Relevant Previous Documents: Welsh Assembly Government Programme Level Agreement

Transcription

1 Stop Smoking Wales Annual Report

2 Authors: Stop Smoking Wales Editorial Group Date: 15/08/2011 Version: 1 Status: Final Relevant Previous Documents: Welsh Assembly Government Programme Level Agreement Publication/Distribution when finalised: Publication in Public Health Wales Document Database (Health Improvement) Link from Public Health Wales e-bulletin Link from Stakeholder e-newsletter Stop Smoking Wales website Other distribution/publication (e.g. Directors of Public Health) Public Health Wales is an NHS organisation providing professionally independent public health advice and services to protect and improve the health and wellbeing of the population of Wales. 2

3 Further copies of this Annual Report are available in hard copy from: Stop Smoking Wales Public Health Wales Block B, Mamhilad House, Mamhilad Park Estate, PONTYPOOL, NP4 0YP Download from: Public Health Wales NHS Trust Material contained in this document may be reproduced without prior permission provided it is done so accurately and is not used in a misleading context. Acknowledgement to Public Health Wales to be stated. Copyright in the typographical arrangement, design and layout belongs to Public Health Wales. 3

4 Contents 1 Foreword Executive summary Smoking and health in Wales Service delivery Activity and outcomes of behavioural support programme Raising awareness and marketing Training Primary care engagement Partnerships with community pharmacy Pre-operative smoking cessation Pregnant Women Services for vulnerable groups Workplace health Acknowledgements Appendices Appendix 1: Calculation of service outcomes i. Treated smoker ii. Four-week quitter (self reported) iii. Four-week quitter (carbon monoxide [CO]-verified) iv. Lost to follow-up v. 52-week quitter References

5 1 Foreword Smoking remains the leading cause of preventable death and disease and is one of the main causes of health inequities in Wales. One of the key priorities in the strategic framework for improving public health, Our Healthy Future, is the need to reduce smoking and exposure to secondhand smoke. During 2010/11 Stop Smoking Wales has delivered National Health Service (NHS) specialist smoking cessation services across Wales in local, accessible venues helping thousands of smokers to stop. This is a time of great potential for reducing smoking rates in Wales. Welsh Government began the formal consultation on the Draft Tobacco Control Action Plan for Wales in February 2010 and the final production of a Wales wide plan is due to follow shortly. The plan will provide a central focus on tobacco control. It will locate smoking cessation services firmly within a clear and agreed national plan to control tobacco in Wales and reduce smoking rates across the population. Challenging targets are proposed to reduce smoking across Wales from the current average of 24 per cent regular smokers in the adult population to under 16 per cent by This report describes the activity and outcomes of Stop Smoking Wales in supporting adult smokers in Wales to stop smoking during 2010/11. The report also outlines the progress made in specific priority areas for developing smoking cessation services, in maternity services with pregnant women who smoke and in pre-operative services with patients who smoke and who are waiting for surgery. These activities together have made and continue to make a major contribution to reducing overall smoking rates in Wales. 5

6 The services delivered by Stop Smoking Wales have been established on the best evidence currently available and are controlled by standard operating procedures. This is to ensure that the most effective approaches are provided to help smokers to stop smoking. The service aims to maintain the delivery of a standard smoking cessation intervention tailored to need so that smokers who want to stop can expect the same quality wherever they are in Wales. During the past year, training has been planned and delivered to a range of health care and other professionals to support and increase brief interventions for smoking cessation to encourage more smokers who want to stop to access services. The national service is delivered in partnership with other organisations, services and bodies and the provision of the service requires the sustained support and commitment of our staff and partners. I would like to thank all staff and the colleagues whom we have worked with (including Health Boards, primary care and community care, local authorities and the voluntary sector) for their support during the last twelve months. Stop Smoking Wales looks forward to the next year working in partnership to increase access across Wales to high quality smoking cessation services, in order to reduce smoking rates and improve the health of the population of Wales. Cindy Marsh Locum Consultant in Public Health (Health Improvement) 6

7 2 Executive summary Stop Smoking Wales is now well established as the National Health Service (NHS) specialist smoking cessation service covering the whole of Wales. 2010/11 has been a successful year for the service in supporting people to stop smoking. The service provides high quality smoking cessation to local populations across Wales and this year more people contacted the service than in any previous year. This year has also seen the highest number of self reported quitters since the ban on smoking in public places which was introduced on 2 April Smoking Cessation services sit within a wider context of tobacco control and Stop Smoking Wales has made a valuable contribution to developing tobacco control plans at a national and local level. The key service outcomes for 2010/11 achieved in excess of the agreed success rates for self-reported and carbon monoxide validated quits at four weeks and include the following results: 16,006 people contacted Stop Smoking Wales in 2010/11 7,755 smokers participated in the six-week behavioural support programme. This represents 48.5 per cent of people who contacted Stop Smoking Wales 4,655 clients who participated in the six-week behavioural support programme self reported that they had quit smoking at four-week follow up. This represents 60.0 per cent of all clients who participated in the six-week behavioural support programme 3,280 clients who participated in the six-week behavioural support programme and attended the final treatment session were validated 7

