Treating tobacco dependency

Tobacco is the single largest cause of early deaths and disability and contributes to widening inequalities in our North East North Cumbria (NENC) populations. The NENC Smokefree NHS/ Treating Tobacco Dependency Taskforce works across the ICS to reduce the harm caused by tobacco through a multi-strand approach that prioritises tobacco dependency treatment, prevention and wider tobacco control strategies.

Rachel McIlvenna Rachel McIlvenna – Smokefree NHS Strategic Manager – rachel.mcilvenna@nhs.net  
Dr Ruth Sharrock – Clinical Lead for Tobacco – ruthsharrock@nhs.net 
Joojo Kyei-Sarpong – Project manager – j.kyei-sarpong@nhs.net

The core team work closely with a wider Smokefree NHS Taskforce made up of key strategic partners including the NHS, local authorities, Fresh and the Public Health Prevention in Maternity Programme.

The Taskforce is focused on driving and supporting sustained, system-wide treatment of tobacco dependency in the North East. The Taskforce is a sub-group of the ICB Prevention Board and is jointly chaired by the Tobacco Clinical Lead for the ICS, Dr Ruth Sharrock (Respiratory Consultant at QE Gateshead) and Chris Woodcock, Deputy Director of Public Health at North Tyneside Council 

The Smokefree NHS / Treating Tobacco Dependency Taskforce is focused on driving and supporting sustained, system-wide treatment of tobacco dependency in the North East & North Cumbria in partnership with Local Authority Tobacco Commissioners & Public Health teams. Together, the region is working towards a vision in North East & North Cumbria for every smoker to make at least one significant quit attempt per year, with Tobacco dependency being discussed by every Health Care Professional they come into contact with.

Working with regional and national partners such as Fresh, Office of Health Improvement & Disparities (OHID), Northern Cancer Alliance, ASH and Cancer Research UK, the Treating Tobacco Dependency Taskforce supports wider comprehensive tobacco control strategies to reduce adult smoking prevalence and narrow health inequalities. This work supports the national ambition for a Smokefree 2030.

The ICS has signed the Declaration for a Smokefree Future alongside Fresh and the Association of Directors of Public Health North East (ADPHNE).

Our vision for holistic support to quit smoking across the North East and North Cumbria ICS is illustrated below.

Current workstreams/projects

The NENC Treating Tobacco Dependency Taskforce is overseeing the roll-out of the NHS Tobacco Dependency Treatment Service across all ten Foundation Trusts in the NENC Integrated Care System (ICS). This ensured that by 2023/24 all people admitted to hospital that smoke, including pregnant smokers in the maternity pathway, will be offered support from NHS funded Tobacco Dependency Treatment Services, including specialist support from dedicated Tobacco Dependency Advisers. Now all Trusts in NENC have established pathways in place. You can find out more about the three service pathways below:

NHS Standard Treatment Plans for Inpatient Tobacco Dependence

Following on from the successful delivery of Tobacco Dependency Treatment in the SMI population in 2022/23 across 4 pilot sites as part of Early Implementer sites nationally, the NENC Tobacco programme is working with Cumbria Northumberland Tyne & Wear (CNTW) Mental Health Trust to deliver a community Mental Health Tobacco Dependency Offer

Coming soon

NENC has been a forerunner nationally with the (TLHC) programme roll out with Newcastle/Gateshead being the largest of the 10 original NHS England pilot sites. The Lung Cancer Check programme offers a unique way to identify and engage with our current 'smoking' populations and offer to reach out to support them in a way that they don't seek themselves. An enhanced team working alongside the Lung Cancer check nurses will provide rapid, flexible support for smokers identified who are not ready to engage with a LA SSS providing rapid access to NRT & vapes to aid cessation. Smokers who are identified and prepared to engage with LA SSS will be referred directly.

Smoking is the single most important modifiable risk factor in pregnancy. Pregnant people who smoke require more care and place additional costs on the NHS than non-smokers. It’s estimated that maternal smoking cost the NHS over £20 million in 2015/16 through 10,032 episodes of admitted patient care.

  • NENC Maternity Incentives Scheme

Funded by the NENC ICS Healthier & Fairer programme, utilising £176,000 NECS Transformation funds, the NENC Incentive scheme tobacco dependency in pregnancy was launched across all 8 NENC maternity Services between November 2022 and July 2023. Find report here.

  • National Pregnancy Incentives Scheme

The scheme is being introduced across England to support more pregnant people to stop smoking and tackle health inequalities.

