Quality summary report: Stop Smoking Service

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1 Quality summary report: Stop Smoking Service CLCH Quality Report Jan Dec 2011 Service exact name CLCH Stop Smoking Services (Barnet, Kensington & Chelsea, Westminster) Address line 1 Address line 2 Town/city County Postcode No. beds Website Main telephone Completed by Isaac Ojo / Hena Jamshed / Olga Gozdzikowska Approval Ivan Okyere-Boakye

2 CLCH Quality Report 2011 Summary report for Stop Smoking Service Directorate Children, Family, Health and Well-being Service area Stop Smoking Service Boroughs Barnet Kensington & Chelsea Hammersmith & Fulham Westminster CQC statement of purpose for this service Smoking is the leading single preventable cause of death and disease in the UK. It is one of the most significant contributing factors to life expectancy, health inequalities and ill health, particularly cancer, coronary heart disease and respiratory disease. The primary role of NHS Stop Smoking Services is to provide a high-quality clinical smoking cessation service to their local population. NHS Stop Smoking Services sit within the overall tobacco control programme and form a part of wider action to reduce local smoking prevalence. Since the start of NHS stop smoking services, there has been a big reduction in smoking rate nationally. There are 3 Stop Smoking Services within the Central London Community Healthcare Trust Barnet, Kensington & Chelsea and Westminster. Stop Smoking Services are targeted at all smokers that live, work, or are registered with GP in these 3 boroughs. Support to quit smoking is delivered in group and on one-to-one basis. Clinics are set up and run in different settings; including GP Practices, Pharmacies, work places, and Community Centres and at different times to allow for easy access by smokers wanting to quit smoking. The prevalence of smoking in the boroughs that the 3 Stop Smoking Services serve are between 17% and 19% compared to the national average of 21%. A recent review carried out by the Public Health department of INWL, the K & C stop smoking service was found to be very effective in targeting smokers from

3 deprived areas of the borough and also from routine and manual group. This is important because of the impact on health inequalities associated with deprivation and socio-economic groups. The Services are performing at either comparable success rate with national average or better. Success rates are 52%, 60% and 70% in Kensington & Chelsea, Westminster, and Barnet respectively. The rate of those lost to follow up in Kensington & Chelsea is higher than national average; access to communities with high level of deprivation has been a challenge in Westminster, Engaging GP Practices and Pharmacies have been a challenge in Barnet. Increasing the rate of service users validated by CO Monitoring; reducing rate of those lost to follow up; increasing access to services by those living in areas of high deprivation, and increasing conversion rates in Pharmacies and GP Practices will be priorities for the 3 services in the coming year. Overall summary of quality performance and next steps Service delivery has been effective and of good quality for the 3 services in that it is in good demand by residents; its general success rate has either been better or comparable to national average; and it is successfully targeting the right people (those that really need it). Advisors are trained to high standard before they can deliver support to patients, they are well supervised and adequate feedback given to them to help them improve their service delivery practice, and they adhere to strict quality protocols and standard. The success of this approach is evident in that there was 0 incident in the year. In a recent review carried out by the Public Health department of INWL, the K & C stop smoking service has been found to be very effective in targeting smokers from deprived areas of the borough and also from routine and manual group. This is important because these are the group that need the service the most and as such has a great impact on health inequalities that is always associated with geographical and other socio-economic deprivations. The Barnet stop smoking service has maintained an average of 2,000 quitters a year. 91% of service users that respond to survey stated that they were happy with the service and would recommend it to others. The rate of those accessing services in Kensington & Chelsea that become lost to

