Tobacco Control: How local authorities can make best use of diminishing resources Ailsa Rutter OBE, Director, Fresh - Smokefree North East

“…the burning injustice that if you’re born poor you will die on average nine years earlier than others.” Prime Minister Theresa May, July 2016

Current situation Smoking rates have reduced considerably over the last 20 years, by a third nationally amongst adults and two thirds amongst children. However, smoking remains the largest cause of preventable and premature death in England killing nearly 80,000 per year. Preventative tobacco control work is hugely cost effective, but funding is being cut.

Burning Injustice APPG Inquiry into the state of local and national tobacco control. Published in January 2017. Contains recommendations for the government, local authorities and the NHS. http://ash.org.uk/download/burning-injustice/

National leadership and action New cross-government Tobacco Control Plan that includes ambitious new targets to reduce rates of smoking for all groups Letter Jan 2017 signed by 1000 plus Levy on tobacco companies to support investment nationally and locally- four major tobacco manufacturers amongst most profitable companies on earth.

Taken from Better Health for London, the report of the London Health Commission

Local impact Local activity on smoking contributes to local outcomes: Children the best start in life Boosting the income of our poorest social groups Tackling crime Reducing social care and NHS costs Increasing productivity of the local workforce NICE has estimated that for every £1 invested £2.37 will be saved through treating smoking-related disease and lost productivity.

Burning injustice recommendations The report contains 7 specific recommendations for local authorities. These focus on: Creating budgets informed by Public Health needs- written assessment; impact; considered by Cllrs; in context of NHS and CCG budget decisions. Developing local tobacco control plans- NICE and PHE guidance; alliances. Developing roles for HWBB to oversee implementation of local plans and facilitating coordination with local NHS organisations; tracking progress. Reliance on current evidence of the impact and cost-effectiveness of different interventions- evidence fully reported to Cllrs. Prioritising provision of specialist services for vulnerable groups when budgets prevent provision of a universal service. Collaboration across boundaries in forming regional partnerships- working with established six key strands approach Commitment to sharing best practice and exploring joint working and commissioning

Strategic local tobacco control

Local action: Support to quit Attempting to quit with the support of a stop smoking service is 4 times more effective than quitting unaided and highly cost effective Stop smoking services have experienced budget cuts alongside other TC activities Budgets are under pressure BUT complete removal of services likely to be a false economy in the long-run. New models such as ‘Stop Smoking +’ offer a more strategic deployment of limited resources Hugh untapped potential of the NHS primary and secondary care. Maximise opportunities through the Sustainability and Transformation Plans and CQUINS

Local action: Harm reduction NICE guidance on tobacco harm reduction: quitting best BUT if you can’t then nicotine alternatives better than smoking PHE evidence review- estimate around 95% safer than smoking Massive rise in use of e-cigarettes now 2.9 million users in GB – just over half ex-smokers- levelling off Locally need to maximise benefits and minimise risks e.g. ‘Ditch or Switch’ message

Local action: Trading Standards Effective enforcement by trading standards is essential to successful tobacco control work. One of the most important areas is illicit. However, trading standards has experienced a 12% decline in staff since 2014. Joined up models of working shown to be effective and can deliver value

Local action: Youth Prevention Smoking is an addiction of childhood with two thirds starting smoking before age 18. This may make youth prevention work seem attractive. However, an NCSCT evaluation found that the return from school-based youth prevention is minimal compared to adult smoking cessation services. Changing the adult world

Regional Partnerships Working at a regional level is an effective way to deliver tobacco control. The North East has had a locally commissioned comprehensive regional programme since 2005 – Fresh. The evidence for regional partnerships is illustrated by the above average decline in absolute smoking prevalence in the NE – 12 percentage points compared to 9 across England.

Change in regional smoking prevalence 2005-2016- overall relative reduction Comprehensive/ efficiencies

Figure 2.3 Projection of smoking prevalence in England to achieve prevalence of less than 5% in all socio-economic groups by 2035

For more information ASH FRESH Ash.org.uk 0207 404 0242 enquiries@ash.org.uk @ASH_LDN FRESH Freshne.com 01913337141 info@freshne.com @FreshSmokeFree