Grampian NHS Board

Implementation of Smoke-free sites.

  1. Actions Recommended
  • The Board is asked to note progress towards the national and local policy of becoming a smoke-free NHS.
  • Consider how Board members can support the implementation of the Tobacco Policy.

2. Strategic Context

The Need:

Smoking is the most important cause of preventable ill health and premature death in Scotland and Grampian. Every year, tobacco use is associated with over 1000 deaths in Grampian and nearly 5000 hospital admissions. Tobacco related illness is estimated to cost NHS Grampian £30-46.6 million per annum.

In Grampian improvements have been made:

  • The number of adults who smoke has reduced from 27% in 2000 to 24% in 2013
  • Regular smoking among 13 and 15 year olds in Grampian reduced over the last 10 years from 7% to 1 % in 13 year olds and from 24% to 7 % in 15 year olds.
  • Fewer pregnant women than ever report they smoke and the gap in smoking prevalence between the most and least deprived pregnant mothers has narrowed.

However, we cannot be complacent because:

  • Smoking is a key contributory factor to health inequalities in life expectancy between the richest and poorest in our communities. Heavy smoking is 4 times more likely in the most deprived communities compared with our most affluent communities.
  • Smoking in pregnancy in the most deprived areas is considerably more common than in the least deprived i.e. 31% and 6% respectively.

Tobacco control is therefore a key aspect of our efforts to reduce health inequalities.

Every 1% reduction in Grampian smoking prevalence could result in a potential £2.1 million annual reduction in health costs in Grampian.

The response:

In Scotland, the introduction of the smoking ban in public places in 2006 delivered demonstrable improvements for health with cleaner air, a reduction in heart attacks, and reduced second- hand smoke exposure in children, non smokers and among staff in high tobacco-smoke exposure workplaces.

In 2012, CEL 01 (2012) required the NHS to become smoke-free by end March 2015. In line with the national tobacco control strategy, NHS Grampian Tobacco Control 2020 and action plan, approved by the Board in 2013 aims to create a smoke free generation through:

Prevention - creating an environment where young people choose not to smoke

Protection - protecting people from second hand smoke

Cessation - helping people to quit smoking

Tackling the clear variation in levels of smoking between different parts of our society mains an important theme.

  1. Key matters relevant to the recommendations:

3a. Consultation and Engagement

A Tobacco Control Strategy Group, under the chairmanship of the Director of Workforce, was established to oversee and drive the implementation of the Tobacco Control Action Plan. Membership of the Group included representatives from the three Grampian Local Tobacco Alliance ensuring strong connections to the three Community Planning Partnerships in Grampian.

A Tobacco Policy Review Group was established by Grampian Area Partnership Forum (GAPF) with representatives from all sectors. The Board approved 'Heads of Agreement' underwent a comprehensive consultation and communication process involving patients, staff and other users of NHS Grampian sites and premises. A total of 1600 responses were received with majority support for the measures proposed. The redraft of the policy took account of the feedback received and further consultation undertaken in line with GAPF approval processes. Following a further redraft the Policy was formally adopted by GAPF in May 2014. The Policy has been impact assessed. Each sector within NHS Grampian has an identified lead to take implementation forward.

The implementation process for this type of policy will be challenging. However, the timescales and principles have been agreed in collaborative partnership with staff side representatives. Maintaining this partnership will help overcome any challenges.

3b. Support for those affected by the Policy

The National Institute for Health and Clinical Excellence (NICE) ranks evidence- based smoking cessation support as one of the most cost-effective interventions that is available to the NHS. NHS Grampian aims to provide high quality smoking cessation support to all those who wish to stop smoking. Tailored services are available across all our communities and to patients in our healthcare facilities. The NHS Grampian Smoking Advice Services perform well.

Giving up smoking is the single biggest thing that someone can do to improve their health. The Planned Care Programme has been working towards embedding smoking cessation in all care pathways. Initial work focused on the maternity care pathway and pre-operative surgical services pathway.

Stop Before Your Op - is a pre-operative smoking cessation programme. 52% of smokers will experience wound complications following an operation compared to 18% of those who quit smoking prior to their operation. The average length of stay for patients can be reduced by between 0.4-2days. In Grampian the equivalent (maximum benefit) of six beds per day could be saved if smokers stopped smoking 4-8 weeks prior to surgery.

Staff and patients who experience nicotine addiction will be offered support through the NHS Grampian smoking cessation programme. Like any member of the local community our staff will have access to pharmaceutical nicotine and smoking cessation support free of charge.

Training on the Tobacco Policy has been offered to a range of staff. This includes how to approach and discuss issues with people smoking on NHS sites. All staff, but primarily health professionals, will be encouraged to use brief interventions to raise the issue of smoking with patients/ smokers attending for care. These brief interventions may extend to carers and friends where it would support better outcomes for patients.

3c. Communicating the Change

A communication plan has been developed and is being implemented to raise awareness of the forthcoming change in policy. This includes external signage, amendments to in-patient and outpatient booklets and patient letters and staff briefings.

  1. Risk Mitigation

There are a number of risks associated with not providing a smoke-free environment including compromising patient safety, protecting our staff, financial risks arising from increased costs of smoking related ill health.

The policy will be effective if it is implemented consistently across all NHS Grampian sites, at all levels in the NHS Grampian workforce and consistently with all visitors and patients. This will require senior sponsorship and ownership of implementation. Support for staff to implement the policy is outlined above.

  1. Responsible Executive Director and contact for further information

If you require any further information in advance of the Board meeting please contact:

Responsible Executive Directors
Annie Ingram
Chair of Tobacco Policy Control Group

Susan Webb
Acting Director of Public Health
/ Contact for further Information
Derek Petrie
Tobacco Control Coordinator
t

27 January 2015

1