haringey.gov.uk

Smoking in Haringeyupdate with focus on smoking cessation

and smokefree policy in the NHS

Haringey CCG Governing BodySeptember 2017

Sarah Hart

[Senior Commissioner public health ]

haringey.gov.uk

Source: Haringey Annual Public Health Report 2015, PHE 2017

Smoking remains an important risk factor for

long term conditions

haringey.gov.uk

Smoking Attributable Hospital Admissions by NCL borough

0

500

1000

1500

2000

2500

3000

Barnet Camden Enfield Haringey Islington

Smo

kin

gat

trib

uta

ble

ho

spit

alad

mis

sio

ns,

rate

pe

r 1

00

,00

0 London region

England

Source: Public Health England, Local Tobacco Control Profiles for England , 2017

Smoking attributable hospital admissions in 2015/16 were higher than the London and England averages in Islington and Haringey. Islington has a significantly higher rate than the rest of NCL.

Directly standardised rate of Smoking Attributable Admissions in people aged 35 and over, 2015/16

haringey.gov.uk

Smoking Attributable Hospital Admissions by NCL borough:

trends

When compared to other NCL boroughs, smoking attributable admissions in people aged 35+ are higher in Islington and Hariney between 2009/10 and 2015/16.

• Directly standardised rate of Smoking Attributable Admissions in people aged 35 and over, 2009/10 to 20015/16

• 3500

• 3000

• 2500

500

0

1000

1500

2000

2009/10 2010/11 2011/12 2013/14 2014/15 2015/16

Smo

kin

gat

trib

uta

ble

ho

spit

alad

mis

sio

ns,

rate

pe

r 1

00

,00

0

2012/13

Year

Barnet

Camden

Enfield

England

Haringey

Islington

London region

Source: Public Health England, Local Tobacco Control Profiles for England, 2017

haringey.gov.uk

Smoking attributable mortality by NCL borough

150

100

50

0

200

Barnet Camden Enfield Haringey Islington

Esti

mat

ed

de

ath

s at

trib

uta

ble

tosm

oki

ng

pe

r1

00

,00

0p

op

ula

tio

n,a

ged

35

+

London region

England

Source: Public Health England, Local Tobacco Control Profiles for England , 2017

In 2013/15, deaths attributable to smoking in residents over 35 years were higher in Islington and lower in Haringey, compared to the London and England averages.

Estimated deaths attributable to smoking per 100,000 population, aged 35+, 2013/15

400

350

300

250

haringey.gov.uk

N C LPrevalence of smoking by NCL borough

3

Source: Public Health England, Fingertips, 2017

Current smoking prevalence in each NCL borough is similar to prevalence in London or England, except in Haringey, where it is higher.

0

5

10

15

20

25

30

Barnet Camden Enfield Haringey Islington

Pro

po

rtio

n o

f s

mo

ke

rs a

mo

ng

th

e p

op

ula

tio

n

Smoking Prevalence in adults 18+ (APS), 2016

England

London

haringey.gov.uk

Prevalence of smoking by NCL borough: trends

0.0

5.0

10.0

15.0

20.0

25.0

2012 2013 2015 2016

Pe

rce

nta

geo

f sm

oke

rsag

ed

18

+

2014

Barnet

Camden

Enfield

England

Haringey

Islington

London region

Prevalence of smoking has shown a slight decrease in the last few years. Across NCL,

prevalence remains between 10% and 20% of the adult population. Haringey remains the

highest at 17.7% in 2016

Prevalence of smoking among persons 18 years and over, 2012 – 2016 (APS)30.0

Source: Public Health England, Local Tobacco Control Profiles for England ,2017

Smoking and health inequalities

Smoking rates are declining but stark

inequalities remain

Employment

Education

Type of work

Employed = 15.9%

Unemployed = 29.8%

£40,000+ = 10.5%

Up to £9,999 = 19%

Educated to degree level

= 9.1%

GCSE grade D-G /CSE =

22.8%

General population = 15.5%

Serious mental illness = 40.5%

£Managerial & Professional

=10.9%

Routine & Manual = 29.4 %

Income

Mental Health

haringey.gov.uk

Smoking and health inequalities

• Smoking remains a major cause of the life expectancy gap,

accounting for up to 50%

• There is always a risk that our interventions may increase

health inequalities

0

5

10

15

20

25

30

2013 2014 2015

Sm

okin

g p

revale

nce (

%)

