional & local policy and decision making for tobacco control

Use the One You national branding to deliver effective City-wide and targeted marketing and awareness campaigns

National One You Campaign to be launched April 2016

Ongoing Cheryl Morgan

On-going participation in local and regional networks including the Public Health Tobacco Control leads meetings quarterly and national Public Health England events

Send representation from Public Health Portsmouth when appropriate

Ongoing Sam Hibberd & Cheryl Morgan

PH Portsmouth will be represented at the Working Together to Tackle Illicit Tobacco in the South East

29

Ref. Objective Actions Targets Timescale

Lead

Progress

meeting

Protect tobacco control work from the commercial and vested interests of the tobacco industry- ensure compliance with World Health Organisation Framework Convention for Tobacco Control article 5.3. http://www.who.int/fctc/guidelines/adopted/article_5_3/en/

Ensuring all practice in tobacco control meets current ethical standards

Ongoing Sam Hibberd

Effective marketing and communications for tobacco control including LA support of national campaigns.

Follow national recommendations

Ongoing Sam Hibberd, Peter Emmett & Cheryl Morgan

Support Government action at national level through local level actions. Including actions to:

Make tobacco less affordable

Stop the promotion of tobacco

Follow Government recommendations and cascade relevant information

Ongoing Sam Hibberd

2.4 Exploit opportunities for improved collaborative working with key partners

Tobacco Control Alliance to be held biannually

Terms of Reference for Alliance to be agreed at next meeting

Next Tobacco Control Alliance: 26th January 2016

Sam Hibberd

30

Ref. Objective Actions Targets Timescale

Lead

Progress

Effective joint marketing and communications relating to mass quit attempts (Stoptober and No Smoking Day).

Multi- agency city wide approach planned, delivered and evaluated for each campaign

Ongoing Cheryl Morgan