  • It is modelled on regional schemes that have been successful in reducing smoking in pregnancy by increasing engagement with stop smoking services. 
  • The scheme is funded by the Office for Health Improvement & Disparities (OHID), part of the Department for Health & Social Care (DHSC) and delivered by Accenture. 
  • All eligible pregnant people can be offered the scheme.

All our NENC Trusts are either on the scheme or actively working toward it. Read more here

We are committed to supporting our NHS organisations in improving access to stop smoking pharmacotherapy. All our NHS Trusts are actively working on incorporating stop smoking medications in all treatment pathways such as Varenicline, Cytisinicline and other nicotine receptor partial agonists.

The NENC Smokefree NHS Taskforce Position Statement on Vaping has been updated. This document outlines the current stance of the North East and North Cumbria (NENC) ICB Smokefree NHS/Treating Tobacco Dependency Taskforce on nicotine vaping and replaces the previous statement issued in April 2023.

The updated position is informed by the findings of the Nicotine vaping in England evidence review, alongside other key research. It also aligns with the Association of Directors of Public Health North East position statement on nicotine vaping.

The statement has been reviewed by colleagues across hospital trusts within the ICB region, as well as members of the Smokefree NHS/Treating Tobacco Dependency Taskforce.

The position statement centres around four key points:

  • Tobacco smoking is still our biggest killer
  • Vaping poses a small fraction of the risks of smoking but it is not risk-free – it is not recommended for non-smokers and young people
  • Vaping is effective in helping people quit smoking

We need to promote effective quitting options – including vaping – while protecting children from using nicotine.

The position statement can be accessed here.

Primary care and VCSE organisations have a key role in improving the health outcomes for our populations, and delivering very brief advice to those who smoke is a critical part of this.

The Smokefree NHS/Treating Tobacco Dependency Taskforce are keen to understand how they can support colleagues in primary care and the VCSE sector to embed treatment of tobacco dependency as routine practice. For additional information on delivering smoking cessation advice or supporting patients to quit in primary care or in the VCSE sector, please contact rachel.mcilvenna@nhs.net

If you smoke, the right help and support can significantly increase your chances of quitting for good.

Support is available if you are still smoking at the time of admission, through the hospital Tobacco Dependency Treatment Service teams. Additional support is also provided for pregnant smokers as part of routine maternity care.

Below, you will find the relevant leaflets.

a. TDTS Patient Leaflet

b. Maternity Leaflet

c. Mental health Leaflet

For further advice and information on quitting, visit www.freshquit.co.uk

The Tobacco Programme is data driven and that helps to informs practice and fosters a culture of continuous quality improvement.

  • OHID Fingertips: Includes data on a arrange of health & wellbeing themes - fingertips
  • NHS Digital : Includes statistics on various metrics including stop smoking services outcomes, smoking at time of delivery– NHS Digital SSS Data 

The North East and North Cumbria Smokefree NHS Programme is part of the region’s Tobacco Eight Key Strands Programme. Tobacco control across the North East is led by Fresh, the regional tobacco control programme established in 2005. Fresh is jointly funded by the NENC Integrated Care Board (ICB) and 12 Local Authorities across the region.

The government is currently progressing the Tobacco and Vapes Bill through Parliament. As a programme, we fully support this legislation as a vital step toward ending tobacco-related harm for future generations.

Previous workstreams/projects

There were 4 SMI early implementer sites across the North East testing a new model of support for people with a diagnosis of a severe mental illness.

The model of care was is based on findings from the SCHIMITAR study, and offered intensive behavioural support alongside an enhanced package of nicotine replacement therapy or vapes to support people to reduce the harm from tobacco.

The 4 early implementer sites were:

  • Durham (Chester-Le-Street)
  • Northumberland
  • South Tyneside
  • Middlesbrough

The North East and North Cumbria Tobacco Dependency Taskforce & Smokefree NHS Programme worked closely with Mental Health Trusts to expand the model into community outpatient settings and developed this model further in financial year 2023/24. 

Northumbria University was commissioned to evaluate the pilot; their report can be found here.

In March 2024, the NENC ICB completed a pilot programme that supported NHS staff to quit smoking.

Find out more about the project through the following resources:

1. End-of-project report

2. Evaluation conducted by NIHR and Newcastle University

3. Policy briefs

4. Published paper

5. Recorded webinar

6. Imagery from the dissemination webinar

In December 2023, the North East and North Cumbria (NENC) Smokefree NHS / Treating Tobacco Dependency Taskforce identified an opportunity to allocate underspend from the 2023/24 budget to pilot small-scale vape interventions within NHS Foundation Trust (FT) settings. The primary objectives of the pilot were to:

• Gather localized insights on integrating vapes into routine NHS care, particularly within Foundation Trusts.