Smoking and sexual identity, 2013-15

Heterosexual/Straight Gay/Lesbian Bisexual Other

Bisexual

10% higher

than

heterosexual

in 2015

05

10152025303540

Sm

okin

g P

reva

len

ce

in

ad

ults -

cu

rre

nt

sm

oke

rs

Smoking and Socioeconomic class, 2016

Haringey London region

England Haringey average

haringey.gov.uk

Smoking has a significant

relationship with mental

wellbeing.

21.6% of current smokers have

low mental wellbeing, compared

to 14% for non-smokers and 6%

for ex-smokers

In the more deprived east, current

smokers are most likely to have

low mental wellbeing (15.6%)

Smoking prevalence is the

main contributor to health

inequalities:

There is a higher proportion of

smokers in the most deprived

areas of Haringey (24.2%),

compared to the total area

sample (20.1%)

Smoking and inequality – Focus on mental health -

Mental Wellbeing Survey 2016

77%

45%37%

0%

20%

40%

60%

80%

100%

Sm

okin

g p

rev

ale

nce

Source: Haringey Council Mental Wellbeing Survey (2016)

haringey.gov.uk

N C LNorth Central London

Sustainability and TransformationPlan

Service Use – number setting a quit date and quitting in NCL

12000

Rat

e o

fp

eo

ple

sett

ing

aq

uit

dat

ep

er

10

0,0

00

smo

kers

Rat

eo

f p

eo

ple

sett

ing

aq

uit

dat

ep

er

10

0,0

00

smo

kers

10000Barnet

10000Camden

10000

8000 8000 8000

6000 6000 6000

4000 4000 4000

2000 2000 2000

12000 12000

Rat

eo

f p

eo

ple

sett

ing

aq

uit

dat

ep

er

10

0,0

00

smo

kers Enfield

10000

8000

6000

4000

2000

0

2013/14 2014/15 2015/16

Rat

e o

fp

eo

ple

sett

ing

aq

uit

dat

ep

er

10

0,0

00

smo

kers Haringey

10000

8000

6000

4000

2000

0

0 0 0

2013/14 2014/15 2015/16 2013/14 2014/15 2015/16 2013/14 2014/15 2015/16

12000 12000

2013/14 2014/15 2015/16

Rat

e o

fp

eo

ple

sett

ing

aq

uit

dat

ep

er

10

0,0

00

smo

kers Islington

Number setting a quit date Successful quitters at 4 weeks

Rate of smokers setting a quit date and quitting have declined in all NCL boroughs between 2013/14 and 2015/16, mirroring the national trend

Source: Public Health England, Local Tobacco Control Profiles for England, 2017

0

2000

4000

6000

8000

10000

12000

2013/14 2014/15 2015/16

England

Ra

teo

f p

eo

ple

se

ttin

ga

qu

it

da

tep

er

10

0,0

00

sm

ok

ers

Rate of people setting a quit date and successful quitters at 4 weeks per 100,000 smokers, 2013/14 to 2015/16

haringey.gov.uk

N C LNorth Central London

Sustainability and TransformationPlan

Breakdown of quit attempts by setting

7

Most quit attempts happen in GP practices in Barnet, Islington, and Enfield. In Camden, most quit attempts happen in pharmacies, while in Haringey most happen in a community setting.

58

20 22

0 00

20

40

60

80

100

Barnet

2737 31

3 2

0

20

40

60

80

100

Camden

58

248 7 5

0

20

40

60

80

100

Islington

79

165 0 0

0

20

40

60

80

100

Enfield

3116

51

2 00

20

40

60

80

100

Haringey

haringey.gov.uk

N C LNorth Central London

Sustainability and TransformationPlan

Maternity data by NCL borough

4

2

0

6

8

10

Barnet Camden Enfield Haringey Islington

Nu

mb

er

of

wo

me

n

Very few pregnant women accessed stop smoking services in NCL between April and December 2016. Of those who did, the majority did not quit or were lost to follow up, with only 13 quitters.