8 by carbon monoxide (CO) monitoring and confirmed as not smoking. This represents 42.3 per cent of all clients who participated in the six-week behavioural support programme Of the 2,370 clients who had self reported abstinence from smoking at four weeks between 1 April 2009 and 31 March 2010 and were therefore eligible to be followed-up at 52-weeks post quit date, 1,704 were successfully contacted. Of those eligible to be followed up, 783 (33.0 per cent) clients reported that they were still not smoking at 52-weeks 1 In 2010/11 Stop Smoking Wales provided the accredited smoking cessation brief intervention training course. 68 brief intervention training courses were delivered to over 800 healthcare and community professionals. In addition to the accredited course, work is underway to develop a set of training, awareness raising and educational sessions to increase support for good quality brief interventions at every opportunity. This includes development of e- learning modules in brief intervention for smoking cessation. This will increase and widen access to knowledge and skills in smoking cessation across Wales As part of the five year strategic framework for NHS Wales, National Prevention and Promotion Programme, Stop Smoking Wales has supported smoking cessation implementation in NHS Wales across community, primary and secondary care settings with the aim to reduce demand on health services and to cut costs Stop Smoking Wales has worked in partnership with Health Boards to target action across local populations to maximise the numbers 1 It should be noted that due to an administrative error, the 52-week follow-up figures quoted in this section refer to data for Betsi Cadwaladr University, Aneurin Bevan, Cardiff and Vale University and Cwm Taf Health Boards only. Please see section for a full explanation 8

9 of smokers accessing evidence based smoking cessation support within local tobacco control action plans A primary care engagement programme has been implemented, including systematic visits to GP practices, production of an educational resource and a pathway for patient care The service has worked closely with pharmacists in Health Boards and the community to support consistent approaches to smoking cessation across Wales. Level two pharmacy schemes have been supported and developed in several Health Board areas. Stop Smoking Wales has delivered training in brief intervention to pharmacy staff and to pre-registration and practising pharmacists under the Welsh Centre for Pharmacy Professional Education Programmes Service development in priority areas have continued to build smoking cessation pathways in maternity and pre-operative smoking cessation. Reports on the pilot projects have been produced to inform and steer further work. Stop Smoking Wales continues to work closely with Health Boards to develop strong pathways into smoking cessation services and to consider the most effective routes for clients Stop Smoking Wales has developed guidance to assist employers to help employees to stop smoking within the overall policy of smoke free workplaces. The guidance has been developed for incorporation into the Corporate Health Standard package. Twentyseven workplace based smoking cessation programmes were delivered during 2010/11 Work is underway to develop a smoking cessation service delivery model and a Stop Smoking in Prisons Toolkit for use in the prison setting 9

10 3 Smoking and health in Wales Whilst 24 per cent of adults in Wales smoke (Welsh Assembly Government, 2010), most want to stop smoking Approximately 5,600 deaths each year are caused by smoking (Public Health Wales Observatory, 2010) Smoking remains the leading cause of preventable death and disease and is one of the main causes of health inequities in Wales Welsh Government has produced a Draft Tobacco Control Action Plan for Wales Evidence based NHS smoking cessation services are highly effective both in cost and clinical terms (Brose et al, 2011) and are a key element of tobacco control Stop Smoking Wales is an evidence based NHS stop smoking service delivering consistent and standardised national smoking cessation support to smokers motivated to stop smoking The service coordinates, delivers and evaluates training for healthcare and community workers to support brief intervention and encourage uptake of effective services The current prevalence of smoking in the adult population in Wales is 24 per cent (Welsh Assembly Government, 2010). However smoking rates range from 20 per cent to 30 per cent in different local authority populations which helps illustrate how smoking leads to inequalities in health outcomes in Wales. 10

11 Figure 1: Percentage of Adult Smokers by Local Authority Source: Welsh Assembly Government, 2010 Tobacco continues to be the leading preventable cause of death in Wales and the world today (WHO, 2008). It is calculated that 5,600 premature deaths are attributable to smoking each year in Wales (Public Health Wales Observatory, 2010). Smoking leads to significant health inequalities; evidence suggests that smoking is the primary reason for the gap in healthy life expectancy between the rich and poor (Welsh Assembly Government, 2011). Tobacco smoking has been estimated to cost the NHS in the UK 2.7 billion every year (Callum et al 2010). Specifically, the cost of tobacco smoking to NHS Wales was an estimated 386 million in 2007/08 which accounts for 7 per cent of healthcare expenditure (Phillips and Bloodworth, 2009). 11

