LTP Tobacco Dependency Early Implementers: James Paget University Hospitals Foundation Trust

Friday, December 17, 2021

Respiratory Futures spoke to Vandana Khurana, the Project Manager of the Tobacco Dependency service at James Paget University Hospitals Foundation Trust, an Early Implementer Site.

Can you tell us a little about how you became involved in this programme?

Along with several other acute trusts, James Paget University Hospitals Foundation Trust (JPUH) has been chosen as an Early Implementer Site (EIS) to test and refine different models of tobacco treatment services to see which is most effective in reaching inpatients, particularly those from hard-to-reach groups.

Why do you feel this is an important programme to roll out within an acute trust?

The NHS Long Term Plan (LTP) sets out clear commitments for NHS action to improve prevention by tackling avoidable illness, as the demand for NHS services continues to grow.

What was the first step to get your project off the ground?

The primary step was to do the stakeholder mapping. It was an important pillar to success in implementation and the progress achieved, it involved comprehensive and collaborative partnership with multiple stakeholders and directorates.

We also established a Memorandum of Understanding (MoU) between all stakeholders involved in the project. Though not legally binding, it set the commitment for engagement and sharing responsibilities towards enhancing project work for an equitable service delivery across the ICS footprint.

It was also a great help to make a stronger presence within the Trust and across region to promote our agenda. Engagement from the Medical Director and Operational Lead support has been vital in progressing communication and information with the staff internally in the Trust.

Can you explain what you did within the first 3 months of the project launch?

We set up a multi-stakeholder Steering Group and established key working groups and work streams, which  reported any progress to the steering group on a regular basis. We used these groups to help develop a clear project plan and liaise with senior executives to get further traction.

We also agreed on an inpatient pathways in ‘Delivery Model’ to meet the system level requisites, and an NRT funding split to understand levels of pharmacotherapy activity early on. In addition, we launched a ‘Smoking App’ for electronic data capturing in line with referrals to the smoking cessation team.

What have been your main barriers/difficulties in the early stages of starting the programme and how did you overcome these?

The start of the project was delayed due to the unprecedented challenges of COVID-19. However, once the peak of the pandemic was over, thanks to the consistent attendance to and clear agenda/priorities for the operational steering group meetings, we ensured tobacco dependence treatment remained high profile despite other priorities.

A delay in confirming funds from sponsors at National level caused a major challenge in recruiting advisers to lead the project. This is still ongoing but we are considering secondment opportunities, but we would prefer substantive positions under the tobacco cessation team.

Having permanent posts will help progress the agenda without delays without the need to restart recruitment once secondment is over.

Staff awareness and culture change have been a challenge. We have made progress through using various communication channels to include - Induction training, VBA sessions, Grand round presentations.

Having executive leadership to help with engagement and to help challenge where culture change is not happening at all levels and departments, is important.

How do you feel the programme is benefitting the trust and most notably, patients with a tobacco dependency?

For us at JPUH, it means tailored help for tobacco addiction with treatment to reduce the risk of early ill health and diseases.

Supporting our patients, service users and staff to overcome their tobacco dependence will not only provide improvements in their health, but also reduce health inequalities. It will also decrease demand on services by reducing the number of smoking related admissions and readmissions.

It has been very beneficial to sharing project work and lessons learnt with other Trusts and other neighbouring county hospitals who are also preparing to embed this service in line with NHS long term plan commitments.

What would be your top 3 tips for others about to embark upon the programme?

  1. Connect with CCGs and ICSs from early onset. It helps with resource allocations and system wide trajectory planning in developing the Tobacco dependence treatment services in the region.
  2. Ensure the programme sits in the governance structure within the respiratory directorate and that the respective clinical leadership is engaged. It is important to have an executive sponsor and a strong and engaged clinical lead.
  3. Establish and secure funding sources to avoid delays in implementation.

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?

It is helpful to have a strong Operational Delivery Group and Steering Group. In our case they helped make sure that the Transformation and Strategy lead and PHE (OHID) leads engaged with the project.

It was also a great help to make a stronger presence within the Trust and across region to promote our agenda. Engagement from the Medical Director and Operational Lead support has been vital in progressing communication and information with the staff internally in the Trust.

Wider representation is vital, and support from other stakeholders has helped in driving the implementation.

Is there anything that was particularly helpful to support the delivery of your programme
Yes, the development of a Smoking Referral App on Trust Intranet system to capture data of smoking status of inpatients and number of referrals made to cessation services and the development of a bespoke Very Brief Advice (VBA) training session for all the JPUH staff.

This training was collaboratively developed by our community service providers across two different counties to produce and deliver a shared and standardised training to all staff.

We are working to share the project out in other Trusts in the local ICS.

Is there anything you would do differently if you had the opportunity to start from the beginning?
Capacity modelling is vital, to manage expectations it is essential to identify the required number of staff and how much staff time will be needed.

Ensure that you have a dedicated project manager for each site to keep momentum of initial implementation and ensure that all teams are aware of the priority deliverables through clear communications.