4 follow up has been greater than that expected. Also, success rate in pharmacies has not been as good as it could be. Westminster SSS had 2 incidents last year with low and minor severity. Both incidents were based on IT problems and didn t impact directly on patients. The service has various protocols in place to ensure safety is observed and risk is minimised. Safety and risk mitigation are one of the key issues covered during training, mentoring and on-going supervision. Increasing success rate for service delivery in pharmacies and reducing the rate of those lost to follow up will be priorities for Kensington & Chelsea in the coming year. Plans are underway to utilize best practice from Westminster to increase the success rate in K and C. In addition over 75% of Westminster quitters come from pharmacies, which have been identified as an effective and efficient way of providing stop smoking support. This approach will be shared with the K and C service to ensure service users have better access to services. Another priority for The Stop Smoking Service is to increase success rates at GP surgeries, group support, one-to-ones and pregnancy in the coming year. Safety Overview We aim to make our service as safe as possible at all times. All 3 Stop Smoking Services have robust protocols and guidelines in place to ensure safe delivery of services and also to monitor that all Community Advisors follow these protocols and guidelines. The fact that there was 0 incident in K&C, 0 in Barnet, and only 2 in Westminster in the year, evidence that the measures to ensure safety of patients have been successful. Below are some of the measures taken to ensure safety of patients and staff: 1) All Advisors go through training that adheres to the standards set by the

5 defunct Health Development Agency and adopted by the department of health before they start to run clinics. 2) Safety and risk mitigation are part of the issues covered during training and in supervision. 3) Medications for smoking cessation are only recommended after proper assessment for clinical suitability of those needing them. 4) Clinics are run in venues assessed and deemed safe for patients and staff 5) Core staff members and bank staff are CRB-checked before they are allowed direct contact with patients. 6) Advisors that are not directly managed come from organisations where we are sure they would have been CRB-checked for the work they do. 7) Carbon monoxide monitors are calibrated every six months and infection control procedures are in place to prevent cross infection Key achievements this year In our risk assessment last year, we identified a number of issues that could, potentially, impact on safety of patients and staff. Such issues included lack of adequate information to patients on their medications; inadequate clarity in the forms sent to doctors for prescription request; lack of clinical supervision to the team members; and issues around safety of vulnerable service users such as young people. In the year, we: 1) Developed informational materials on medications to be given to patients 2) We changed and improved the clarity of the form used to make request for prescription of Champix 3) We established regular supervision sessions for the core team 4) We developed a generic risk assessment to be used by people wanting to set up stop smoking services in their organisation 5) We identified a need to review the lone working policy particularly evening sessions and home visiting. These are being reviewed and will be implemented in the coming year. Key results Total incidents Jan-Dec 2011 by category

6 Degree of harm Low Minor Medium High Catastrophic 1 1 Level of reporting: Incidents are recorded on Datix, in every case in Westminster. Kensington & Chelsea have not had any incident in the year and therefore nothing has been reported Themes arising As the graph and table above indicate, there have been only 2 minor incidents in the year of low to minor degree of harm and these had to do with IT system. Safety Actions Expected Named Improvement completion lead Actions for date 2012 Continue to focus on safety and ensure advisors are June 2012 Isaac / aware of all procedures. Hena / Maintain the incidence register April 2012 Lorrain e Implement monitoring of the lone working policy. End of year Isaac / Hena / Lorrain e Raise awareness to Level 2 advisors about infection control requirements on the usage of carbon monoxide machines and CO validation. On-going Isaac / Hena / Lorrain e

7 Effectiveness Overview We aim to achieve the best possible outcomes for patients by regularly checking to see that we are delivering care and treatment according to best practice standards. We are increasingly looking to measure and improve clinical and patient reported outcomes. NICE guidance relating to smoking cessation is fully implemented. Broadly speaking, effectiveness of service is measured in terms of the number needing stop smoking services and whether or not we achieve the DH target of target in terms of the total number successfully quitting smoking at 4-week follow up. The 3 Services achieved the DH targets with success rates comparable to or above the national average. Evaluation showed that the services have been successful in targeting who live, work and are registered with GP Practices in the boroughs. Services have been successful in targeting those in routine and manual economic groups the groups that need the services the most. The Services face a number of challenges; including: Kensington & Chelsea Service having a higher than national average rate of those lost to follow up; Westminster Service looking for effective ways improve access to those in areas of high deprivation and Barnet Service looking to improve conversion rates in GP Practices and Pharmacies. Key achievements this year The 3 Services met and indeed over-performed their DH target in the year. In Kensington & Chelsea: A total of 2,249 smokers accessed services and set quit dates in the year 1,213 of them successfully quit smoking at 4-week follow up In Westminster: 1) A total of 3,587 smokers set quit date; 2) 2,250 of them successfully quit at 4-week follow up 3) 15% of these still remain quit at 52 week follow up.