12 Smoking also costs the wider UK economy an estimated 2.5 billion per annum for sick leave and lost productivity (McGuire et al, 2009). Smokers are more likely to be absent due to ill health, and for longer, than those who do not smoke (Boorman 2009). Smoking can be estimated to cost the smoker 2,400 per year, based on smoking 20 cigarettes per day The potential health benefits of smoking cessation are substantial. Stopping smoking reduces the future risk of tobacco related diseases, slows the progression of existing tobacco related disease, and improves life expectancy by an average of 10 years (Centers for Disease Control and Prevention, 2004). 3.1 Strategic approach to tobacco control The Strategic Framework for Public Health in Wales Our Healthy Future sets direction for action to protect and improve health in Wales (Welsh Assembly Government, 2009b). Reducing smoking prevalence is one of the ten identified priorities in the strategic framework. A comprehensive approach to tobacco control is necessary to reduce smoking rates effectively. Smoking cessation is a significant component of this approach but must be seen alongside other measures to reduce uptake and create environments that support tobacco free lifestyles. The draft Tobacco Control Action Plan for Wales was published for consultation in February 2010, with the expectation that the plan will be published in 2011/12. It will help to provide a central focus on tobacco control and will locate smoking cessation services firmly within a clear and agreed national plan to control tobacco in Wales, encouraging sectors and organisations to work together to reduce smoking rates. A national target is proposed in the draft plan to reduce smoking across Wales from the current average of 24 per cent regular smokers in the adult population to under 16 per cent by 2020Welsh Assembly Government, 2011a). 12

13 The Welsh Government Draft Tobacco Control Action Plan has four main areas for action: 1. Promoting Leadership in Tobacco Control 2. Reducing the uptake of smoking 3. Reducing smoking prevalence levels 4. Reducing exposure to second-hand smoke (Welsh Assembly Government, 2011a) The Advisor that held the session I attended was very helpful and he didn't only give us ideas to help us stop smoking, he encouraged the group to have ideas of their own. I would recommend this to anybody who is serious about quitting smoking. Female 42 years 13

14 4 Service delivery Stop Smoking Wales provides an evidence based six-week intensive behavioural support programme Standardised protocols and procedures aim to ensure consistent, high quality service delivery This year has seen the highest number of self reported quitters since the ban on smoking in public places which was introduced on 2 April 2007 Public Health Wales provides specialist smoking cessation services for the people of Wales on behalf of the Welsh Government through a Programme Level Agreement. Research has demonstrated that evidence based smoking cessation services are a highly cost-effective way of helping smokers to stop smoking (Brose et al, 2011) (West, McNeill and Raw, 2000). In Wales, 27 per cent of adults have already stopped smoking (exsmokers). Out of those adults who still smoke, 70 per cent would like to give up, whilst 40 per cent state that they have tried to stop in the last year (Welsh Assembly Government, 2009). This is in line with the UK overall where approximately two-thirds of smokers state that they want to stop smoking (ONS, 2010). It is known that a combination of behavioural support from a trained smoking cessation advisor plus pharmacotherapy can increase a smoker s chance of stopping smoking by up to four times (Ferguson, et al, 2005). 14

15 In addition, from NHS smoking cessation clinic data and controlled trials, it has become clear that if smokers receive support from specialist clinics, with treatment in groups along with access to combination nicotine replacement therapy or varenicline, they will be more likely to succeed than those smokers receiving treatment in primary care, one-to-one and single NRT (Brose et al, 2011). It is important that all smokers should have access to the most effective services (Croghan, 2011). Smokers who are motivated to stop smoking are the main target audience for Stop Smoking Wales services, based on established knowledge that cessation is more effective when individual reason and motive exists. Stop Smoking Wales has the following core aims: to provide an effective, evidence based behavioural support programme offering choice and access to smokers who want to give up smoking to train healthcare and community workers to increase brief intervention for smoking cessation at every opportunity encourage contacts into the service to 4.1 Intensive behavioural support programme Smokers may self refer to the programme when they are motivated to quit smoking, they do not need a referral from a healthcare professional. The service operates a freephone number ( ) where a booking to attend a session can be made by the smoker when it is convenient to them. Every session I attended was excellent, any questions or fears of failing I asked and I was reassured on every aspect. It is an excellent service and would recommend to anyone. The support is great. Female 61 years 15

16 Stop Smoking Wales delivers an evidence based intensive behavioural support programme for people who are motivated to stop smoking. The programme is based on the withdrawal oriented therapy model (Hajek, 1989) which focuses on key objectives: maintaining or enhancing motivation to stop smoking avoiding or minimising motivation to smoke preventing the desire to smoke turning into action (West, McNeill and Raw, 2000) The sessions are client centred, providing encouragement and support to stop smoking during the period that withdrawal symptoms are at their worst. Carbon monoxide (CO) monitoring is a requirement of good practice in smoking cessation, where validation of smoking status is required at the four week post quit point. It is part of the Stop Smoking Wales service delivery model and is offered to all clients. Measuring CO weekly is a motivational tool where clients can observe their CO reading decrease in a relatively short period on quitting smoking. When a person stops smoking, CO is eliminated from the body within approximately 24 hours (McEwen et al, 2006a). The Stop Smoking Wales programme is delivered by trained smoking cessation Advisors who work predominantly in the area of smoking cessation. Following attendance at an initial assessment session, smokers are eligible to attend six consecutive weekly treatment sessions. Sessions are primarily delivered on a closed group basis; as this is the most effective and efficient method of delivery (Brunnhuber et al, 2007). Groups have been identified as more effective than individual treatments (McEwen et al., 2006a) and also have been found to produce higher success rates (McEwen et al., 2006b). Results from treatment delivery methods have shown that closed group provision is significantly more effective, with average success rates of 64% compared with 49% for oneto-one treatment (NHS Information Centre, 2009). However, one-to-one 16

