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Aim two

Reduce the number of local residents who smoke, particularly those who have the strongest dependence and face the most challenges in quitting successfully

What's driving this?

We know from our smoking JSNA that certain groups have smoking rates that are at least twice as high as those in the general population. These include:

  • People who are unemployed or in routine and manual occupations (25 per cent). In Cheshire West and Chester the areas of Winsford, Blacon, Lache and Garden Quarter and Ellesmere Port have the highest percentage of smoking residents
  • People with mental health conditions (40 per cent). Smoking is the main cause of the much lower life expectancy in people with long-term mental health conditions
  • People who identify as lesbian, gay, bisexual, and transgender (25 per cent)
  • Hospital inpatients (25 per cent). Life-long tobacco addiction is a major contributor to long-term health conditions in middle and older age
  • People who are homeless (87 per cent).

Social segmentation research gives us more insights into the social and behavioural characteristics of communities with higher than average smoking rates. For example we know that they are also more likely to:

  • have a range of health conditions and other unhealthy behaviours
  • be engaged with a range of health services, including emergency services, hospital respiratory and diabetes services, community and secondary mental health services
  • be engaged with social services
  • live in social rented accommodation
  • have carer responsibilities
  • face financial stresses
  • prefer communication via text or phone

And less likely to:

  • wish to be informed about health issues or services (although this group is also more likely to include people who want to participate and get involved in community initiatives)
  • be regular users of the internet.

Objectives and key actions

Develop a range of support to reflect the varying needs of all smokers, including those in priority groups

  • Develop services that enable us to deliver the most intensive interventions to key priority groups. Develop and support opportunities for evidence based brief advice and self-management information for other smokers
  • Ensure relevant staff have the right skills to support clients with complex needs for example, by fostering closer links with services that use social prescribing or community referral models
  • Strengthen the links between the stop smoking professionals and other public health services, e.g. substance misuse, sexual health and children's centres, as well as other health and supportive services e.g. debt advice, housing, mental health, work zones, housing associations and citizen's advice bureaux
  • Embed 'Making Every Contact Count' brief advice, engagement and signposting into relevant services and care settings. Signpost others to training and learning to expand the number of people who can give effective brief advice
  • Work closely with locality teams, district advisory panels and the Poverty Truth Commission to best understand local opportunities and barriers and improve the design of our stop smoking offer
  • Engage with third sector services and community groups to hear first-hand about the needs of smokers of all ages

Achieve smokefree Hospital Trusts by 2020 and continue to support smokefree mental health services

  • Work with Hospital leaders to fully implement NICE guideline PH48 and the Preventing Ill Health Commissioning for Quality and Innovation service (CQUIN's) improvement plans from 2018
  • Work with mental health services to continue improvements that promote physical health, as set out in the Five Year Forward View for mental health
  • Support joined up service improvement and tobacco dependence pathways across acute and community mental health services, taking account of NICE guideline PH45 dealing with harm reduction
  • Support system-wide change by engaging with clinical commissioning group partners to ensure a joined up approach to service development. For example, to support the new health optimisation pathway (a routine offer of support to tackle unhealthy behaviours prior to planned surgery) and CQUINS
  • Further develop the Smokefree Partnership Network to bring together relevant collaborators, encourage collective pathway development and harmonise smoking policy and health messages across organisations. This approach should also be widened out to a more regional footprint
  • Collaborate with Public Health England to ensure their commitment to offer training for all health carestaff is accessible locally, linking to the 'Making Every Contact Count' requirement in the standard contract for hospitals
  • Support health settings to examine the implications of current and any new Public Health England guidance on vaping in relation to smokefree policy. Seek to develop common approaches.

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