Can you tell us how you became interested and involved in this area of work?I’ve worked in the NHS since 1992. My current role involves the day to day running of all aspects of the department. E.g., counsellor, line manager, plan new pathways/projects, compile reports, produce and present training and ad hoc duties when requested.
I love the job because we have the flexibility to tailor our support programme around the needs of the smoker. This is less frustrating for staff and patients, as the guidelines fit around the patient not us having to try to fit the patient into the correct "tick box" Being hands on in all aspects, managerially, gives me greater insight into patient needs, so able to be very proactive in any changes required.
Can you tell us about how the demographics of your local population impacts how you plan and deliver a tobacco dependency service?
We have 3 main hospitals within our Health Board. We have low socio-economic groups that have high prevalence of smoking and pre- operative patients who have a tight deadline to quit. Also, complex needs patients who have a variety of issues stopping them leading a normal lifestyle. In addition, chronic or terminally ill smokers who need someone to off load to with all the changes occurring in their lives. Finally, those of all ages who live alone, live an isolated lifestyle.
We are a hospital service that offers smoking support (like phlebotomists, physios etc, an allied health professional role), not a stop smoking service. We follow the mission statement of the Health Board, whose role is to look after the holistic welfare of the individual.
The patient’s priority in most cases may not be giving up smoking, so we need to offer a flexible all round support package which includes smoking cessation support, not just dealing with stopping smoking.
Why do you feel this is an important programme to roll out within your trust?Smoking prevalence is still very high and can have huge benefits, if smokers stop before having any procedures it can improve their general quality of life. Also having intensive behavioural support empowers the patient to make positive changes in their lives.
Can you explain what you did within the first 3 months of the project launch?The service at the University Hospital of Wales was set up over 21 years ago. We had no room, desk, computer or telephone and little budget. Due to our large city hospital, there was little communication or collaboration between various departments, so we had to speak with each individually to discuss how to help.
I attended various meetings to introduce myself and my first goal was to find office space, order equipment, furniture and purchase and lay carpet!
It was integrated into the Respiratory teams’ service, line managed by the respiratory consultant who raised the service profile with Executive Board and fellow colleagues. They contacted lead consultants across all specialities advising them of the new service. I undertook daily ward rounds, introducing myself and explaining the purpose of the service and how each ward could refer using the quickest and easiest way. I attended Clinical Board Management meetings, set up links with the occupational health department and placed an article in the hospital magazine and intranet.
How would it differ to setting up a service now?
When I started 21 years ago, there were very few smoking cessation posts in place, so it was difficult to brainstorm or discuss issues, having to set everything up blindly. On a positive it did mean that the service could be set up and tailored around patient needs and that all those who worked in the field supported each other, no competition. Now, it is great to have so many colleagues in the same role so we can all brainstorm new ways forward and share experiences.
Can you share tips on how to deal with these issues based on your vast amount of experience?
I try not to over complicate any new structures. I ensure the patient is central to the decision making, not what looks good, but what would they need in place to help support them effectively. Hospital departments usually work in isolation, so I arranged face to face meetings with all departments and tailored the smoking cessation support pathways around their individual needs.
Finally, it’s imperative to set up good working relations with a clinical lead and levels of management who can initiate change at a higher level.
Is there anything you would do differently if you had the opportunity to start from the beginning?My priority should have been to find suitable leads that would champion the service from all specialities/departments. I naively believed that all departments within the hospital worked in a cohesive and collaborative manner so having one lead would be sufficient, I would love to have fought for more resources but there was nothing available.
Unfortunately, our Health Board resources are still very limited, current funding for our service comes solely out of the hospital Medicine Clinical Board's budget and we have had no additional funding streams. Currently the whole service consists of 1 WTE practitioner undertaking all duties alongside a 15 hour practitioner post in Barry hospital and a 5 hour post in Llandough hosptial. We also have the invaluable support of 2 part time administrative assistants. We do have very close links and support with our Medicines Clinical Lead and Directorate Lead. Motto is just get on and do what you can!
What would be your top 3 tips for others about to embark upon the programme?
- Set up links with clinic leads as soon as possible - produce cost effectiveness business plans using current toolkits available and ensure you put your own Health Board data in the report. If no current data in place, carry out a mini audit, similar to the BTS audit. Distribute this to management leads and request a place on the agenda of Clinical Lead and Directorate management meetings.
- Arrange face to face communication with ward staff, ward managers and outpatient staff and managers
- Wales smoking prevalence is a Tier 1 target so make sure you include that information in any emails. Ideally also ask if you can have a slot on the Clinical Board Management meetings and speak to Ward Managers, Outpatient Managers etc and ask if you can spend 5 mins speaking to ward staff or have a slot on departmental audit days. This can be a very time-consuming exercise. It’s also good to get a regular spot at induction days.
How do you feel the programme is benefitting the trust and most notably, patients’ with a tobacco dependency?The non-judgemental, flexible long term programme empowers smokers to quit smoking in their own time. The holistic service fits the programme around all the problems the smoker is currently going through. Quitting smoking can improve patient morale and health which reduces medical problems and can reduce the need for surgery
Do you have any recommendations on how to maintain and sustain the programme to ensure it is embedded within the trust in the longer term?Try to encourage each department to integrate smoking cessation onto their departmental pathways, make it flexible to support programmes that can be adapted to individual departmental requirements. Have a regular presence on hospital wards so get your face known. If possible have a 5 mins slot on medical inductions to introduce yourself and briefly explain about the service. Produce regular statistics for the Executive Board to demonstrate the excellent work that is being undertaken.