Minutes:
The Cabinet Member (CM) for Social Care and Health Integration delivered a presentation on the Barking and Dagenham Smoking Cessation service. The presentation began by highlighting the particular context within Barking and Dagenham, with the seventh highest smoking attributable hospital admissions in London, the highest percentage of women smoking at the time of delivery in London and a smoking attributable mortality higher than London and England. It detailed:
· The current service provided to residents;
· The health impacts of smoking;
· Inequalities in relation to the Smoking Cessation service (such as age, ethnicity and gender);
· The number of residents supported by the service and current success rates;
· The current issues and work already underway to address these issues; and
· Future areas of work.
In response to questions from Members, the CM stated that:
· It was important that frontline staff were able to have brief initial conversations with residents about smoking cessation advice, referring them into the right part of the service that was able to provide them with more guidance.
· Whilst she did not want to stop the service, it was not having the desired impact and as the service received nearly half a million pounds in funding, she wanted this to be more effective for residents. As such, she felt that targeting the service via programmes to specific groups, such as those who were pregnant, young people, and ethnic communities within the Borough, for at least a couple of years, could result in more cost effectivity and better health outcomes, making a real difference to these groups. This method would require co-production with these target groups. Residents that did not fall into the target groups would be offered a service via the GP referral route.
· Whilst it would be difficult to enforce a Borough-wide outdoor smoking ban, she could look into this possibility for certain areas, such as playgrounds.
In response to a question from the CM, the DPH stated that the London Borough of Havering had decommissioned their smoking cessation service a few years ago, and that their cessation rates had actually improved. A number of other boroughs had also decommissioned their services over the past few years, with Barking and Dagenham being in the minority of those councils in London who had kept their service. Many boroughs had also moved to a digital service offer. As such, the CM wanted to review how the Council was targeting its service, and come back to the Committee with proposals as to how to move forward, as addressing only two percent of smokers in the Borough as currently, was not value for money.
In response to further questions from Members, the Public Health Strategist (PHS), the Integrated Care Director at NELFT and the DPH stated that:
· The vast majority of referrals came from GPs, with a negligible number coming from self-referrals.
· Mental Health service staff were trained in terms of level one service support, having active conversations with patients around their smoking status. Smoking cessation conversations were also part of the annual health check for those with serious mental illnesses, with signposting into this service as necessary. Smoking prevalence was much higher in those with serious mental illness, in comparison to other cohorts of the population. Patients at Goodmayes Hospital were also supported to access free nicotine replacement therapy (NRT) and smoking cessation support, as well as vaping (due to the increase in aggression incidents when restrictions on smoking were put in place around NHS property), as an alternative.
· Whilst the price of Champix (a medication used in smoking cessation) had increased, the service was able to provide this due to low service usage. Champix was not suitable for many, and had to be prescribed by a clinician.
· The Council’s Licensing team was working on a project to tackle shisha use and to work with shisha bars, due to start in April 2022. The programme would initially focus on education, rather than enforcement. The team was also working in conjunction with the Smoking Cessation service.
· The Smoking Cessation service was accessed by some Havering residents, as they lived on the Barking and Dagenham/Havering border, and were on the GP practice lists for Barking and Dagenham. Havering Council also bought in to Barking and Dagenham’s smoking cessation maternity offer.
The CM acknowledged that smoking was an addiction and that the Council and its partners needed to get better at supporting individuals. She, along with the Committee, questioned whether the Improving Access to Psychological Therapies (IAPT) service could ask patients more about smoking, to increase referrals into the Smoking Cessation service and to help individuals before they needed more extensive support. The CM would also discuss with the Council’s HR team, what the Council could be doing to offer smoking cessation support to its employees.