17 sessions are arranged when appropriate to accommodate specific needs of clients. The service model reflects the existing evidence base for smoking cessation. The programme includes: Week 1 Week 2 Preparation to stop smoking. Agreeing a quit date by the following week. Discussion on withdrawal symptoms and changing daily routines, to prevent the association with the habit of smoking Weeks 3-5 Mutual encouragement and sharing of experiences relating to quitting, such as coping strategies Week 6 Relapse prevention techniques and assessment to determine smoking status (four-week follow up) Stop Smoking Wales offers clients a choice of where and when they access the community based service. Sessions are delivered in a range of local venues including primary care settings, community health clinics, libraries, leisure centres, community halls and workplaces. Clients are able to choose a convenient appointment with day and early evening sessions available. In 2010/11 Stop Smoking Wales ran 2116 stop smoking groups in 238 locations across Wales. I found the service brilliant! More than anything I did not want to let my fellow quitters down so that was a BIG motivation. I also found that having people there who were going through the same thing helped. We all still keep in touch now to give each other support Female 28 years 17

18 4.2 Service developments Stop Smoking Wales recognises that alternative methods of service delivery are necessary to meet the needs of the widest number of smokers who wish to quit. Plans are in development to introduce new service approaches, including telephone based support Text Messaging In the last year a pilot programme has been introduced to explore the use of text messaging as part of the intervention to maintain continued engagement and reduce drop-out. As outlined in the Stop Smoking Wales Annual Report 2009/10, a text message reminder service was piloted in South East Wales between 1 April and 30 June The aim of the pilot was to establish if sending text reminders to clients would increase the proportion of clients that attend the assessment session, are converted to treated smokers and subsequently self-report abstinence at 4-weeks post quit date. All clients who contacted the service between 1 April and 30 June 2010 were asked if they would like to receive text message reminders prior to each behavioural support session. Only 0.9 per cent (n=7) opted out of receiving reminders. The activity and outcomes of this group (SMS text reminder group) were then compared to an historical cohort of contacts who contacted the service between 1 April and 30 June In total, 2,644 contacts to the service were included in the analysis; the text reminder group consisted of 1,295 clients and the historical cohort 1,349 clients. The results of the pilot were mixed. There was a statistically significant decrease in attendance at the initial assessment session in the text 18

19 reminder group. There was, however, a statistically significant increase in the proportion of clients converted to treated smokers in the text reminder group. The analysis at 4-weeks post quit date excluded those clients who could not be contacted to establish a quit status. The lost to follow up rate in both groups was 8.9 per cent. Of those clients who were contacted to establish a quit status, the text reminder group demonstrated a higher quit rate, although this was not statistically significant. It is hoped that further analysis can be undertaken during 2011/12 to further understand the role of text messages in smoking cessation. 4.3 Quality framework A quality framework is in place for Stop Smoking Wales. This helps to support and develop the delivery of high quality, evidence based smoking cessation across Wales. It ensures that issues including consistency and standardisation of the programme, accuracy of data and information and competent delivery are reviewed and addressed Service manual The Stop Smoking Wales manual provides a comprehensive guide to delivering the service model, standardised client materials and data collection procedures. The service manual contains the detailed protocols and procedures to ensure standard and consistent service delivery across Wales. All staff delivering the programme receive a copy of the manual which helps the service to work to a standardised service delivery model Client database Stop Smoking Wales uses a national database to collect formal data on the activity and outcomes from the services delivered across Wales. The service collects data established from the agreed standard criteria used throughout the UK in NHS smoking cessation services. Data is collected 19

20 on service activity, volume and outcome. 2010/11 has been the first year the service has collected combined data onto a single service database. This new client data base has the added quality benefit of allowing flexibility of booking to offer consistent customer service. It allows clients to be booked onto an assessment session that is not within the geography of the office that they call. In addition, the in-built validation rules ensure that data is complete and capable of audit to assess quality Audit cycle Audit cycles are in place in Stop Smoking Wales. This year an audit has been conducted on telephone access across regional bases and this has helped to inform the development of systems to improve consistency and access into the services. I have tried to give up Smoking in the past by myself and failed. The Stop Smoking Wales is an excellent service; the staff were friendly + offered excellent advice. The weekly session were very supportive + text reminders ensured I didn't forget or miss Female 33 years 5 Activity and outcomes of behavioural support programme Improving the quality and consistency of outcomes recording and reporting has been one of Stop Smoking Wales key priority areas in recent years. The service adopts nationally agreed standards in recording and reporting it s outcomes, in line with other services across the UK. 20

21 The Russell Standard (West, 2005) is widely accepted as the leading standard for calculating outcomes in smoking cessation services. The standard is composed of set criteria and these are used to define Stop Smoking Wales services outcomes for 2010/11. include; The criteria Treated smoker Four-week quitter (self reported) Four-week quitter (carbon monoxide [CO]-verified) Lost to follow-up Further detail on the Russell standard is contained in Appendix 1. The Stop Smoking Wales Advisor was extremely knowledgeable and I would highly recommend the service to anyone who wanted to give up smoking Male 44 years 5.1 Activity and outcomes at four-weeks The number of contacts made to Stop Smoking Wales between 1 April 2010 and 31 March 2011 was 16,006. Stop Smoking Wales analysed smoking prevalence estimates (Welsh Assembly Government, 2009a) and population data (Office for National Statistics, 2010) to enable the calculation of a crude rate of smokers contacting the service to illustrate the variation in referrals to the service across Wales. Figure 3 shows that there was wide variation in referrals from Health Board areas across Wales with the lowest contact rate in 21

