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/
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