Agenda item

The appendix to this item is included in the ‘Supporting Documents’ pack.

Dr Fiona Wright, Consultant in Public Health, presented the report and explained that tobacco was one of the most significant ill health contributors in the Borough and the effects of smoking impacts upon all sectors of the community and at all ages.  The risks of smoking are well established and include heart and lung disease, cancers and asthma, ear infections in children and cot death in infants.  Smoking is the major factor in health inequality and accounts for half the difference in life expectancy between the lowest and highest income groups.  Smoking related illness is a significant resource drain on the NHS and it was estimated that each year in the Borough the cost to society was £52.8m.  In addition to this was the costs associated with social care, workplace and school absenteeism, house fires, removal of cigarette butts from streets and the crime associated with counterfeit tobacco etc.

The new Strategy had been based upon an understanding of the local prevalence of smoking and the risk groups, and the local smoking prevention resources.  The Strategy has been informed by the Joint Strategic Needs Assessment (JSNA) and key national, regional and local strategies and best practice guidance.  A multi-agency workshop had also been held in June 2017. 

The Board discussed several issues including, the three-pronged approach set out in the report, future action being concentrated on high risk groups, including shisha usage, illegal ‘fake’ tobacco, those with mental health or other addiction issues, staff training, review of smoking in public places and in smoking prevention.  It was noted that it was also intended to refresh the Tobacco Control Alliance in order that Partners could be held accountable on the delivery of the Action Plan.

Cllr Turner asked why it had the word control rather than reduction in the title of the Strategy.  It was noted that it was for consistence, including with national documents.

The Chair commended the Strategy for concentrating on the prevention of smoking by young people, rather than concentrating on hardened smokers where cessation success would be harder to achieve.  The best health outcomes would be in stopping the habit starting, rather than stopping the habit later in life. 

Discussion was held on the need for signs to be placed outside all health sites asking people not to stand in the entrances whilst smoking.  It was agreed that all GP practices should be asked to have prominent signs at the entrance to their premises.  BHRUT and NELFT were asked to reinforce the no smoking principle on their estate.  Cllr Oluwole raised the issue of the practice of patients in wards being allowed to smoke.  Melody Williams explained the rational for allowing detained mental health patients to be safely escorted outside to exercise their choice to smoke and the risks of not doing this. 

Cllr Carpenter said that she had seen many reports with similar words over the years and wanted to know what would make a difference this time.  The Chair advised that this rather than trying to get hardened long-term smokers to quit, there was a significant shift in resources to the prevention agenda and to target young people to stop them starting the smoking habit in the first place.  Fiona advised that they would also be focusing on those that really need help and extra support when they decide to quit smoking, for example those with other addictions or mental illness.

The Board discussed the very brief advice (VBA) that could be given by health and other professionals to raise awareness and the time constraints of a GP meaning that they could not concentrate on smoking during a general patient consultation.  Dr Mohi stressed that patients often have very complex needs and in his experience consultations rarely centre on smoking, but they can allow a VBA about healthy lifestyles like weight and smoking.  Fiona explained that whilst every opportunity should be taken to subtly encourage change in habits, the VBA allows for more time to be spent to support those individuals when they indicate that they want to quit smoking, often because of an incident in their own lives that changes their own perception.  The Chair commented that an individual who wishes to stop was more likely to succeed.

Cllr Chand drew attention to the increasing number of individuals using shisha pipes and risks that the tobacco and carbon monoxide from the burning charcoal causes and that there was a mistaken belief that shisha was safer in some sections of the community.  The Chair advised that she had been told that the toxin levels in one day of shisha pipe use equates to 100 cigarettes and we needed to educate the community that shisha pipes are certainly not safe or a safer alternative to cigarettes.

Cllr Chand also raised the issue of vaping and the attraction of those to young people and pointed out that nobody really knows the long-term effect of using those or cigarette alternatives and the chemicals that they contain.  Matthew Cole explained that currently the NICE guidelines state that the kitemarked / certified vaping cigarette alternatives are better than smoking tobacco and that vaping, along with patches etc, can be a useful tool in breaking tobacco smoking habits.

The Board:

(i)  Approved the Tobacco Control Strategy and the key priorities identified, as set out at Appendix A to the report;

(ii)  Agreed to receive a six-monthly progress reports on the implementation of the Tobacco Control Strategy;

(iii)  Requested partners to actively engage in a refreshed Tobacco Control Alliance; and

(iv)  Suggested that it would wish to see:

(a)  All health sites and GP surgeries encouraged to have signs asking people to not smoke in the entrances and that partners discourage individuals from leaving hospital wards to smoke.

(b)  The significantly higher risks of shisha pipe usage is highlighted, particularly in the communities where it has traditionally been used.