22 Estimated % of s mokers contacting SSW Cardiff and Vale University Health Board, whilst the highest contact rate was within Abertawe Bro Morgannwg University Health Board. The service is working in partnership with stakeholders to better understand this variation in referrals to the service. Figure 2: Contact rate by Health Board, 2010/ Wales Cardiff and Vale Betsi Cadwaladr University University Aneurin Bevan Cwm Taf Powys Teaching Hywel Dda Abertawe Bro Morgannwg University Of all contacts to the service, 7,755 (48.5 per cent) participated in the six-week behavioural support programme and became treated smokers, whilst 21.0 per cent only attended an assessment session and 30.5 per cent failed to attend an appointment. Of the 7,755 treated smokers, 6,826 (88.0 per cent) were successfully followed up at four-weeks post quit date, with 4,655 (60.0 per cent) self reporting that they had successfully quit at the four-week follow up (see table 1). The total number of treated smokers who were verified as not smoking at four-week follow up by carbon monoxide monitoring was 3,280 which represents 70.5 per cent of those who self reported abstinence. 22

23 Of a total of 7,755 smokers who participated in the six-week behavioural support programme a carbon monoxide validated quit rate of 42.3 per cent was achieved. It should be noted that it is only possible to carbon monoxide validate those clients who attend the week six treatment session as this coincides with four-weeks post quit date. Clients who do not attend this session are followed up by telephone. Consequently only a self reported smoking status can be recorded. A more detailed breakdown of activity and outcomes for 2010/11 is provided in Appendix 2. My participation in the scheme was the best thing I ever did in order to stop smoking. I stopped smoking on (it is now ). Excellent course, big thank you to Stop Smoking Wales. Female 38 years 23

24 Table 1: Activity and outcomes for behavioural support programme, by Health Board area, 2010/11 Health Board area Betsi Cadwaladr University Health Board Powys Teaching Health Board Contacts Attended assessment session only Treated Smokers Followed up 2, ,292 1, Quit at fourweeks selfreported (%) 794 (61.5) 184 (58.8) Quit at fourweeks CO validated (%) 524 (40.6) 138 (44.1) Hywel Dda Health Board 2, , (59.0) 516 (47.0) Aneurin Bevan Health Board 2, ,294 1, (62.1) 462 (35.7) Cwm Taf Health Board 1, (53.7) 286 (31.4) Abertawe Bro Morgannwg University Health Board Cardiff and Vale University Health Board 5, ,370 2,099 1, ,461 (61.6) 275 (57.7) 1,183 (49.9) 171 (35.8) All Wales 16,006 3,366 7,755 6,826 4,655 (60.0) 3,280 (42.3) 24

25 5.1.1 Activity and outcomes at four-weeks by age, gender and ethnicity The highest numbers of contacts in the reporting period were from females aged between 35 and 59 who accounted for 28.8 per cent of all contacts. The least contacts were received from males aged under 18 (1.0 per cent). Overall a higher proportion of contacts were females (55.3 per cent) compared to males (44.7 per cent). For both males and females the highest proportion of contacts were aged between 35 and 59 (51.7 per cent) and the lowest from those aged under 18 (2.1 per cent) (see Appendix 2 for full breakdown by age, gender and ethnicity). With regards to self reported quit status at four-weeks, females over 60 had the highest success rate (64.3 per cent). Overall 61.5 per cent of males self reported that they had successfully quit compared to 58.8 per cent of females. The largest proportion of contacts by ethnic group was from the White category (98.5 per cent). The least contacts were received from the Black category (0.1 per cent). Predictably the majority of treated smokers are from white backgrounds, accounting for 98.5 per cent of those treated, as a result the highest rate (98.6 per cent) of self reported quitters are in this group Activity and outcomes at 52-weeks Due to an administrative error, full activity and outcome data are not available for Powys Teaching Health Board, Hywel Dda Health Board and Abertawe Bro Morgannwg University Health Board. This error consisted of 669 clients not being contacted to establish their 52-week quit status. This error has been fully investigated and systems have been improved to ensure that this does not recur. However, as a result it has not been possible to include information from clients in this area when calculating 12 month quit rates. Consequently the following activity and outcome data only includes results for Betsi Cadwaladr University Health Board, 25

26 Aneurin Bevan Health Board, Cwm Taf Health Board and Cardiff and Vale University Health Board. Of those clients who successfully quit smoking between 1 April 2009 and 31 March 2010, 71.9 per cent were contacted during 2010/11 to ascertain their smoking status 52-weeks post quit date. The results are reported in table 2. The follow up rate ranged from 74.9 per cent in Cardiff and Vale University Health Board to 64.5 per cent in Betsi Cadwaladr University Health Board. Of those eligible to be followed-up, 33.0 per cent had quit at 52-weeks, this ranged from 36.3 per cent in Aneurin Bevan Health Board to 28.9 per cent in Betsi Cadwaladr University Health Board. At a local authority level the quit rates ranged from 40.8 per cent in Monmouthshire to 18.8 per cent in Gwynedd. A more detailed breakdown of 52-week follow-up outcomes is shown in Appendix 2. 26