8 In Barnet: 1) A total of 3,542 smokers set quit date; 2) 2,045 of them successfully quit at 4-week follow up We have also successfully expanded the services to some key setting such as Royal Brompton and Royal Marsden Hospital; we have increased the number of Community Advisors delivering the service; raised the awareness of the Service by residents through events that we deliver or support, and materials that we regularly send out. Key results.patient Reported Outcome Measures (PROMs) No PROMS were completed; however, the Westminster SSS used a post session feedback questionnaires which showed that patients were happy. The majority of responders reported that they were satisfied with the level of access they had with the service and also that they had Advisors. However, whilst the benefits of stopping smoking may not be realised at the 6 week stage, the service may implement of PROM at the 6 week period (rather than during the treatment) to measure the outcome of the 6 week session. PROMS will be implemented from June Actions are listed below. PROM for 2012: Mid Feb ) Meeting CLCH Clinical governance manager to find information and get understanding of PROMS. 2) All the information and study will be done to implement PROMS. (Hena Jamshed) 3) The commissioners will be informed and invited to a meeting by mid Mar 2012 so that we can facilitate the process from GP and Pharmacy contractors. (Hena Jamshed) 4) All the GPs and Pharmacist and clinical advisors will be sent letter to keep them updated on PROMS. May ) The Service newsletter will keep posting the progress on PROMS. Clinical Outcomes

9 Westminster SSS follows up patients who have stopped smoking for 52 weeks. About 15% of Westminster 4 week quitters manage to remain non-smokers for at least a period of 52 weeks. Other measures of effectiveness The 3 services have been effective in engaging GP practices and pharmacists by routinely training and up-skilling their staff. This has increased the effectiveness of the service as patients are able to access the service in a variety of settings. NICE compliance The following NICE guidance is either fully or partially relevant to this service: PH1 - Brief interventions and referral for smoking cessation in primary care and other settings PH5 - Workplace health promotion: how to help employees to stop smoking PH10 - Smoking cessation services PH26 Quitting smoking in pregnancy and following childbirth TA39 - Guidance on the use of nicotine replacement therapy (NRT) and bupropion for smoking cessation TA123 - Varenicline for smoking cessation CG Lung Cancer CG 127 Hypertension CG 130 Hyperglycaemia in ACS To ensure that we are complying with these best practice guidance, we have carried out the following actions in 2011: NICE related education included in Level 2 smoking cessation training Permanently have on team meeting agenda discussion of issues raised by new guidelines from NICE. Quarterly NICE related education for staff has been organised with the aim to improve quality of the service [If relevant, identify any existing barriers for putting guidelines into operation and

10 explain next steps to tackle these] Research and innovation From 2012, we are to have a SMS service in place for patient appointment reminders to minimise those that did not attend and to reach more smokers. What the patients say about the outcomes of their care and treatment I was a smoker for about forty years, I really didn't believe I would ever be a nonsmoker, but now I am. Receptionists and counsellors were really friendly and helpful and thanks to them I am saving health and money not to mention all the other benefits of not smoking. Also my husband gave up as well as me so on behalf of both of us thank you very much. I have smoked for over 30 years but after one appointment at the Edgware hospital clinic and medication I have not had a cigarette in over 7 weeks. Clinical Effectiveness improvement actions Actions Better understanding of the effectiveness of service delivery in various settings i.e.; specialist, pharmacist or GP and spreading best practice across. Expected Named completion lead date on-going Isaac / Hena / Lorrain e Encourage all clients to provide evaluation feedback/prems Reducing lost to follow ups and DNA s on-going Isaac / Hena / Lorrain e Experience Overview We care about treating everybody with kindness, dignity and respect at all times. Feedback questionnaires have impacted on the way service is provided. For example; patients requested an on-going community group at St Mary s, which we

