UKCTAS comment on the latest tobacco control plan for England: “Towards a smoke-free generation”

The new tobacco control plan, ‘Towards a smoke free generation’ is a welcome restatement of the government’s commitment to reduce the prevalence, and hence the burden of death and disability caused, by smoking. The recognition that harm reduction strategies can play a key role in achieving these ambitions is applauded, and puts the UK at the forefront of global tobacco policy. However, the ambition to reduce adult smoking in England from 15.5% to 12% by 2022, representing as it does a reduction of 0.5 of a percentage point per year, is modest given that smoking prevalence has fallen by 2.9 percentage points in the last three years.

Recognising reducing smoking in pregnancy as a priority, and aiming to reduce prevalence in pregnancy to 6% or less, is welcome but will not be achieved without adequate resources, improved care pathways and addressing significant gaps in training for midwives and obstetricians. The commitment to make NHS inpatient mental health settings smoke-free by 2018 is long overdue, but it is disappointing that the same strong commitment is not extended to other NHS settings.

The ambition to make stop-smoking services more available is also welcome, but like the commitments to NHS settings and for pregnancy requires funding: when public health budgets are being slashed, how will local authorities afford to increase their smoking service provision?

What matters now is delivery: Action to achieve and exceed these ambitions is the next and crucial step

PDF of the Press Release

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MAJOR NEW REPORT  – UK HOSPITALS FAIL TO MEET NATIONAL STANDARDS IN EITHER HELPING PATIENTS QUIT SMOKING OR PROVIDING ‘SMOKE-FREE ENVIRONMENTS’

 

According to a major new report launched today (7/12/16) by the British Thoracic Society (BTS), NHS hospitals across UK are falling ‘woefully short’ of national standards on helping patients to quit smoking and enforcing smoke-free premises.

Experts f1-mediumpresenting the findings at the British Thoracic Society (BTS) Winter Meeting, will state that many NHS hospitals are missing out on a ‘golden opportunity’ to provide what is often the most effective front-line treatment for smoking patients who are sick  –  support and medication to help them quit tobacco.

The BTS Report ‘Smoking cessation: policy and practice in NHS hospitals’ is
unique in its scope and size; reviewing the smoking cessation & smoke-free policies and practices of 146 hospitals across UK between April and May 2016 – including the analysis of 14,750 patient records.

The main findings of the report are as follows:

  • Over 7 in 10 (72%) hospital patients who smoked were not asked if they’d like to stop
  • Only 1 in 13 (7.7%) hospital patients who smoked were referred for hospital-based or community treatment for their tobacco addiction
  • Over 1 in 4 (27%) hospital patients were not even asked if they smoke
  • Only 1 in 10 hospitals completely enforce their fully smoke-free premises. Rates of enforcement were even lower for hospitals which provided areas where smoking was allowed. The report highlights the importance of a smoke-free NHS – to trigger and support quit smoking attempts for patients and reduce second hand smoke exposure for children, staff and the public
  • Provision of nicotine replacement therapies and other smoking cessation treatments were ‘poor’ in hospital pharmacy formularies
  • Only 26% of hospitals had an identified consultant ‘lead’ overseeing their smoke-free and smoking cessation plans
  • 50% of frontline healthcare staff in hospitals were not offered training in smoking cessation

In the study, 25% of hospital patients were recorded as being ‘current smokers’ – which is higher than rates in the general adult population (19%)   Other studies have shown that approximately 1.1 million smokers are admitted to NHS hospitals a year.

The Society is using the report findings to call for all hospitals to deliver NICE Guidelines in this area (PH48) and that national regulators such as the Care Quality Commission (CQC) hold Hospital Boards accountable for the delivery of smoke-free and smoking cessation hospital policies.

