To note the report.

Anna Richards, Consultant in Public Health, said that it had been agreed at the last Board meeting that there would be a focus on smoking.

Charlotte Fox, Public Health Programme Officer, explained that a Health Needs Assessment (HNA) had been undertaken on smoking in RBWM. There was a goal in the Corporate Plan to reduce the number of residents that smoked in the borough. There were three main aims of the HNA:

·         How many residents smoke and did it vary across different groups?

·         What services did residents have to support them to stop smoking?

·         Was there anything that should be done differently to help people to stop smoking?

Considering the evidence of best practise, all frontline health professionals provided brief advice to anyone that they came into contact with, who had been identified as a smoker. Services had an aim to treat 5% of the estimated population who smoked each year. Of those who accessed services for smoking cessation support, 35% or more should achieve a successful quit within 4 weeks. It was also recommended that behavioural support and pharmacotherapy was made available to adults that smoked.

The NHS Long Term Plan suggested that by 2023/24:

·         All people admitted to hospital that smoked would be offered NHS-funded tobacco treatment services.

·         The model would also be adapted for expectant mothers, and their partners, with a new smoke-free pregnancy pathway which included focused sessions and treatments.

·         A new universal smoking cessation offer would be made available as part of specialist mental health services for long term users of specialist mental health.

Charlotte Fox explained that different data sets had been used as part of the HNA, which could provide slightly different results depending on the data which was used. In RBWM, just under 10% of the population or 16,195 people, were currently smokers. This was 6,495 male and 9,700 female, with 77.7% being of white ethnicity. This data was caveated as it relied on clinical coding on GP records, which could be out of date if patients had not visited their GP for a duration of time. Therefore, the first recommendation of the HNA was to work collaboratively with Frimley ICS, Primary Care Networks and GPs to identify any current gaps to improve how smoking status data was recorded on patient records. After considering the data on who smoked and who needed the service, the second recommendation was to undertake targeted work with those residents and communities who had disproportionately high rates of smoking.

Considering the current service provision, a smoking cessation specialist practitioner provided behavioural support for adult residents. Pharmacotherapy was not currently provided and the service did not currently perform carbon monoxide validations for quits. The third recommendation of the HNA was to use evidence to start discussions and develop a costed appraisal to determine the health impact of providing pharmacotherapy with psychosocial support, balanced against the financial impact. In 2019/20, there were approximately 55 people in RBWM that set a quit date, with 73% achieving a successful 4 week quit. This led to the fourth recommendation, which was to continue to commission a psychosocial support service that delivered a combination of in person and virtual support for any adult in RBWM who wished to quit smoking. There was an NHS ambition for a smoke free society by 2030.

Considering other Berkshire authorities, RBWM was at the lower end of the scale in terms of the total number of smokers who had successful quit within 4 weeks. The fifth recommendation from the HNA was that opportunities should be explored for joint commissioning with Frimley ICS to procure a joint smoking cessation contract in the future. Smoking cessation should also be considered as an integral part of an integrated healthy behaviours service. To improve smoking data, it was recommended that in depth quantitative and qualitative feedback was acquired from the local service and service users, this would allow an evidence base to drive future proposals.

Considering the next steps, the Public Health team had started to draft a paper on nicotine replacement therapy options. Work was being done with the Communications team on an engagement campaign, while an integrated healthy behaviours health needs assessment was also underway.

The Chairman asked what was being done in terms of prevention and younger people.

Kevin McDaniel, Executive Director of Children’s Services, said that there were a number of activities in secondary school PSHE programmes which was around healthy behaviours, which included smoking. The work from the HNA would feed into the development of the curriculum.

The Chairman said that persistent smoking could be linked to mental health and this was a challenge that was important to consider.

Huw Thomas agreed that they often linked with mental health, it was important that there was easy access for nicotine replacement therapy. It was disappointing to see low figures for quit rates in RBWM. He asked when the findings of the HNA would be discussed.

Anna Richards said that the HNA had been completed and it would be published on the Joint Strategic Needs Assessment website as soon as this was up and running. Charlotte Fox was currently completely the options appraisal paper for the nicotine replacement therapy to see the options and enable the team to make a decision.

Huw Thomas asked when residents could see a different service, as a result of the HNA.

Anna Richards responded by saying that decisions would be made in weeks, so would be coming through in the imminent future. There was a wider piece of work on service delivery of smoking cessation and how to increase the numbers accessing the service. Those that were using the service had a high quit rate. There was an ambition for more integrated services, as people who needed support to quit smoking could also need support to lose weight, become more active and drink less, these behaviours did not happen in isolation. Work was being done in relation to this with colleagues from Bracknell Forest and Slough.

Stuart Lines, Director of Public Health for East Berkshire, said that one of the Frimley ICS ambitions specifically focused on smoking. A smoke free society could only be achieved by all partners working together, it was also important to stop new smokers from starting. Promoting environments that did not support smoking was also key, society had made big strides in developing this target.

The Chairman said that the context of the pandemic also needed to be considered with smoking.

RESOLVED UNANIMOUSLY: That the Health and Wellbeing Board noted the Smoking Cessation Health Needs Assessment as set out in Appendix A.