Working in Partnership to Reduce Smoking throughout Pregnancy Tackling smoking in pregnancy to reduce health inequalities and infant mortality Wednesday 15th March 2017 Better Start Bradford Working in Partnership to Reduce Smoking throughout Pregnancy

Every Baby Matters in Bradford District Joanne Nykol Public Health, Tobacco Lead

Every baby Matters in Bradford District Smoking in pregnancy is the single most modifiable risk factor for pregnancy and pregnancy outcomes Today is about a call to action because if we are going to make a difference to health inequalities and infant mortality we have to tackle smoking in pregnancy

Welcome Set out the rationale for action and the evidence base What we have already achieved What we plan to do Increase knowledge, identify opportunities for partnership working, gaps, recommendations Welcome we would like to share with you the work achieved and the work in progress sit back, relax – engage and participate

Smoking at time of delivery (SATOD) by CCG 2015/16 (source HSCIC) 15% for the district as a whole England 10.6% - target 2015 11% or less

Where are they smoking? Source: Public Health Analysis team, CBMDC 2014

Bradford driving force ~ Every Baby Matters Strategy and Action Plan - 10 recommendations to improve maternal and infant health and reduce infant mortality rates Every Baby Matters (EBM) - Steering Group Smoking In Pregnancy Action Plan Every Baby Matters (EBM) leads on reducing infant mortality rates. Steering Group - key partners to identify the actions required – The Health and Wellbeing Board, Children’s Trust Board and Integrated Early Years Strategy Steering Group will monitor progress on the Every Baby Matters Action Plan and progress in reducing infant mortality rates as well as the Health and Social Care Overview and Scrutiny Committee. The infant mortality rates for Bradford district is now the lowest rate over the last decade and has reduced year on year for the last six years.

Collaborative commissioning Bradford Council Bradford Districts CCG Bradford City CCG Public Health England Reducing smoking in pregnancy everybody's business This is a challenge that can not be achieved in isolation Reducing health inequalities and infant mortality is a local authority priority it is also a priority for our CCG partners . The work started with an opportunity to come together and co fund babyclear here in Bradford to achieve consistent intervention and messages across the antenatal care pathway

Working together…our partners Commissioned Specialist Midwife Better intelligence Planning Services Children’s Centres Front line services Health Visitors Referrals

Working together…our partners Commissioned Specialist Midwife Better intelligence Planning Services Children’s Centres Front line services Health Visitors Referrals Smoking is an addiction that often starts in childhood – it is not a lifestyle choice – women don’t start smoking in pregnancy – partnership working to achieve a consistent, evidence based intervention. 4 x more successful with support and medication – ensure smokers get the best chance of quitting

Hilary Warring and Lisa Fendall has been on this journey with us right from the beginning

Lisa Fendall…..where it all began “There are a lot of common misconceptions out there and it may be surprising but often women continue to smoke because they don’t really understand the impact this can have on their babies” Lisa Fendall - Specialist Midwife

Every Baby Matters in Bradford District Carolyn Sadler – Public Health Stop Smoking Specialist, Pregnancy Lead

Our Key Message….. MAKING EVERY CONTACT COUNT Following the NICE guidance (PH26) Collaborative working with:- Midwives Health Visitors Children’s Centres Better Start Bradford MAKING EVERY CONTACT COUNT

Progress so far Stop Smoking Specialist Midwife commissioned BTHFT All Ante-natal Midwives babyClear trained Midwifery staff provided with CO monitor and consumables Integration into antenatal care pathway Referral process that ensures referrals are received by the Stop Smoking Service within 24 – 48 hours of CO screening Quarterly reporting Ensure those responsible for providing health and support services understand why and how to identify those who smoke and refer to the Stop Smoking Service

Source: HSCIC, 2016

Next steps Risk perception implementation. 36 week CO readings. Support for antenatal admissions – rapid access to NRT

Further Training http://elearning.ncsct.co.uk/vba-launch http://elearning.ncsct.co.uk/shs_vba-launch http://breathe2025.org.uk/ 19

Bradford Stop Smoking Service - 01274 437700 stopsmokingservice@bradford.gov.uk Resources available from : Health Promotion Library & resources At Lynfield Mount Hospital 01274 223900 Bradford Tobacco Health Needs Assessment available online at:- https://jsna.bradford.gov.uk/

References BMA (2007) Breaking the cycle of exposure to tobacco smoke Royal College of Physicians: Passive Smoking and Children. A report of the Tobacco Advisory Group of the Royal College of Physicians. London, RCP(2010) www.breathe2025.org.uk/.../Breathe-2025-partners-document.pdf Bradford Joint Strategic Needs Assessment, 2014 NICE (PH26), 2010 Smoking: stopping in pregnancy and after childbirth https://www.nice.org.uk/guidance/pH26 Smoking Cessation in Pregnancy: A call to action (2013) Nicotine Addiction in Britain (Royal College of Physicians, 2000) Action on smoking and health www.ash.org.uk/ (various facts sheets available) Bradford Tobacco Health Needs Assessment availble online at:- https://jsna.bradford.gov.uk/documents/Health%20Needs%20Assessments/Tobacco%20Health%20Needs%20Assessment/Tobacco%20Health%20Needs%20Assessment%202014%20-%202015.pdf