Jo Locker, Senior Tobacco Control Programme Manager Implementing the Tobacco Control Plan: Supporting a smokefree pregnancy Jo Locker, Senior Tobacco Control Programme Manager

The burden of smoking 15.5% of adults still smoke in England 20% of acute inpatients smoke (BTS) Smoking responsible for 17% of all deaths in people aged 35+ Around 70,000 babies are born to mothers who smoke each year Each year it causes up to 5,000 miscarriages; 2,200 premature births; 300 perinatal deaths. (RCP, 2010) . Responsible for 1 in 3 Sudden Infant Deaths 10.7% smoking in pregnancy. FNP evaluation: 56% smoking in late pregnancy. Cost of smoking to society in England is £14.2bn per annum. Direct costs to the NHS are estimated at £2.7bn and costs to social care at £1.4bn Smokers who manage to quit reduce their lifetime cost to the NHS by 48%

National ambitions Reduce smoking prevalence among adults from 15.5% to 12% or less by 2022. Reduce smoking prevalence among 15 year olds from 8% to 3% or less.    Reduce smoking prevalence in pregnancy from 10.7% to 6% or less. Reduce the inequality gap in smoking prevalence between those in routine and manual occupations and the general population. The plan sets out the roles of PHE and NHS England in providing national leadership, and the need for close partnership working across local healthcare systems to deliver targeted, evidence-based interventions to support smokers to quit.

Golden Threads… Reducing Inequalities Targeting priority populations NHS Sustainability Emphasis on smokers in the healthcare system Remember, to reduce inequalities, we need to target smokers with the best interventions that we can; And if we do that, we address the burden to the NHS and improve NHS sustainability as a result. And we acknowledge, smokers are not hard to reach… they are sitting in our waiting rooms and hospital beds. This is NOT the responsibility of any one single agency. It requires a whole system approach in terms of both: Leadership, and Delivery

Smokefree NHS Many longer term smokers will already be in poor health and be in regular contact with their GPs, the NHS and wider community health services; this will also be true for many people with mental health problems and pregnant women.   A quarter (25%) of all NHS inpatients are smokers and the number of patients using mental health services that smoke are staggeringly higher, estimated to be around 64%. That is why NHS settings provide a great opportunity to engage many of the harder to reach smokers. The plan capitalises on this with a series of actions for PHE and NHS England working together to support acute and mental health trusts and all frontline health staff to take every opportunity to encourage anyone using, visiting and working in the NHS to quit.

Stamping out inequality: smokefree pregnancy By 2022 - Reduce the prevalence of smoking in pregnancy from 10.7% to 6% or less. Commitments include: Assess current practice in use of CO monitoring and the implementation of smokefree. Implement CO testing at antenatal care and referral to stop smoking services through the Saving Babies’ Lives Care Bundle Through the MTP, work to reduce stillbirths, neonatal and maternal deaths, by consistently emphasising opportunities to achieve and sustain smokefree pregnancies. Continue to work to improve the reliability of data measures for smoking during pregnancy. Locally: full implementation of NICE PH26, including CO screening and opt-out referral. Smokefree Champions to drive forward this agenda.

System-wide action (1) NICE Guidance (PH26) 8 Recommendations requiring action across the healthcare system. Including: Identifying & referral (CO screening, opt-out) Contacting referrals & delivering support Meeting needs of disadvantaged pregnant smoker Training to deliver interventions   Tobacco Control Plan, July 2017 New ambition to reducing smoking in pregnancy to 6% or less by 2022. Care Bundle Element 1: Smoking Cessation Local prevention planning: - Sustainability and Transformation Plans Prevention at Scale Local Maternity Systems Tobacco Control Plan for England: Reduce smoking rates from 15.5% down to 12% or less. Reduce the prevalence of 15 year olds who regularly smoke from 8% to 3% or less.   Reduce the prevalence of smoking in pregnancy from 10.7% to 6% or less. Reduce the inequality gap in smoking prevalence between those in routine and manual occupations and the general population. Maternity Transformation Programme: Improving Prevention (work stream interdependencies)

System-wide action (2) Place based approaches Smokefree communities, supporting reductions in smoking (or high prevalence perpetuating high prevalence) Key role for local authorities in supporting system wide action.

Tobacco control plan: action so far Menu of Preventable Interventions Commissioning Support Packs (JSNA resources) Models of Local SSS Delivery Report Local Tobacco Control Profiles CLeaR Improvement model (incl. Deep Dives) Training for healthcare professionals Working across the MTP, Care Bundle CQUIN Risky Behaviours Right Care PDA and clinical pathways Leading Change Adding Value Evidence and resources on e-cigarettes Implementing NICE Guidance (PH26 & 48) Improving Data? Smokefree NHS? What PHE has done / still has to do, in providing national leadership to support local systems to take local action. Menu of Preventable Interventions Commissioning Support Packs (JSNA resources) Models of Local SSS Delivery Report Local Tobacco Control Profiles CLeaR Improvement model (incl. Deep Dives) Leading Change Adding Value CQUIN Risky Behaviours Right Care PDA Evidence and resources on e-cigarettes Survey of Mental Health trusts Better Mental Health Data? Smokefree NHS?

Tobacco Control Plan and MTP: Smokefree pregnancy activity Commitment Activity MTP and organisations engaged Assess current use of CO monitors and SF policies Survey of SiP activity through LA’s Oct 2016 Care bundle quarterly survey PHE, NHS E, NHS Improvement CO testing and saving babies lives care bundle Care Bundle Element 1 Evaluation underway NHS E, NHS I, PHE Maternity Services Dataset – recording outcome of CO monitoring MSDS updates in development NHS E, NHS Digital Action across the MTP to consistently emphasise smokefree pregnancy Interdependencies identified Joint action plan in preparation ALL Ongoing work with the SiP Challenge Group Quarterly communications meetings Joint production of new resources Shared key messages PHE, NHS E Improving data New SATOD definition Removing those with unknown status from baseline NHS D, NHS E Training for healthcare professionals Online training module (NCSCT & RCM) E-learning for health New project engaging with health visitors PHE, HEE, NCSCT, Royal Colleges, Universities, Trusts The Presentation title - edit in Header and Footer

Next steps: Opportunities for further integration of systematic support to quit for smokers in the healthcare system Local and national agencies engaging more effectively to secure system-wide actions Providing leadership to ensure the delivery of meaningful reductions in smoking prevalence to reduce inequalities and contribute to a more sustainable NHS

Jo Locker Jo.locker@phe.gov.uk