The Scottish Government

Chief Executives, NHS Boards

Dear Colleague

SMOKING CESSATION SERVICES

Summary

Further to NHS Circulars MEL (99)38 and HDL (2001)64 and the allocation letters issued in September 2003 and June 2004, this letter confirms the allocation next financial year of a further £4m to support the expansion of cessation services. Allocations to individual Boards of this funding, which are in addition to that allocated previously for this purpose, are detailed in Annex A.

Priorities and targets

Reducing smoking levels in Scotland are central to the Scottish Executive's health improvement drive. Key priority groups for action remain as before-pregnant women, children and young people, and adult smokers particularly those in deprived communities. The current national targets are:-

General

The targets originally set in the white Paper Towards a Healthier Scotland were updated in the tobacco action plan A Breath of Fresh Air for Scotland to reflect action in the plan. The current targets are:-

• To reduce smoking among young people (aged 12-15) from 14% to 12% between 1995 and 2005 and to 11% by 2010.

• To reduce the proportion of women who smoke during pregnancy from 29% to 23% between 1995 and 2005 and to 20% by 2010.

• To reduce smoking among adults (16-64) from an average of 35% to 33% between 1995 and 2005 and to 29% by 2010.

Inequalities targets

In order to step up action to reduce health inequalities the Executive announced new targets aimed at increasing the rate of health improvement for the most deprived communities by 15% by 2008. This includes two new smoking reduction targets:-

• To reduce smoking during pregnancy in the most deprived areas by 10.0% from 35.8% in 2003 to 32.2% in 2008.

• To reduce the smoking rate for adults aged 16-64 in the most deprived areas by 10.9% from 42.1% in 2003 to 37.5% in 2008.

The tobacco control action plan acknowledges that the achievement of these smoking-reduction targets is dependent upon the current level of smoking cessation services being increased. Smoking affects every social group but we know that the highest rates are found within the areas of highest socio-economic deprivation, particularly socially-excluded groups. Services, therefore, need to be sensitive to the needs of individuals, particularly those who may find it difficult to engage in services and who are not necessarily catered for by traditional health or workplace settings.

Against this background, Boards are asked to ensure that these new resources are targeted appropriately to increase smoking cessation capacity in order to contribute towards reducing smoking rates among the three priority groups identified. Partnership Action on Tobacco and Health (PATH) is continuing to build up a strong evidence base on the effectiveness of different approaches to cessation activity in Scotland which Boards can draw upon for their service planning. The Smoking Cessation Guidelines published by NHS Health Scotland and ASH Scotland in September 2004 can also help to guide service provision.

Allocation formula

In order to ensure that resources are targeted appropriately in light of the national targets, we have looked very carefully at the most appropriate allocation formula for the new money. It has been agreed that the funding should be allocated on the following basis:-

• A flat rate component of £10,000 is to be allocated to each Health Board;
• The remainder of the available funding is being distributed using the Arbuthnott formula, adjusted using data on smoking prevalence (from the Scottish Household Survey) - giving a higher weighting to the lower Deprivation Quintiles.

Monitoring and evolutionevaluation

Data collection

As indicated in the allocation letter issued in June, the Executive has been working through PATH to develop and agree a minimum data set with smoking cessation co-ordinators. Following successful completion of the pilot study steps are now underway to roll the data set out across Scotland with a view to creating a uniform local and national data base of service provision. Information Services Division of the Common Services Agency are in the process of developing a web-based national data collection system which all Health Boards will be expected to input to in order to provide a clear and comprehensive picture of national smoking cessation activity across Scotland. This will all serve to facilitate national and local monitoring and evaluation. PATH in conjunction with ISD are holding a

familiarisation/consultation session on the new system on 6 December to which all Smoking Cessation Coordinators have been invited. It is proposed the system will become operational by April 2005.

Local target setting

In addition, as indicated above, we will be negotiating and agreeing cessation targets with each NHS Board within the next few months. As part of that process we are working with PATH to introduce reliable baseline measures and develop outcome based measures for future use. Further details on both of these developments will be available shortly.

Yours faithfully

Mary G Cuthbert

ANNEX A

Smoking Cessation Distribution to NHS Boards (Allocation £4million)