Treating Tobacco Dependency in the North East and North Cumbria
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.
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 Amanda Healy & Alice Wiseman, Directors of Public Health at Durham County Council & Gateshead Council (co-regional DPH lead for tobacco).
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.
Current workstreams
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 will ensure 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. You can find out more about the three service pathways below:
There are currently 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 is based on findings from the SCHIMITAR study, and offers 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 are:
Durham (Chester-Le-Street)
Northumberland
South Tyneside
Middlesbrough
The North East and North Cumbria Tobacco Dependency Taskforce are working closely with Mental Health Trusts to expand the model into community outpatient settings, and hope to develop this model further in financial year 2023/24.
For more information, please contact Project Manager Guy Nokes - guy.nokes@nhs.net
The NENC ICB recently completed a pilot which supported NHS staff to quit smoking. Whilst the pilot has come to an end, support for NHS staff to quit smoking remains available via local authority commissioned stop smoking services or via the Smokefree app. We look forward to welcoming a national digital offer which will launch first for NHS staff around April 2024.
For more information, please contact Project Manager Caitlin Barry - Caitlin.barry1@nhs.net
The North East North Cumbria Smokefree NHS/ Treating Tobacco Dependency Taskforce has developed a position statement on nicotine vaping to outline key evidence on vaping in relation to tobacco smoking and to provide guidance on promoting vaping to support smoking cessation.
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 mcilvenna@nhs.net
If you smoke, you’re significantly more likely to quit for good with the right help and support.
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
Supporting smokers to quit is part of a multi-strand approach to wider tobacco control which also includes advocacy, tobacco and nicotine regulation and data, research and evaluation. Tobacco control across the North East is led by partners Fresh, the regional tobacco control programme that was established in 2005 and is now jointly funded by the NENC ICB and 12 Local Authorities in our region.
Training and resources
A wide range of training is available to understand the harms from tobacco, and how tobacco dependency can be treated. The National Centre for Smoking Cessation and Training offer a wide array of free courses and competency checklists, available to all healthcare professionals, stop smoking practitioners and beyond.
It is recommended that all healthcare professionals, or anybody with direct client contact should complete Very Brief Advice training. Very brief advice comprises of three simple steps:
ASK – all patients if they smoke, and document this
ADVISE – the most effective way to quit is with a combination of behavioural support and nicotine replacement therapy/use of a vape
ACT – provide a referral or offer behavioural support and treatment (NRT/vape)
Implementation Plan
The NENC ICS Implementation Plan for the LTP Tobacco Dependency Treatment Services sets out the scope, governance and delivery aims of this work. For information about local NHS Trust Tobacco Dependency Treatment Service plans please contact the tobacco dependency team in the named Trust.
Pathways
Visual representations of the three Tobacco Dependency Treatment pathways can be found below:
A short briefing outlining the current SMI smoking cessation pilot can be found here
The ADPH 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 To be added to the circulation list, email susan.swindon@fresh-balance.co.uk.
Further resources
The latest OHID e-cigarette review can be found here
Making Conversations Count for All (full report and exec summary): This report examines the impact of improving GP delivery of smoking cessation interventions across socioeconomic groups, over a 20 year period
Impact of smoking on Core20PLUS5 in NHS North East and North Cumbria ICB can be found here
An independent review of Smokefree 2030 policies, which sets out bold ambitions over the next two decades to make smoking obsolete: The Khan Review: Making Smoking Obsolete.
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.
Read more about the new hospital support available for smokers who are to quit here.
Read more about how the North East is working together to make smoking history here.
Find out how hospitals in the region will be offering more support to smokers 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.
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;
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:
