The Scottish Government

« Previous | Contents | Next »

Listen

A BREATH OF FRESH AIR FOR SCOTLAND IMPROVING SCOTLAND'S HEALTH: THE CHALLENGE TOBACCO CONTROL ACTION PLAN

CHAPTER 4: PROVISION OF SMOKING CESSATION SUPPORT SERVICES

The Challenge

4.1 A reduction in smoking levels in Scotland will require us to increase and tailor the provision of services across a wide range of settings. Smoking affects every social group. We do know, however, that the highest smoking rates are found within the areas of highest socio-economic deprivation and that prevalence is particularly high amongst socially excluded groups such as heavy drinkers, homeless people, prisoners and people with serious mental health problems. Services need to be sensitive to the particular needs of such individuals who may be difficult to engage in services and not necessarily catered for by traditional health or workplace settings.

4.2 In providing services, we also need to be mindful of the effects that smoking can have on young and unborn children. The review report points out that smoking during pregnancy is the single largest preventable cause of disease and death to the foetus and infants and accounts for a third of perinatal deaths. Around 27% ⁷ of Scottish pregnant women currently smoke in pregnancy, meaning that about 13,500 babies born in Scotland have been put at risk from the effects of tobacco.

Current activity

4.3 The review report acknowledges the major expansion in cessation services across the UK since publication of Smoking Kills. It looks at the effectiveness of a range of interventions - from low intensity support such as self-help materials and telephone helplines to more intensive interventions, including individual and group counselling - which assist increased quit rates. It also refers to the value of national activity such as 'Smokeline' and 'No Smoking Day' in encouraging people to quit and offering support and advice to enable them to do so.

4.4 In Scotland, substantial resources are made available to NHS Boards through the following funding streams:

Smoking Kills: 1 million in each of 3 years (1999/00, 2000/01 and 2001/02) was provided as part of NHS Boards' revenue allocations specifically for smoking cessation services and NRT which was to be targeted particularly at areas of deprivation. This funding, which the majority of Boards have indicated has been used for smoking cessation activity, is now included in NHS Boards' unified budgets and continues to be available.

Health Improvement Fund (HIF): smoking prevention and cessation was identified as a priority for investment from the 26 million per annum fund which has been available since 2000/01. Information supplied by NHS Boards about HIF expenditure suggests that over 750 thousand per annum is allocated to smoking-cessation developments.

Revenue allocations: 5 billion has been allocated for 2003/04. NHS Boards have a standard increase of 7.4%, with an average increase of 7.8%. Indicative revenue allocations totalling 5.4 billion for 2004/05, a standard increase of 6.5% and 5.8 billion for 2005/06, a standard increase of 7% were notified to Boards in August 2003.

4.5 Within HIF resources and revenue allocations, Health Boards have flexibility to direct the appropriate level of funding required to meet smoking cessation and prevention needs within their areas. As a result, all areas now have one or more smoking cessation service, although their extent varies greatly according to what is made available on the basis of local decisions. NHS Board Health Promotion Departments are sources of expertise, training, information and resources for smoking cessation and can assist with the development and evaluation of prevention and cessation services. Most NHS Boards have appointed a smoking cessation co-ordinator and a variety of service delivery models are being developed and evaluated.

4.6 The ASH Scotland/Health Scotland's Smoking Cessation Guidelinesfor Scotland⁸ were sent to all NHS Boards in 2001 to provide evidence-based information on the most effective smoking cessation services. Further pieces of guidance - a patient's guide and a heath professional's guide - were also circulated. The Scottish Executive funded initiative Partnership Action on Tobacco and Health (PATH), launched in June 2002, was specifically set up to support tobacco control activity through gathering and disseminating evidence of best practice, the development of training standards and recommendations on information management and data collection.

Future direction

4.7 There remains an untapped demand for smoking cessation services and the Scottish Executive is committed to making further funds available to support the expansion of such services in Scotland. We aim to agree annual cessation targets with individual NHS Boards and take a proactive role in ensuring that local providers are indeed translating additional resources into additional cessation capacity.

4.8 However, the expansion of cessation services should not just be seen as a matter of numbers. We need to ensure that the services we offer are of high quality and produce long-term results. GPs, practice nurses, midwives, dentists, pharmacists, health visitors, and other health professionals, all potentially have a role to play in giving smoking cessation advice. Such advice need not take long but the messages need to be consistent. Moreover, it needs to take account of the conclusion within the review report that, in general, the more intensive the intervention, the greater probability of success. Also that some individuals find it more difficult than others to give up and, therefore, need longer-term and more intensive support. It also notes that quit rates double, irrespective of the interventions, when combined with the use of NRT or bupropion.

4.9 Our approach to the provision of services must continue to be based squarely on the evidence of their effectiveness. PATH has a central role to play in identifying this evidence from around the world, and then distilling and disseminating best practice guidance through publications, and the development of training standards for service providers in Scotland. This work includes the management of a 900 thousand fund over 3 years - 2003/04 to 2005/06 - which is supporting 11 innovative projects aimed at improving understanding of how to help different types of people to quit. The work being undertaken by ASH Scotland and Health Scotland to identify acceptable and effective approaches to smoking cessation for young people, through a programme of eight pilot smoking-cessation interventions, will also help to strengthen the knowledge base.

4.10 We will also work with partners to encourage the development of services that are accessible to those in the most deprived areas of our country and sympathetic to those groups who have proved to be hard to engage in conventional approaches. We will continue to pay special attention to smoking during pregnancy. All this will require efforts to embed smoking cessation within services (e.g. debt counselling, housing, social work, etc.) which tackle the broader social issues that can contribute to smoking behaviour and create barriers to smoking cessation. We need to help professionals working within both the statutory and the voluntary sector to take advantage of opportunities to raise the subject of tobacco use with clients and patients, assess smokers' readiness to make an attempt to quit and ensure appropriate motivation and support is provided to help them to stop. This requires us to find ways of equipping workers with the necessary skills to empower them to do so.

Actions

« Previous | Contents | Next »