The growth of North East Stop Smoking Services: challenges and successes since 1999 Martyn Willmore Performance Improvement Delivery Manager Fresh – Smoke Free North East

Structure North East has got an adult population of 2.15 million Smoking prevalence of 21.2% 12 Local Authorities served by 6 SSS: Northumberland Newcastle and North Tyneside South of Tyne and Wear County Durham and Darlington Hartlepool and Stockton Middlesbrough and Redcar & Cleveland

North East Stop Smoking Services Like most areas of England, the North East established NHS Stop Smoking Services in 1999 NE SSS have built up an enviable record of delivery over the last 14 years Consistently topping the national table for number of quitters per population size Consistently attracting a higher number of smokers into our NHS Services than other regions

Number of 4-week quits delivered by NE NHS SSS since 1999

Decline in NE smoking prevalence vs. England average since 2003 Since 2005, we have seen NE adult prevalence fall by 9%. That’s around 170,000 fewer smokers. SSS are estimated to have contributed around 0.3% of the fall in prevalence each year

What makes a good SSS?? Capacity and reach to help as many smokers engage as possible Quality of Service (crudely measured by quit rates) Reaching key audiences and helping them to quit, thereby tackling health inequalities Cost-effectiveness

% of adult smokers setting a quit date with NHS SSS in 2011/12

4-week quit success rates (%) through NHS SSS in 2011/12

Is there a correlation between high throughput and lower quit rates?

North East quits per population size compared to national average

Differing Local Models of Delivery Clearly there is no “magic wand” solution, and one size does not fit all Even localities with nominally the same SSS model achieve strikingly different results But there is significant variation in the service models adopted across the North East as a whole And significant variation in outcomes too…..

NE quits through SSS per 100,000 smokers in 2012/13

What NE SSS have in common… They all have a dedicated “hub” team at the centre of the service (although roles/responsibilities differ) All these hubs are hosted within traditional NHS settings Until January 2013, all SSS consisted of a “specialist” hub provider arm, with a large army of Tier 2 providers All SSS offer a combination of evidence-based interventions (e.g. drops-ins, one-to-ones, different settings, range of pharmacotherapies, etc)

What differences are there….? The size of the specialist hub varies significantly Also, what is the hub commissioned to do? See smokers directly? See a target number? Train and mentor other providers? Administer reimbursement to other providers? Proportion of clients seen by Specialists and Intermediates varies enormously (from 14% to 88%)

What differences are there….? Availability of NICE approved pharmacotherapies o Proportion of clients given Varenicline ranges from 18% to 45%. Regionally it`s 30% Variation in 4-week quit rates o Range from 40% to 54% in 2012/13 Different data systems Success levels around pregnancy o Both in terms of quit rates, but also throughput

Quits rates amongst Pregnant Women Q /13

Proportion of pregnant women setting a quit date with SSS in Q /13

Challenges SSS have, in part, become victims of their own success. Targets are increasingly stretching Local SSS no longer nationally mandated – what happens after 2013/14? National context. 2012/13 saw a 13% FALL in quit dates set through SSS in first three-quarters of year Specifically, we`ve seen a massive drop in Primary Care activity Growth of electronic cigarette market??

Challenges Whilst SSS interventions on an individual level are hugely cost-effective, we know that they are not the main driver of reductions in overall prevalence Fostering an understanding of the role of SSS The move towards Harm Reduction Linking services to secondary care and using SSS as a key part of chronic disease management Raising standards to that of the highest performers regionally/nationally

Are we making a real difference? Coronary Heart Disease mortality rates – NE vs. England DSR

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