Pregnant women setting a quit date and outcome by NCL borough between April and December 2016

18

16

14

12

Not known / lost to follow up

Not quit

Successful quitters (self-reported)

Total number setting a quit date

haringey.gov.uk

The stop smoking service consultation

completed in 2014 found that across

the survey and focus groups:

• Barriers to quit smoking were predominantly stress, drinking and socialising,

living with current smokers and having friends/family who smoked.

• Respondents were worried about gaining weight when they gave up

smoking.

• 29% said they would go to their GPs for information about how to stop

smoking (29%), 23% internet (23%), and chemists

• 15% seek support through adverts on the street, mobile phone apps and 6%

friends/family

• A number of people suggested that incentives like gym passes would help to

keep them feeling healthier and manage their weight - though people with

mental health issues said they might lack motivation to use them

haringey.gov.uk

E Cigarettes

5.6% of respondents stated in 2016 survey1 they were current e-

cigarette users, which equates to approximately 2.9 million of the

population.

Of those using 50.1% current and 48.2% ex-smokers stated

their main reason for using e-cigarettes was as an aid to stop smoking.

The second most common reason for both groups was that they

perceived e-cigarettes to be less harmful than cigarettes,

1. Smoking habits in Great Britain using data from the Opinions and Lifestyle Survey,

1974 to 2016 (adults aged 16 and over)

haringey.gov.uk

Smoking clinics with COPD services

Well London

St Mungo’s smoking pilot

Stoptober

Smoking cessation maternity

CQUIN smoking

One You Haringey

Healthchecks with GPs and smoking cessation referral

London phone service pilot

Community Pharmacy 1:1 smoking cessation support

MECC and brief advice

Population Health Community Health Personal Health

Homes for Haringey Health Hubs

Primary Prevention

Secondary Prevention

Tertiary Prevention

Our prevent approach to smoking cessation

haringey.gov.uk

Activity in BEHMHT and acute trusts

National CQUIN

Indicator Indicator weighting (%

of CQUIN scheme

available)

CQUIN 9 -Tobacco

9a Tobacco screening

5% of 0.25% (0.0125%)

9b Tobacco brief advice

20% of 0.25% (0.05%)

9c Tobacco referral and medication offer

25% of 0.25% (0.0625%)

CQUIN 9 –

Alcohol

9d Alcohol screening 25% of 0.25% (0.0625%)

9e Alcohol brief advice or referral

25% of 0.25% (0.0625%)

It’s so important that we help anyone who has contact

with our services to reduce smoking, and hopefully

help them to quit. We have a great opportunity to

have a major impact on their lives not only in terms of

their mental health but their physical health too.”

Maria Kane, Chief Executive of BEH

CQUIN to be introduced in 2018

- aim to reducing health

inequalities, encourage

collaboration across different

providers and improve the

working lives of NHS staff

haringey.gov.uk

N C LKey challenges highlighted in discussion for the NCL

STP prevention programme

• Cuts to the public health grant

• Falling footfall into all community cessation services

• Inconsistent and incomplete capture of smoking status within clinical

encounters

• Lack of systematic implementation of identification and brief advice /ask,

assist, advise embedded in all clinical settings and pathways

• Lack of established referral pathways into community services

• Variable use of CO monitors in maternity

• Variable approaches to going smokefree

haringey.gov.uk

Key opportunities highlighted in discussion for the

NCL STP prevention programme Opportunities

Review smoking pathways in maternity across NCL:

Best practice – learning from other parts of London e.g. implemented BabyClear

Gaps in CO monitor provision in maternity

Work together to overcome professional and organisational barriers to

ask, assist, advise and refer/ IBA and make the links to making every

contact counts

Facilitate sharing of learning and toolkits between trusts to go smokefree

and support staff who want to quit.

Using CHINs to reach into targeted groups

haringey.gov.uk

Discussion

• What is the best way to support access into smoking cessation

services?

• How can we embed smoking cessation in CHINs?

• Are there any specific group of patients to focus on, i.e. stop before

the op?

• Which primary care staff need to be involved and what skills do they

need?

• How best can we ensure that the CQUINs in acute services actually

lead to maintained smoking cessation activity?

haringey.gov.uk

Get involved in this years Stoptober Champaign from 21st

September

www.oneyouharingey.org/