27 Table 2: 52-week outcomes, by Health Board area, for clients contacting the service in 2009/10 Health Board area Betsi Cadwaladr University Health Board Clients eligible for follow up Clients successfully followed up Quit at 52- weeks selfreported (%) 255 (28.9) Aneurin Bevan Health Board Cwm Taf Health Board Cardiff and Vale University Health Board Total Powys Teaching Health Board Hywel Dda Health Board Abertawe Bro Morgannwg University Health Board Total All Wales (36.3) 140 (36.0) 79 (32.0) 783 (33.0) 54 (23.1) 153 (23.3) 272 (20.6) 479 (21.6) 1,262 (27.5) 27

28 5.2 Comparison of activity and outcomes with previous years Since 2004/05, there has been an increase in the number of contacts to the service. In 2010/11 there was an increase in contacts of 7.5 per cent compared to the previous year (figure 2). Figure 3: Contacts to Stop Smoking Wales 2004/05 to 2009/10 found ***** to be really helpful, she treated me like another human being and not like somebody with a bad habit, she gave good tips and advice without lecturing me which I found helpful and nice. Thank you Male 54 years 28

29 Number of clients With regard to the four-week outcomes, figure 4 demonstrates that this year has seen the highest number of self reported quitters since the ban on smoking in public places which was introduced on 2 April Figure 4: Treated smokers and outcomes, 2004/05 to 2010/ Treated Smokers Quit at 4 weeks Quit at 4 weeks (CO validated) /5 2005/6 2006/7 2007/6 2008/9 2009/ /11 Financial year Found ***** very helpful, have not smoked in 14 weeks, and hope to continue not to restart Male 63 years 29

30 % quit at 4-weeks CO validated The National Institute for Health and Clinical Excellence (NICE, 2008) guidance on performance management of smoking cessation services recommends that carbon monoxide validated four-week quit rates should be between 35 per cent and 70 per cent, and that performance outside of this range should be investigated. Figure 5 demonstrates that the service has performed successfully on this indicator during 2010/11. Figure 5: Percentage of clients carbon monoxide (CO) validated as quit at four-weeks post quit date, 2004/05 to 2010/ % Higher acceptable limit % Quit at 4 weeks (CO Validated) 35% Lower acceptable limit / /6 2006/7 2007/8 2008/9 2009/ /11 Financial year No there are no changes I would like to see, as in my case everything turned out great. I stopped smoking thanks to Stop Smoking Wales and would like to thank everybody concerned. Female 57 years 30

31 6 Raising awareness and marketing Stop Smoking Wales has continued to engage with a range of internal and external stakeholders Stop Smoking Wales attended a range of local and national campaigns and events to promote the service Stop Smoking Wales has produced a range of resources including the new maternity leaflet which is used in conjunction with the Smoke free living leaflet 6.1 Background Raising awareness of the service and service marketing is an integral part of service delivery to ensure that the service can continue to increase the service contacts and treated smokers year on year. Stop Smoking Wales developed a Marketing Strategy in 2009 to guide work to raise awareness about the service and to ensure reach extends to all key target audiences with information about Stop Smoking Wales. The key messages for marketing the service include: Stop Smoking Wales is a free, NHS service to help you quit smoking You are four times more likely to quit with the support of Stop Smoking Wales than in any other way Call Stop Smoking Wales free or visit for further information. 31

32 During the past 12 months, the service has continued to engage with colleagues in primary and secondary care, local government, the community and partner organisations through a variety of mediums. These include radio, television, local newspapers, national and local events/campaigns, the internet and newly developed Stop Smoking Wales promotional materials. 6.2 Radio adverts/interviews Stop Smoking Wales Advisors and Public Health colleagues in North Wales have taken part in local radio interviews to build awareness of the service, for example with Radio Cymru. 6.3 Television Stop Smoking Wales participated in the television programme X-Ray, to raise awareness of the service available to potential service users across Wales. The television programme provided opportunity for the audience to observe the behavioural support sessions and provide insight into the quitting experiences of a number of clients participating in the programme. 6.4 Newspapers The service aims to make local links with national stories and campaigns, where possible. Media coverage in local newspapers through the year has supported the No Smoking Day campaign, work with maternity services and the level two pharmacy schemes running locally. Media coverage has appeared in local papers including Torfaen, Llanelli, Cardiff, Swansea and Merthyr Tydfil. 32

33 just thought the whole stop smoking package was brilliant, I can now say I am a non-smoker. Yippee!! Stop Smoking Wales definitely rocks for me. Haven't had a ciggie since day I went. Thank you so Much! ***** Female 57 years Torfaen Talks, February 2011 SMOKERS in Llanelli and across Carmarthenshire are being encouraged to stub it our today. To mark No Smoking Day, community pharmacies across Hywel Dda region are working in partnership with Stop Smoking Wales service to offer free support for smokers who are ready to pack it in. Those wishing to kick the habit can now attend a local pharmacy to obtain prescribed support, following assessment by a Stop Smoking Wales Advisor. Reformed smoker Robin Gordon, of Llanelli, said: I rang my GP and was told that this is no longer the route I needed to go down. I was given the free phone number to contact Stop Smoking Wales. Call This is South Wales, 9 March

