1. Improving Quality in Stop Smoking Services David Tumilty Senior Health & Social Wellbeing Improvement Officer Public Health Agency, Belfast Dr Gillian Gilmore Health Intelligence Manager Public Health Agency, Belfast UKNSSC, 12 June 2014, London

2. Overview Setting the context Quality Standards & Monitoring Systems Why Quality Improvement Quality Improvement Process & Outcomes key learning & Next Steps

3. 2,300 50% 24% £164m Ten Year Tobacco Strategy Improve structure, process and outcomes Context to this Quality Improvement Initiative

4. Implementation of Strategy TSISG Research & Information Protection & Enforcement Services & Brief Intervention Communication & Education Policy & Legislation

5. Quality Standards & Stop Smoking Services in NI

6. Northern Ireland Stop Smoking Services – Electronic Monitoring System

7. Quality Improvement Programme

8. Uptake of Stop Smoking Services NI and 4 week quit rates 2007/08 – 2012/13 Introduction of smoke free legislation Source: Stop Smoking Services monitoring data 2012/13

9. Examining the success of services 2011/12 Client Uptake Average 4 week quit rate of provider % (n- provider number) Pharmacist28977 (73%)49.9% (407) GP practices5582 (14%)48.4% (132) Hospital3136 (8%)67.5% (13) Community1934 (5%)65.4% (44) TOTAL39,62951.8% (596) Number of providers achieving 4 week quit rate of 35% or under (n) 35.1% - <45.0% (n) 45.0% and over (n) 6962276 382272 2110 7334 11688392 Uptake and 4 week quit rate by provider type 2011/12

10. Online self-monitoring & support services

11. Pharmacy quality improvement process and outcomes

12. Steering group Pharmacy quality improvement process Above 45 quit rate 4 week quit rate >35% Notification to all providers of ongoing QI Process Annual review of quit rates Mid year review QI support 4 week quit rate < 35% - direct entry into QI programme QI support End of year review Service continuity 4 week quit rate > 35%

13. Steering group Pharmacy quality improvement process Above 45 quit rate 4 week quit rate >35% Notification to all providers of ongoing QI Process Annual review of quit rates Mid year review QI support 4 week quit rate < 35% - direct entry into QI programme QI support End of year review 4 week quit rate <35% QI support Suspension Temporary Reinstatement Termination

14. QI Support mechanisms…… Online exercise

15. QI Support mechanisms…… Update training Delivered throughout the region Aligned with commissioner review timelines Key learning Links back to commissioner on attendance QI Support mechanisms…… Individualised support Written communication One to one phone calls Visits to service Signposting to other services

16. Outcomes for supported quality improvement pharmacies Mid year review 13 of 69 taken no action - further individualised support End of year review 9 /69 providers still under 35% Continuity of care for current clients but no new registrations. Further one to one service discussion Service issues identified/ remedies discussed End of first QI group -only 1 termination

17. Impact of quality improvement overall Average 4 week quit rate of providers % (n) Provider type2011/122012/13 Pharmacy49.9 (407)55.6 (445) GP48.4 (132)48.2 (133) Hospital sites67.5 (13)65.7 (10) Community65.4 (44)65.2 (57) TOTAL51.8 (596)56.6 (645) Proportion of providers achieving 4 week quit rate of 35% or under %(n) 2011/12 2012/13 16.0 (69)7.9 (35) 28.8 (38)30.8 (41) 15.4 (2)10 (1) 15.9 (7)10.5 (6) 19.4 (116)12.9 (83)

18. Key Learning Joint working approach necessary Stakeholder communication key Raises awareness of service issues Additional pharmacy support fundamental to success Next steps Pharmacy - annual process Promotion of other standards Work with other providers