The Scottish Government

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RECOMMENDATIONS

Organisational recommendations

• Training and development:ASH Scotland should be funded to develop a training and development arm which will build on the work and achievements of PATH from autumn 2008. Such work will require close partnership working with many stakeholders;
• The MDS and national database:ISD Scotland should be funded to manage the day-to-day operational aspects of the MDS and national database, although some of the training should be provided by ASH Scotland's new training arm. ISD Scotland's work should be overseen and directed by a body similar to the current Project Board, which will be responsible for ensuring that the MDS and national database are fit for their local and national purposes. This body will comprise representatives from key stakeholders with national and local perspectives, and should be hosted by ASH Scotland (or another organisation outwith ISD Scotland);
• Supported projects:ASH Scotland should be funded to continue to develop the smoking cessation evidence base through managing supported projects focusing on social marketing and community development work with whole communities as well as with hard-to-reach groups of smokers. This should be done in partnership with the academic community to promote rigorous research. Findings from all of the research projects should be widely disseminated and incorporated into ASH Scotland's training and development work.

Specific recommendations for each element of PATH's work

Training and Development - Accredited Courses

• A training and development arm should be created within ASH Scotland. Funding should continue to be provided by the Scottish Government to enable this element of ASH Scotland to build on and extend PATH's current portfolio of training courses relating to smoking cessation, working closely with GCU to draw fully on their experience of developing training materials. This is important for several reasons:
• • There is an identified need for a wider range of courses, including courses for specific professional groups (e.g. pharmacists; dentists; social workers; youth workers) as well as courses for staff from a variety of professional backgrounds;
  • There is an identified need for courses of different durations (including some very short courses) carrying a range of accreditations (e.g. certificates of attendance; certificates of completion);
  • There is an identified need for courses that use a range of delivery media (e.g. distance learning);
  • Central development of such materials will ensure consistency across Scotland, with high quality courses that are regularly updated and based on recent evidence;
  • It is very time-consuming to develop such materials in-house (especially for the smaller Health Boards) and such central development will provide good value for money.
• The three current courses accredited by GCU should be updated/revised in light of the internal review undertaken by PATH and their delivery should be streamlined so that they are offered less frequently.
• Mechanisms should be devised to ensure that all previous course participants are 'formally' updated about relevant changes and developments in facilitating smoking cessation (e.g. those relating to nicotine replacement therapy).
• PATH staff (and subsequently ASH Scotland's training and development staff) should work closely with the NHS Health Boards to prioritise their needs for 'off the shelf' courses on smoking cessation that can be delivered by themselves and/or by local staff and then develop the materials for such courses.
• PATH staff (and subsequently ASH Scotland's training and development staff) should ensure that the key lessons on smoking cessation and prevention from the supported projects within PATH and ASH Scotland are incorporated into training materials to facilitate their dissemination across Scotland. Particular emphasis should be placed on working with traditional hard-to-reach groups (e.g. people living in socially deprived areas; young people; pregnant smokers; people from ethnic minority groups; people with mental health needs), and also with those living in rural and remote areas.
• PATH staff (and subsequently ASH Scotland's training and development staff) should work closely with the NHS Health Boards and relevant professional bodies to ensure that they are all actively involved in national discussions relating to the potential for developing a formal, national competency framework for smoking cessation (and to identify its resultant implications for training).
• PATH staff (and subsequently ASH Scotland's training and development staff) should explore the possibilities of building training-related alliances with others working within substance misuse services (especially regarding the use of cannabis).

Training and Development - Approved Courses

• The mechanism for approving locally-developed courses in smoking cessation should be retained within the remit of ASH Scotland's training and development work, but the approval process should be simplified and streamlined. This is especially important with respect to identifying the circumstances under which courses need to be resubmitted for approval (e.g. the extent of course changes; the time period since approval was granted).
• PATH staff (and subsequently ASH Scotland's training and development staff) should develop and launch a database of approved courses.
• PATH staff (and subsequently ASH Scotland's training and development staff) should explore the potential for working with all Health Boards delivering locally developed training courses in smoking cessation to help them to link these to competency frameworks, with the objective of promoting consistency across Scotland. If there is considerable interest in this, it is an important area for future collaborative work.

Data Collection and Monitoring

• The ongoing day-to-day management of the MDS and national database should continue to rest with ISD Scotland (with continued appropriate remuneration from the Scottish Government).
• Their work should be overseen and directed by a body that includes representatives from a wide range of partners and stakeholders. This body will be responsible for ensuring that the MDS and national database are fit for their local ('micro') and national ('macro') purposes, without being unnecessarily cumbersome for service providers to complete and submit.
• It will perform similar functions to the current Project Board (and be able to convene ad hoc Expert Working Groups, where relevant, to address specific aspects of the MDS and national database). It should also oversee the choice of the specific topics for additional reports, analysis and research at local and national levels using the national database.
• Such a body will need a 'host' organisation outwith ISD Scotland, and ASH Scotland is ideally placed to provide this function. It is therefore suggested that ASH Scotland undertakes this role (although it could be located within another external organisation if the partners feel this to be more appropriate).
• Although the day-to-day support and some of the training should remain the responsibility of ISD Scotland, PATH staff (and subsequently ASH Scotland's training and development staff) should also continue to contribute to delivering the required training relating to the MDS and national database as part of ASH Scotland's training portfolio.
• Ways need to be found to provide academic researchers with easier access to the national database. For example, the new Project Board could act as a gatekeeper that reviews and approves proposals for access, thus enabling additional research to be undertaken by suitably qualified and experienced personnel/organisations.

Supported Projects

• Funding should continue to be made available (e.g. to ASH Scotland) for enabling and managing short-term service-based and research projects. This funding should generally be for a minimum period of three years. Many respondents stressed that work in this area is in its infancy and it is vital that the momentum achieved to date is not lost.
• A future round of supported projects should focus on undertaking community development work that not only engages with hard-to-reach groups but also explores ways of working across different groups of smokers. This work should include promoting techniques such as social marketing, and it should be extended to cover the delivery of smoking cessation services to those living in rural and remote areas. It should also include developing aspects such as motivational interviewing and relapse prevention and management.
• Voluntary sector organisations should be invited to bid for funds, as some hard-to-reach smokers may prefer to work with their staff rather than with those from statutory services.
• Before any further funds are allocated to projects, ASH Scotland should develop partnership working with one or more academic organisations to ensure that future funded projects are soundly structured (e.g. in terms of their methodologies and outcome measures), well managed and realistically resourced and funded.
• Lessons from all the PATH and ASH Scotland supported projects (past and future) should be synthesised and disseminated in a variety of ways (e.g. summary documents; ASH Scotland website; conference presentations) in a timely manner so as to deliver maximum impact.
• Lessons for service providers from all of the supported projects should also be incorporated into the portfolio of training courses that will be developed by PATH staff (and subsequently by ASH Scotland's training and development staff).

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