“Evaluating the impact of a regional approach to babyClear, and tackling the high levels of maternal smoking in North East England” 2015 UKNSCC, Manchester Martyn Willmore Fresh Smoke Free North East

Overview o Current NE position on maternal smoking o What we`ve done to address this o What the data is telling us o Lessons learned in terms of stop smoking support o We await the academic evaluation of babyClear o Acknowledgements and thanks go to: o Hilary Wareing and Tobacco Control Collaborating Centre o Newcastle University team o Teesside University team o Eugene Milne o Jane Beenstock o NE Heads of Midwifery o NE SSS providers & commissioners

The North East & Maternal Smoking o SATOD rates across NE have been consistently high since data started o They don`t reflect progress made in NE adult/youth smoking levels o We recognise that maternal smoking is not just a “pregnancy issue” or a cessation issue o Yet we felt we needed to do more to improve our systems to support pregnant smokers to quit

BabyClear So after months of negotiations and work done with key partners, we started to implement babyClear o Systematic approach to CO monitoring and referral by midwives at first booking appointment o “Risk Perception” intervention by midwife at time of scan clinic o Skills training for midwives and SSS staff (advisers and admin teams) o Clarifying referral pathways/systems o Supply of all related materials in Year One

BabyClear planned roll-out

BabyClear actual roll-out

Changes in SSS models o Throughout the implementation, we faced a changing landscape (e.g. CCGs, maternity teams, LAs Public Health) o But one of the biggest challenges was the move from 6 SSS to effectively 10 separate SSS with a variety of models: No specialists and pregnant women seen by any willing provider No specialists, but clearly defined pregnancy advisors Traditional hub & spoke model with pregnancy specialist advisors DarlingtonNorth TynesideCounty Durham GatesheadNorthumberland South TynesideNorth Tees SunderlandSouth Tees* Newcastle**

Resources provided o Two-hour training for all staff who do booking appointments o Around 450 attendees o Train the trainer support for localities o Approx. 350 picobaby CO monitors provided o All-day training for small cohort of risk perception midwives o Around 55 North East midwives attended o 20 maternity units provided with relevant software/CO monitor o One-day training for 28 SSS hub administrative staff o One or two day SSS pregnancy advisor training for 117 staff

Change in number of quit dates set by pregnant women (Q1-3 12/13 vs. 14/15)

Estimated % of pregnant smokers using SSS in 2014/15 and validated quit rates

SSS models – some thoughts o There is no obvious correlation between having a “specialist-delivered” SSS and outcomes o But having specified pregnancy providers is vital in terms of achieving quality outcomes o If non-specialist providers are active, well-trained and supported (usually by hub), their quit rates can be good o ……but, if specialist provision is removed without a clear handover strategy, we`ve seen major disruption o Real difference in attendance levels with arranged one-to- one sessions, rather than drop-ins

Other thoughts…. o Having stop smoking advisors on-site after dating scan increases engagement. As do morning scans o Yet, there are on-going practical issues around triaging smokers into dedicated scan clinics o CO screening at every opportunity is vital o Challenges around who provides CO equipment post- implementation (we are clear it should not be the SSS) o Smoking rates at booking vary hugely. From 15% to 50% o Attendance rates at first appointment also vary significantly

Change in NE local smoking at time of delivery rate (Q1-3 14/15 vs.11/12)

Change in regional smoking at time of delivery rate (Q1-3 14/15 vs.11/12)

What next? o Ensure babyClear (especially the risk perception element) is routinely embedded. Possibly extend beyond midwives? o Await formal evaluation of babyClear, in terms of attitudinal changes (staff and patients), and impact on birth outcomes o More PR/Media about reasons to quit o Greater use of mobile phones/Apps/online resources? o Incentives? We see the evidence building up in support of well-structured financial incentives o Greater insight into North East pregnant smokers?

Summary o Taken longer to get to this point than expected o Partly due to extent of change in the system o Still variation across region (in both midwifery and SSS support), but less than before o babyClear still reliant on the SSS model and the support of maternity teams o We can`t just treat tackling smoking in pregnancy as an isolated issue o Signs of progress, but still a long way to go

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