34 The overall sessions were really good and helpful. The leaflets are still on my fridge as a reminder. Carbon Monoxide testing is good as this reassures that you are doing well (keeps you motivated). I would recommend this service to anybody Female 35 years 6.5 National and local campaigns and events Stop Smoking Wales supported a range of local and national campaigns and events to promote the service and to raise awareness of the health effects of smoking. No Smoking Day is an annual UK evidence based health promotion campaign for smokers who want to stop. The campaign took place in March 2011 with a theme of Time to quit? Stop Smoking Wales worked with local partners to raise awareness of the campaign and to promote the service. Partners included: Public Health Teams, Community First teams, Fire Services, Youth Services, local Health Challenge teams, leisure centre staff, Tenovus and Sure Start teams. Activities included raising awareness in the following settings: Communities First areas Leisure Centres Hospitals Shopping centres Schools, colleges and universities A total of 25 No Smoking Day events were supported by Stop Smoking Wales across the country 34

35 The service attended the Royal Welsh Show in July 2010 in partnership with ASH Wales to provide information and advice to smokers about giving up and how to access support in their local area, and to continue to raise awareness of tobacco control issues. 6.6 Stop Smoking Wales DVD As part of the Stakeholders Communication s Plan to engage with colleagues and partners to increase the recognition of the service, a Stop Smoking Wales DVD has been created. The DVD has two versions, English and Welsh, of which Stop Smoking Wales Advisors and actual clients have taken part in the filming. The clients filmed have successfully completed the programme and are now smoke free. In the DVD, they have shared their experiences and positive outcomes following the programme. A dissemination plan to distribute the DVD will take place during 2011/12 with partner organisations and stakeholders. 6.7 Stop Smoking Wales website The Stop Smoking Wales website has undergone a review and relaunch is planned for 2011/12. Improvements include new material such as case studies, quitting tips, health advice and clips from the newly developed DVD. 6.8 Other resources A Stop Smoking Wales leaflet dedicated to supporting pregnant smokers and their families has been distributed to support the maternity referral pathway which has been implemented in several maternity departments across Wales. The maternity leaflet is being used in conjunction with the Smoke free Living leaflet to promote smoke free homes to protect families from second hand smoke. 35

36 The service has continued to distribute Quit Kits to those who have requested self help materials. Over 90 Quit Kits have been requested and sent out this year. I have given up for over 9 weeks and could have not done it alone, without the help you gave me. My advisor was *****. He was very easy to talk to and very supportive. Good work *****, Thank You Stop Smoking Wales. Female 38 years 36

37 7 Training Brief intervention training for smoking cessation has been developed and provided by Stop Smoking Wales since July 2009 The training is accredited by the Royal College of Nursing and Agored Cymru (formerly Open College Network Cymru) Between April 2010 and March 2011, 68 brief intervention training courses were delivered to 809 participants Since training began in July 2009, the service has delivered 117 brief intervention training courses to 1,406 participants across Wales A new set of smoking cessation training opportunities (including awareness raising, educational sessions and e- learning methods) is being developed Supporting others to develop skills in smoking cessation, particularly brief intervention is one of the key objectives of the Stop Smoking Wales Service. This is both in recognition of the important role that brief advice and brief intervention play in recruiting smokers to the service and in recognition that many Smokers will access support to quit from other less intensive interventions in a variety of settings. There is strong evidence that health care providers can make a significant difference in helping their clients quit (Stead et al, 2008). 37

38 7.1 Training standards Standards for training in smoking cessation practice are important to provide good quality, effective smoking cessation interventions in Wales. This will lead to better consistency of approaches based on a common understanding of the theoretical basis and most effective practices in smoking cessation. ASH Wales and Public Health Wales have produced guidance on standards for training which provide details levels of intervention and associated training. 7.2 Brief intervention Brief intervention is an evidence based approach to discussing smoking and quitting with smokers, with the aim of triggering a quit attempt. It can be delivered by a broad range of health and community workers. Brief intervention involves a structured, opportunistic discussion during which the practitioner offers information, advice and encouragement to stop smoking, along with referral to intensive support services such as Stop Smoking Wales. The provision of brief intervention is supported by national stop smoking guidance (NICE, 2006). Stop Smoking Wales provides Brief Intervention training across Wales to a range of health and community workers as part of its Programme Level Agreement with the Welsh Government Accreditation of the training programme The brief intervention training programme has been accredited by the Royal College of Nursing and Agored Cymru (formerly Open College Network Cymru) since Accreditation adds value to the training programme by ensuring quality and consistency, and by providing professional development and learning credits for participants. A total of 809 participants obtained Royal College of Nursing accreditation and

