HSQ logo Adding value to every clinical contact by treating tobacco dependence.

Helping Smokers Quit Report

The London Clinical Senate established a Helping Smokers Quit Programme to run from September 2014 until May 2016, chaired by Dr Mike Gill a member of the Senate Council. The values underpinning this work are to reduce the harm caused by tobacco, to reduce health inequalities and to champion value-based care because treating tobacco dependence is THE value proposition for the NHS.

The final report draws out learning from the programme, the examples we have seen and people and organisations that are helping to address this challenge. As a “how to guide” the recommendations it makes will assist clinicians, commissioners and providers to sustain and build on this programme through individual clinical action as well as new opportunities. In particular it has been written to support the planning and implementation of Sustainability and Transformation Plans (STPs) across London.

Helping Smokers Quit Report

The vision is that every London clinician knows the smoking status of each patient they care for and has the competence and the commitment to encourage and support that patient to quit or reduce their consumption through direct action or referral. All London clinicians should complete the Very Brief Advice Training at elearning.ncsct.co.uk/vba-stage_1

The documents below have been developed by the programme to support clinicians, commissioners and others to respond to the programme recommendations and implement the CO4 message.

The Clinical Senate is asking all London’s health organisations to commit to CO4:

  1. The ‘right’ COnversation for every patient and staff member who smokes that gives him or her a chance to quit, referring if necessary.
  2. Make routine near-patient (i.e. desk-top, bed-side and home) exhaled carbon monoxide (CO) monitoring by clinicians possible: “Would you like to know your level?”
  3. COde smoking status and the intervention so we can evaluate effectiveness – including death certification.
  4. COmmission the system to do this right: so the right behaviours are incentivised systematically.

Cost impact of tobacco dependency

Action on Smoking and Health (ASH) have produced a toolkit that sets out the current costs incurred at borough and CCG level due to tobacco dependency in the populations they serve. ASH’s ready reckoner has been updated for 2016 can can be accessed along with other resources at:
Ash Logo

Letters of support

This programme, and its recommendations to address tobacco dependency, have been endorsed by the Mayor of London and Minister for Public Health.
Minister for Public Health response to Helping Smokers Quit
Mayor of London response to Helping Smokers Quit

Achieving best value: Helping smokers quit

The Helping Smokers Quit Award Event was held on 17 March 2016 at Central Hall Westminster. The final programme is here Achieving best value by helping dependent smokers quit – Final Programme. See the HSQ Award Event Invite.

The presentations from the day are below, as well as a summary of the award winners work to treat tobacco dependence.

The award application template below can be used as a tool by NHS Trusts to review their processes for addressing tobacco dependence in their patients and local population.
HSQ Award Form – blank
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Download material

The briefing and slides attached below outline the objectives of the Programme and the evidence that supports the CO4 message.

Below, watch Dr Juliane Kause, Internal Medical Examiner and Lead Consultant for Out of Hours Care and Seven Day Services for University Hospital Southampton, as she discusses death certification, the role of the medical examiner, and their own journey at UHS.

In this video, GP Noel Baxter demonstrates how to use a carbon monoxide (CO) monitor and chart during a consultation, in this case an asthma review, to validate smoking status.

Programme Board member Debbie Robson talks about Treatments to support the implementation of NICE PH48: Smoking cessation in secondary care. This video and more at www.gov.uk/government/publications/smoking-cessation-in-secondary-care-mental-health-settings

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Smoking kills: so why is it missing from death certificates?

The Clinical Senate’s Helping Smokers Quit Programme held a workshop on Thursday 9 July 2015 to focus on improving the coding of death certificates. We would like to improve national data on mortality by requiring smoking history to be recorded on death certificates when it was a significant contributory factor. This event was aimed at clinicians with responsibility for death certification, Clinical coders, Medical examiners, Medical Directors, Pathologists, Professional Bodies, and Coroners.

The workshop aimed to:

  • Explore current practice in death certification across London
  • Discuss opportunities, challenges and potential solutions to better recording of death certification, including smoking as a cause of death
  • Identify key actions needed to improve coding of death certification
  • Agree what practical guidance would assist
  • Consider the potential to develop a consensus statement on coding smoking (tobacco dependency) on death certificates

The National Medical Examiner Professor Peter Furness spoke at the workshop, and all the presentations from the event are available below.

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Smoking in Pregnancy

Report on implementing CO monitoring at booking and 36 weeks in King’s College Hospital’s maternity services. This report will be of interest to any Trust wanting to implement NICE Public Health Guidance 26 “Quitting smoking in pregnancy and following childbirth”, or sign up to the Senate’s CO4 campaign.
CO Monitoring Report KCH Co-authored by Doris Gaga and Rowan Agate, Smoking Cessation Counsellors for Pregnant Women and Parents of Young Children, and shared with thanks to Jill Demilew, Consultant Midwife Public Health & Supervisor of Midwives, King’s College Hospital NHS Foundation Trust.

A case study about the benefits of carbon monoxide screening from the London Maternity Strategic Clinical Network
London Maternity SCN Case Study – carbon monoxide (CO) screening

Article on how research has shown that the public smoking ban has contributed to a reduction in stillbirth rates. Stillbirths-dropped-since-smoking-ban

Slides from the Smoking in Pregnancy Network meeting on Thursday 16 July 2015 at the Waldron Health Centre, New Cross.
2015-7-16 Helping Pregnant Smokers Quit London & South East Tobacco & Pregnancy Network Meeting

Smoking cessation in pregnancy – A Call to action

The Royal College of Midwives letter to Heads of Midwifery about the importance of Carbon Monoxide screening in reducing smoking in pregnancy
Royal College of Midwives letter
Carbon Monoxide Screening – advice for health professionals
Carbon Monoxide Screening – advice for pregnant women

Further resources are available from the Smoking in Pregnancy (SiP) Challenge Group. To find out more information on SiP initiatives in your local area/trust, please contact your local stop smoking service. If you are not sure who that is, please contact Penny Chew, London & South East SiP Network Coordinator on Penelope.chew@nhs.net.