The report also highlights a number of key activities that all NHS hospitals should deliver to help more of their patients quit smoking:

  1. Offer a prescription for Nicotine Replacement Therapy to all patients who smoke to help them cope with their tobacco dependence whilst in hospital
  1. Refer all patients who smoke in hospital to specialised stop smoking support services to explore the option of quitting smoking. Patients can opt out if they like – but the NHS should try to offer the most effective treatment and support whatever the illness – and with many smoking-related conditions such as chronic obstructive pulmonary disease (COPD), support and medication to help people quit smoking are the best front line treatments
  1. Employ an appropriately skilled senior clinician within the hospital to oversee, drive forward, and be accountable for the hospital’s smoking cessation service
  1. Employ smoking cessation practitioners in every hospital – this was recommended by NICE in 2013 but the report shows patchy delivery across the country
  1. Hospital Board involvement in delivering plans is key. Delivering smoke-free hospital grounds – as part of a wider smoking cessation policy – requires Hospital Boards to work together including the chief executive, director of human resources, director of facilities and the medical and nursing directors – in partnership with the ‘smoking cessation lead’ at the hospital

The Society is also encouraging more health professionals to become BTS ‘Stop Smoking Champions’ in their hospital. There are over 160 at present and they deliver a range of vital activities to champion stop smoking service provision.

For further information, contact stopsmokingchampions@brit-thoracic.org.uk or to see a video about the initiative go to: https://www.brit-thoracic.org.uk/standards-of-care/quality-improvement/smoking-cessation/bts-stop-smoking-champions/

Dr Sanjay Agrawal, Consultant Lung Specialist & Chair of the British Thoracic Society’s Tobacco Group, who led the audit said:

“Our report shows that many NHS hospitals are woefully failing to meet national guidance on delivering smoking cessation services and smoke-free premises. This is a dangerous situation that is costing the country dear in both health and economic terms. We must do better. Critically, hospitals are missing out on a golden opportunity to help supply often THE most effective treatment for illnesses that smokers are admitted with – support and treatment for their tobacco dependence.  If patients in other disease areas were not offered, by default, the most effective way to treat their condition – there would probably be an uproar. Nevertheless, this happens all too frequently with people with smoking-related illnesses. Many hospital boards need to sort out their leadership, plans and resources on this issue – so they can deliver some simple but life-changing steps: identify patients who smoke, ask them if they’d like to quit – and give effective treatment and support to help them stop.”

Dr Lisa Davies, Consultant Respiratory Physician at Aintree University Hospital and Chair of the British Thoracic Society Board, said:

“Being admitted to hospital should be a real window of opportunity for smokers to quit – given that smoking should be prohibited on the premises, tobacco use may be linked to their health condition, and expert stop smoking advice and therapies are potentially ‘on tap.’ This report shows, however, that we need to fund, plan and deliver smoking cessation work in hospitals far better – so we can fully deliver on this opportunity for our patients.

At a wider level, there is a real fight going on for the future of stop smoking support services in this country.  Many local authorities, facing overall budget reductions, have cut funding for community-based stop smoking services – meaning that people who need support may have nowhere to go.

The NHS must urgently work together, alongside local authorities, to plan and fund these vital services – to ensure no-one who needs treatment and support to stop smoking falls through the net.”

British Thoracic Society – UK hospitals fail to meet national standards in helping patients to quit smoking

British Thoracic Society, Smoking Cessation Audit Report:

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External news sources:

AOL – Hospitals ‘woefully failing’ to crack down on smoking

The Guardian – A third of children hospitalised with asthma ‘exposed to cigarette smoke’

Birmingham Mail – Number of patients forced to wait for hospital bed ‘rockets in five years’

NHE – All STPs urged to help patients quit smoking

The BMJ – NHS hospitals must help patients quit smoking, says British Thoracic Society

UKCTAS Air Quality Report used to support the move to #Smokefree Prisons in 2016

Leah Jayes, University of Nottingham:

Our findings provide strong evidence that smoking in prisons in England is a source of high second-hand smoke exposure for staff members and prisoners. We are pleased that these findings have been instrumental in the National Offender Management Service (NOMS) decision to start their smoke-free roll out throughout prisons in England and Wales from next month. The harms of second-hand smoke are well established, this move will improve the health and well-being of those who live and work in prisons in England and Wales.

It is estimated that around 80% of the prison population smoke and we appreciate that this is the start of a long journey towards a completely smoke-free prison estate in the UK. However, we know that Young Offender Institutes and Mental Health Units in England, and prisons in other countries with similar penal systems have all implemented similar smoke-free policy and it often soon becomes the norm.

UKCTAS will continue our collaborative work with NOMS and work closely with the four pilot prisons in the South-West to evaluate their move towards becoming smoke-free in 2016. NOMS have outlined a phased approach for all remaining prisons in England to go smoke-free in the future.

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