39 participants submitted evidence portfolios to obtain Agored Cymru accreditation at Level Delivery of the training programme Between April 2010 and March 2011, the service delivered 68 brief intervention one-day training courses to a total of 809 participants. Courses were delivered in each of the 22 local authority areas of Wales. A total of 46 of the courses were offered on an open access basis to a broad range of health and community workers. The main professional groups represented were nurses, health promotion staff, health visiting and community workers. Twenty-two courses were offered to specific teams and professions, including primary and secondary care nurses, midwives, health and social care undergraduates. Since the training was introduced in July 2009, the service has delivered 117 brief intervention one-day training courses to a total of 1,406 participants. Excellent Service, Diolch Male 58 years Feedback from participants Ninety nine per cent of participants (684 participants attending 61 courses) reported that the course provided them with the knowledge and skills to enable them to deliver effective brief interventions including referral of smokers to Stop Smoking Wales. Over 80 per cent of participants rated the course as excellent in terms of content. 39

40 7.2.4 Marketing and promotion of the training programme A training schedule and promotional flyer was actively marketed to a range of health and community professionals through a number of partnership networks and events, locally and nationally. Feedback suggests that most participants heard about the course by receiving the flyer electronically. Others heard about it through word of mouth from colleagues or at meetings. Few found out about the course from websites, such as the Royal College of Nursing and ASH Wales websites. Stop Smoking Wales delivered a workshop at the Smoke Free Futures: Tobacco Control Conference hosted by ASH Wales (October 2010) to outline the challenges and successes of an accredited brief intervention training programme. The workshop provided opportunity to raise awareness about the training available to health and community professionals and gather feedback to inform future work. 7.3 Next steps In response to requests for alternative formats of learning, a set of smoking cessation training and education is being developed. It will include awareness raising, educational sessions and an e-learning package. This will be piloted in 2011/12 for NHS staff across Wales to incorporate the key messages of brief intervention and sign posting to the service. I think it was the best thing I ever done to go to stop smoking Wales. Thank you very much for helping me. Male 22 years 40

41 8 Primary care engagement A GP engagement programme involving systematic visits to GP practices has continued to raise awareness of the evidence base and benefits of referral to Stop Smoking Wales for intensive behavioural support An educational resource has been produced in partnership with the Wales Deanery for Postgraduate Medical and Dental Education. It will be hosted on their online Continuing Professional Development (CPD) and appraisal resource locator A smoking cessation pathway for Wales has been developed to support primary care in understanding the pathway for patient care and smoking cessation. General Practice is a key interface through which Stop Smoking Wales is promoted. The service routinely visits practices to promote the service, encourage health professionals to raise the issue of smoking and refer onwards to Stop Smoking Wales. The service also delivers brief intervention training sessions for practice staff. Stop Smoking Wales staff ensure service materials, such as client leaflets, referral cards and posters, are available across primary care settings. 8.1 GP engagement Stop Smoking Wales has implemented a GP engagement programme which aims to implement a systematic approach of targeting practices where referral to Stop Smoking Wales was identified as being below the 41

42 national average. In 2009/10, 84 practice visits were conducted and feedback from visits was collated to inform future service development. In 2010/11, a further 33 practice visits have taken place. A report of the findings from 117 practices (that were below average in terms of their referral rates to Stop Smoking Wales) has been produced. Stop Smoking Wales wrote to every GP in Wales in December 2010, encouraging them to use the New Year s resolution period as an opportunity to provide brief intervention support to smokers and to refer smokers who want support to quit to Stop Smoking Wales. A copy of Stop Smoking Wales Annual Report 2009/10 was also disseminated to every practice across Wales to promote the service. Over the past year, 76 per cent of clients who contacted Stop Smoking Wales stated that they had heard of the service through their general practice, as highlighted in table 3. Table 3: How clients reported hearing about Stop Smoking Wales, 2010/11 How client heard % of contacts about the service GP / practice nurse 76.0 Family / friend 8.6 Other 6.8 Used service before 2.9 Hospital 1.7 Leaflet / flyer 1.4 Pharmacist 0.9 NHS Direct helpline 0.5 TV or radio advert 0.2 Internet 0.2 Total

43 8.2 Wales Postgraduate Deanery The Wales Deanery (Postgraduate Medical and Dental Education) provides information on specialist training for general practice in Wales, the appraisal system, and continuing professional development (CPD) for all GPs in Wales. In 2010, Stop Smoking Wales commissioned the Cardiff University, School of Postgraduate Medical and Dental Education (Deanery) to develop a module on smoking cessation. In late 2010, capacity within the Deanery to undertake this work changed. To ensure that this opportunity was not lost, Stop Smoking Wales undertook the editorial task of compiling the module under the guidance of the Deanery. The module includes a workbook (outlining smoking, smoking cessation and best practice, and pharmacotherapy) and a pre- and post assessment to demonstrate learning has taken place. The module will be promoted by CPD and Appraisal co-ordinators during 2011/12. Stop Smoking Wales will attend local CPD events to provide additional input in these sessions. 8.3 Pathway for patient care A pathway for patient care and smoking cessation has been developed for Wales. The pathway provides a source of evidence-based best practice guidelines for common conditions and is available to clinicians at the point of care. It helps to visualise and integrate pathways which work as a platform for sharing knowledge between teams and care settings. The pathway was due for inclusion in Map of Medicine, however as the Map of Medicine license has not been continued, the pathway will be circulated using alternative methods. 43