• Implement best practice by offering vapes alongside other nicotine replacement therapies to support smoking cessation

• Strengthen Smokefree policies and ensure NHS sites remain smokefree- work plan

Full report can be found here.

Training and resources

The NENC ICB Learning Academy offers a Tobacco Dependency Programme through the BOOST platform, featuring e-learning modules grouped into three categories:

  1. Identifying Tobacco Dependence and Delivering Brief Advice
  2. Tobacco Awareness
  3. Treating Tobacco Dependence

Click the links above to explore each section.

These modules provide a wide range of training to help understand the harms of tobacco and how tobacco dependency can be effectively treated. The National Centre for Smoking Cessation and Training (NCSCT) also offers a variety of free courses and competency checklists, accessible to all healthcare professionals, stop smoking practitioners, and others involved in patient care.

It is recommended that all healthcare professionals—and anyone with direct client contact—complete Very Brief Advice (VBA) training. VBA consists of three simple steps:

  • ASK – all patients if they smoke, and document this
  • ADVISE – that the most effective way to quit is with behavioural support and nicotine replacement therapy (NRT) or a vape
  • ACT – provide a referral or offer behavioural support and treatment (NRT/vape)

Across NENC we have a Community of Interest forum open to all NHS Trusts  which is coordinated by the Regional Tobacco Programme.

This forum brings together partners from across the region—especially those involved in delivering or commissioning stop smoking support—to:

  • Share best practices and learning from both within and outside the region
  • Collaborate across the system to strengthen efforts
  • Support more people in the North East to make a quit attempt

It’s a space designed to encourage open dialogue, build connections, and drive improvement in tobacco dependency services. To find out more please email info@fresh-balance.co.uk

Pathways

Visual representations of the three Tobacco Dependency Treatment pathways can be found below:

Toolkits

Briefings

  • The ADPHNE Vaping Position Statement can be found here
  • The NENC Smokefree NHS/ Treating Tobacco Dependency Taskforce Vaping Standard here
  • The latest NENC Smokefree NHS / Treating Tobacco Taskforce quarterly briefing can be found here. To be added to the circulation list, email j.kyei-sarpong@nhs.net

News

Fresh has been funded by the NENC to run the regional Don’t Wait stop smoking campaign across the North East and North Cumbria. The latest wave runs December- January 2022/23.

#Don’tWait has been running since 2020 across the North East and North Cumbria.  The campaign is fronted by North East respiratory consultant and clinical chair of the Smokefree NHS / Treating Tobacco Dependency Taskforce, Dr Ruth Sharrock.

The recording and slides from a recent webinar which provided an overview of the community pharmacy smoking cessation service can be found here.

Can the North East lead the way to a smoke free future? Read the full story here.

You can read the stories told by smoking survivors here.

The Smokefree NHS Taskforce hosted a celebration event on the 7th of March 2024 at  Durham's Ramside Hall Hotel. The event showcased the NENC Early Implementer Sites (EIS) that have been delivering enhanced smoking cessation services for people with severe mental illness (SMI) and shared their achievements.

Dr Guy Pilkington chaired the event. Delegates came from across the region, representing secondary and primary care, local authorities, the third sector and higher education.  Presentations were given by four delivery partners from Durham, Middlesbrough, South Tyneside, and Northumberland. They shared their challenges and successes. Northumbria University also provided an update on the planned evaluation of the four pilot sites.

A live visual artist Josie Brooks was on hand to capture discussions and reflections from the event.

Smoking rates are high among people with mental health problems. People with longstanding anxiety, depression or another mental health conditions are twice as likely to be smokers as those without mental health problems. People with mental health conditions are as likely to want to stop smoking as other smokers. However, they face more barriers to quitting, are more likely to be dependant, and need more support.

The EIS teams providing enhanced support for adults with SMI highlight the impact this support is having on individuals' health and wellbeing. This is shown in the two case studies below.   Jim and Gary have both received support around tobacco dependency.

Jim, 62, had smoked for around 50 years. He had become increasingly breathless and bought patches in the past to attempt to quit. Jim tried for around five weeks in July 2023 but had complicating factors of poor mental health. He was also funding his son's smoking habit so ended up smoking himself. Jim attended a respiratory clinic and was diagnosed with COPD. The SMI tobacco cessation worker encouraged Jim to try a switch to a vape. Jim was seen again in February 2024 and was very pleased with himself – he had been vaping for two weeks and stopped buying his son's tobacco. Jim reported that he felt having people interested in his wellbeing and encouraging him time and again, rather than leaving him to feel written off, gave him the motivation to keep trying.