11 now provide. Services have a database of Advisors that speak languages other than English. This is useful in supporting patients that don t speak English. As part of the Level 2 training programme for the 3 services, there is a strong focus on motivational interviewing approaches and a non-judgemental way of working is emphasised. Key achievements this year We identified the following patient experience improvement actions in our 2010 Quality Report. This section outlines the progress we have made on each of them: 1) Westminster will like to explore if the period of medication provided can be increased. The current limit has been set by the Department of Health but clinicians can assess and recommend continued use 2) To increase workplace and community groups 3) Embed stop smoking across clinical pathways to access more patients 4) Distribute evaluation survey more widely and have a mechanism that ensures that evaluation questionnaire gets hard to reach groups. 5) Ensure compliments are recorded as per CLCH procedures. Patient survey results Patient surveys (known as Patient Reported Experience Measures PREMs) Summary of results for core patient experience measures (Aug-Dec 2011) Question Result for this service Trust-wide average % patients / carers rating overall experience good or excellent 98% 93% % patients saying they were definitely involved in planning their treatment 100% 56% % patients saying they were always treated with dignity & respect 97% 92% % patients saying they definitely understood 98% 88%

12 explanation % patients satisfied with waiting time 98% 74% Interpretation of PREM results The PREM results demonstrate that the stop smoking service strives and achieves high standards of care when treating their service users. 98% of patients rated their overall experience of the service as good or excellent. 100% of service users felt they are involved in planning their treatment which far exceeds the trust average. 98% of service users are happy with their waiting time when attending clinic. 98% of service users also felt that they understood the explanation of their care and treatment given to the by the Stop Smoking staff in all three boroughs where the service operates. 97% of service users felt they were treated with dignity and respect. PREM methodology The following table summarises the number of patients that responded to a PREM this year, and shows this as a percentage of all referrals during the survey period (August December 2011). Our aim was to achieve a representative view of patient feedback, so we set out to survey [insert survey approach eg all patients attending the service for one week each month; or all patients; or a random sample of patients every three months etc.]. PREM volume targets Total (Aug-Dec 2011) Number of patients who responded to a PREM 38 Total new referrals 761 % of new referrals who responded to a PREM 5% Target % of respondents 15% Target achieved? No

13 PREMS were not fully administered but most of the aspects from PREMS were monitored through service evaluation survey. However we have action plan to roll out PREMS from Feb 2012 and administer and implement PREMS from April Achievements 2011 Number of quits Number of quitters who responded to evaluation and said they are satisfied with the service= 91% Number of responders who said they will recommend the service to someone else= 100% The response rate from evaluation was about 30%, this response rate is not adequate but with implementing PREMS we shall improve this gap. Compliments and Complaints Compliments and Complaints Number of compliments Jan 2011 Dec 2011: 7 Number of complaints Jan 2011 Dec 2011: 0 Patient user groups and focus groups Other qualitative feedback None None What the patients say...as far as I can remember I finished using the patches on 25th February, nearly a month ago. I have resisted temptation of smoking since then. I am writing to say I am very grateful to you for your help and support, without which I could not give up smoking. Thank you very much... Many thanks for sending your team of nurses to do the smoking prevention classes which were a great success and made much impact here.... Many thanks for your help and support. Have a wonderful Christmas and a happy and healthy New Year

14 I have smoked for over 30 years but after one appointment at the Edgware hospital clinic and medication I have not had a cigarette in over 7 weeks. I found the counsellors very helpful, caring and supportive and I am sure that without their guidance and kind words I would still be smoking. Having attended the clinic for 6 weeks. Having found the support at the clinic so good I advised a relative, who has also been smoking for a number of years, to visit them for consultant and I am pleased to say they have stopped smoking. I was a smoker for about forty years, I really didn't believe I would ever be a nonsmoker, but now I am. Receptionists and counsellors were really friendly and helpful and thanks to them I am saving health and money not to mention all the other benefits of not smoking. Also my husband gave up as well as me so on behalf of both of us thank you very much. Patient experience Improvement Actions Action Expected completion Named lead date All calls are responded within 5 rings On-going Service Lead Anyone contacting service and leaving a message is responded within 24 hours All appointments are made within 3 days On On Service Lead Service Lead

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