Can you tell us about how you became involved in this programme?
Smoking rates are above the national average in South Yorkshire and Bassetlaw, with an estimated 200,000 residents smoking population 1.5 million), so decreasing smoking is a priority for the Integrated Care System (ICS).
Smoking is an addiction, that often starts in childhood. Treating tobacco addiction is one of the most effective treatments the NHS can offer. So we feel that the NHS has a responsibility to treat smoking, just like we would any other chronic disease.
The QUIT Programme was developed in 2019, in partnership with the independent regional charity Yorkshire Cancer Research, which provided £1.8m in funding. It is estimated that 1,350 cancers diagnosed in South Yorkshire every year are caused by smoking.
QUIT is being rolled out in all eight of our Trusts – 4 Acute, 3 Mental Health and a specialist Children’s Hospital. It is the first stage of a new Healthy Hospital Programme. The Programme is evidence based and draws on learning from the Ottawa and the CURE Project Greater Manchester. It aims to embed the treatment for tobacco addiction into the routine care offered to every patient who smokes when they attend hospital.
The QUIT principles are:
- Ask the Question
- Understand their addiction
- Inform patients
- Initiate Treatment
The programme has 4 key strands:
- QUIT for Patients
- QUIT for Parents
- QUIT for Staff
- QUIT for a Smoke Free Hospital
Why is this programme important to roll out in Trusts?
Smoking is the largest preventable cause of disability and mortality. The high local smoking rates are a major contributor to health inequalities in South Yorkshire and Bassetlaw.
There is strong evidence for the effectiveness of behavioural support and pharmacotherapy. Admission or other contact with a hospital provides an ideal opportunity to support people to quit. Stopping smoking very rapidly improves health, reduces hospital readmissions and deaths.
The QUIT Programme will transform the way smoking is tackled by the NHS in the region, with hospital staff recognising it as a treatable addiction – not a lifestyle choice and offering all smokers effective treatments on an opt out basis.
The QUIT Programme will save lives, reduce health inequalities and help reduce NHS demand.
What did you do in the first 3 months of the project ?
QUIT is being delivered by South Yorkshire and Bassetlaw Integrated Care System (SYB ICS) in partnership with eight Trusts; five Clinical Commissioning Groups; five Local Authorities; five local Stop Smoking Services; five Local Pharmaceutical Committees; Yorkshire Cancer Research and The University of Sheffield.
The first priority was to identify and bring all the key stakeholders together to establish the governance, develop the service and staffing model and agree the business case. We had a range of workshops to help inform the service specification and pathways.
Gaining support and leadership from senior leaders across the System and Trusts was key. We have a Trust Chief Executive, Dr Richard Jenkins, as the Programme’s SRO and all of the Trusts have an Executive Sponsor and a Clinical lead.
In addition to ICS PMO support, each Trust appointed a Healthy Hospital Programme Manager and one or more Health Improvement Managers to lead the implementation. Yorkshire Cancer Research provided funding for 45 trained tobacco treatment advisors.
For the QUIT Programme to be successful there needed to be good engagement from both Health Care Professionals and patients. Developing a communications plan and a variety of training packages was a priority. The QUIT website gives an overview of the Programme and has a range of downloadable resources and videos.
What have been your main barriers/difficulties in starting the programme and how did you overcome these?
Embedding the treatment of tobacco addiction is complicated and requires extensive programme management, both at a System level and within Trusts. The ICS programme management support has helped drive the QUIT Programme forward and supported Trusts with implementation.
The COVID-19 pandemic made the launch of QUIT extra challenging and our Trust colleagues have worked hard to get the Programme off the ground. Trust QUIT teams have needed to engage with many different departments in the hospital (e.g. communications and engagement, training, pharmacy, estates, Business Intelligence, Information Governance, clinical systems applications) which when everyone is so busy with COVID-19 has needed real commitment from all those involved. Covid has also limited the amount of communication and training we have been able to provide to clinical staff.
Recruiting staff who have both mental health and tobacco expertise has been difficult. Trusts that offered fixed term contracts have found recruitment particularly challenging.
The biggest challenge to date has been around developing the IT clinical systems which are needed both for day to day service delivery and for NHSE reporting / evaluation. Our Trusts use many different clinical systems, each with different capabilities.
Is there anything you would do differently?
This is a complex and multifaceted programme that involves a huge number of stakeholders. We underestimated the time that the overall set up phase would take.
In retrospect, it would have helped to have defined more clearly the different types of skills and capacity needed (Public Health / Tobacco expertise / Programme Management / Admin) rather than trying to combine roles. We would also recommend that all posts are appointed on substantive contracts.
Ideally we would have facilitated more clinical engagement and training, led by our excellent Clinical leads, but this has not been possible yet due to the pandemic.
What advice would you give others about to embark upon a similar programme?
Have a robust business case and secure funding to supplement the NHS England tobacco funding. The generous support of Yorkshire Cancer Research has enabled us to progress at scale.
Gain high levels of organisational commitment and have clear governance structures in place. Senior support is essential to the success of a programme that is dependent on the involvement of so many departments of the hospital and external partners. Involve your Community Stop Smoking Service and Local Authority colleagues from the beginning.
Be realistic of the amount of capacity needed, both from a programme management and delivery perspective. Appoint substantive senior posts to help develop, implement and deliver the programme and to supervise and train the tobacco treatment advisors. Having Health Improvement Practitioners who have years of Stop Smoking Advisor experience has been critical. QUIT Teams need to have a clear ‘home’ in the Trust structure and clear reporting / escalation routes from their QUIT Steering Groups into Trust Governance Structures.
Have ward QUIT champions supported by the specialist team. This is helping wards to really understand the Programme and embed the QUIT pathways into day to day practice.
How do you feel the programme is benefitting the Trusts and most notably, patients’ with a tobacco dependency?
Many clinicians have wanted to help people to stop smoking for years. QUIT now gives clinicians the support from a dedicated team of specialist staff to help them treat their patients’ tobacco dependency. As well as the Healthy Hospital Programme Manager and Health Improvement Practitioners, there will be over 40 Tobacco Treatment Advisors across the South Yorkshire and Bassetlaw Trusts.
Patients are asked their smoking status and offered nicotine replacement therapy to help with withdrawal symptoms on admission, before being referred to the Tobacco Treatment Advisors on an opt out basis for a specialist assessment and support.
We are also developing pathways to support parents of our child patients, outpatients, community mental health patients and staff who would like to quit smoking.
Not only will we help to save lives and decrease health inequalities for our patients, but we will also help protect children from second-hand smoke and from becoming smokers themselves. Trusts will also benefit from staff keeping well and having fewer absences from work.
Do you have any recommendations on how to maintain and sustain the programme to ensure it is embedded within the Trusts in the longer term?
It’s important to secure long term funding and senior commitment from the beginning of the Programme. Maintaining close working relationships with all of our Partners, especially our Local Authority and Community Stop Smoking Services who have been so helpful in sharing their expertise and helping us set up the Programme and ensuring seamless transfer of patients, will be essential.
Our QUIT teams are working together across South Yorkshire and Bassetlaw to share learning and to continually develop the Programme. Ensuring we have the right support for the tobacco treatment advisors is essential.
When Covid restrictions allow, we endeavour to do more to support smoke free sites and culture change, so that we start to embed the treatment of tobacco into every smoker’s care plan. Our QUIT champions will play a key role in this.