Gary had smoked for 16 Years and with support from an advisor reduced his smoking from 25 cigarettes per day to two per day. His children were his motivation as they were always asking him to quit. Having his partner join him on the quit journey helped too. Gary used the vape, saying it felt the right tool for him. Gary said it was the support that made the difference, and his Link Worker was knowledgeable, non-judgemental, and supportive, even over texts in between appointments when he struggled.

Learning from the four pilot sites is being shared across the NENC system. It is hoped that other colleagues within local authority and primary care will adopt the practice to support this core20 population with enhanced cessation support. The Smokefree NHS Strategic manager contributed to a national webinar on evaluation of the seven national EISs on the 18th of March 2024. A recording of the webinar is available here.

Enquiries: Rachel McIlvenna, Smokefree NHS Strategic Manager, rachel.mcilvenna@nhs.net or Guy Nokes, SMI EIS Project Manager, guy.nokes@nhs.net

Smoking is the leading preventable cause of illness and premature death. It causes around 74,600 deaths in England in 2019. Approximately 13% of North East and North Cumbria adults currently smoke.

The Smokefree NHS Taskforce hosted a webinar on the 23 April sharing findings from the evaluation of a NHS England-funded pilot that aimed to support NHS staff to stop smoking. Between December 2021 and September 2023, the pilot operated across numerous NENC partners:

  • Ten NHS foundation trusts
  • The North East Ambulance Service (NEAS)
  • 13 local authorities

Stopping smoking at any time has considerable health benefits. However, the earlier someone stops, the greater the benefits can be. The Smokefree NHS Taskforce initiated a dedicated workplace offer to support NHS staff to stop smoking. This included:

  • Free access to nicotine replacement therapy and /or a refillable vaping device;
  • Access to flexible behavioural support through a local stop smoking service;
  • Access to the premium version of the Smokefree App.

The offer was promoted across NHS trusts to raise staff awareness. Over 1,900 staff accessed support to make a quit attempt during  the pilot.

Andrew, a security supervisor from Gateshead Health NHS, shared his experience of receiving support from his employer:  

“I wasn’t sure if the service would work or not, but it did work, and I’m happy that I got the help, within the Trust, right where I work… It’s an upskill, because if you quit and you know the benefits of that, you can easily motivate a colleague as well to follow the same road… the more numbers on board the better.”

The pilot has been evaluated by Newcastle University researchers to understand service users' experiences.. E Findings are now available here: NHS Staff Tobacco Dependency Offer - ARC Research. Key recommendations for local authorities and NHS trusts offering similar services are:

  • Provide on-site support and ensure promotions reach all staff groups;
  • Enable NHS staff to access additional support resources, such as peer support groups or a digital offer, and also ensure flexibility in appointments;
  • Ensure support is high quality, and that advisors have enhanced knowledge of treatment options to support troubleshooting and ease of access for service users;
  • Create opportunities for service users to regularly feedback on their experiences, in order to allow continuous service improvement.

The NENC Smokefree NHS Taskforce will be working with partners to apply evaluation learning and embed smoking cessation workforce support as a routine offer across the North East and North Cumbria.

Support to quit smoking is available to all residents in the North East and North Cumbria, including health and social care staff. To find your local stop smoking service, visit Fresh, or download the premium version of the Smokefree app for free today.

This research was jointly funded by North East and North Cumbria ICB Tobacco Taskforce and Newcastle University, and supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration North East and North Cumbria. The views expressed are those of the author(s) and not necessarily those of the NIHR.

Spotlight

Smokefree NHS - Introduction to the NENC Tobacco Dependency Treatment Service.

Get involved

  • The NENC Smokefree NHS Knowledge Hub is regularly updated with key documents and resources.
  • NHS Futures: There is a wealth of information and guidance for all aspect of the NHS Tobacco Dependency Treatment Service on the NHS Futures platform, which provides support to Trusts nationally.

It is strongly recommended that all colleagues and partners involved in the Treating Tobacco Dependency/Smokefree NHS agenda are registered to access both the Smokefree NHS Knowledge Hub and NHS Futures platform.

Smokefree Pledge: The Smokefree Pledge is designed to be a clear and visible way for NHS organisations to show their commitment to helping smokers to quit and to providing smokefree environments which support them. Sign up here -The NHS Smokefree Pledge - ASH: