Image Nicki Watkins July 2023

Tobacco Dependency Project Case Study - Nicki Watkins

Thursday, August 31, 2023

We invited Nicki Watkins along to tell us about her role as the Lead Nurse for clinical projects. She is based at Epsom and St Helier University Hospitals NHS Trust and is leading on the implementation of a tobacco dependency service. We are pleased to welcome her to share her experience of getting a service up and running.  

Can you tell us how you became involved in tobacco dependence?

Whilst I was working as Lead Nurse for Clinical Projects, I was approached by my line manager to produce a briefing paper for our executive team to outline the benefits and challenges of implementing a Tobacco Dependency Service for inpatients and maternity on one site of the acute Trust. This was a great learning experience; I learnt about the requirements of the service and subsequently became interested in developing the service that would support our patients to stop smoking.

Can you tell us who you approached first to help you plan and deliver your tobacco dependency service?

I approached the Programme Manager within Southwest London (SWL) Integrated Care Board (ICB), and they were a great help in signposting other Health and Local Authority services local to the Trust.

I also utilised a range of online resources available from the British Thoracic Society (BTS), Action on Smoking and Health (ASH) and the National Centre for Smoking Cessation and Training (NCSCT)

Within the Trust I set up a steering group, with Executive Lead support to assist in gaining buy-in from Divisional Leads. Although progress was slow to start with, this led to nominated personnel from each Division becoming part of the Steering Group and they were then able to disseminate progress through their networks. This is a really good way to ensure people across the Trust are championing tobacco dependence.

It was also important to gain support early on from our Business Intelligence and Performance and Information teams so we could benefit from their expert knowledge in designing compatible assessments and for data analysis.

Why do you feel this is an important programme to roll out within your Trust?

There are so many reasons that this programme is important!

Firstly, to enable our patients to improve their health outcomes through understanding the support available to help them to stop smoking, and to realise that it is not an impossible task to achieve. Not many smokers realise that they can access free services and nicotine replacement therapy, or that some products may suit them better than others.

It is also a great opportunity to re-educate our staff to view smoking as an addiction rather than a lifestyle choice. With this in mind we have the opportunity to change the mind-set of healthcare professionals so that tobacco dependency is treated as a disease requiring medical management.

Lastly, treating tobacco dependence has the long-term potential to reduce the number of patient admissions due to smoking related disease, and reduce the financial and service delivery pressures on the Trust.

The initial stages of developing a service are always vital. What were you first priorities?

For the first 3 months I was researching tobacco dependency, linking with colleagues in maternity services, setting up the steering group, and engaging with stakeholders. I also prepared job descriptions for a Band 7 Lead Nurse for Tobacco Dependence and Band 4 Tobacco Dependence Advisor, which were then advertised.

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

Initially, the main difficulty was getting consistent support when setting up the steering groups. Although there was enthusiasm, some colleagues had multiple demands on their time and were unable to attend meetings, so took time to complete their actions. This was overcome with the help and support of the steering group Chair and Leadership Team sponsor, who championed the need for divisions to be involved.

It has also been a challenge to recruit into the Tobacco Dependency Advisor role, and five months after advertising, we are still waiting to successfully appoint.

Is there a particular area that you feel could have benefited from more input and time?

I would definitely have allocated more of my time to understanding the Community Referral Pathway and digital platforms that will be used. Currently, the digital platform is not ready for us to refer patients. Spending some time on this aspect of the service early on would help to speed up the process, to engage more with the referral and data pathways ensuring they meet the needs of the service, and maximise opportunities for me to communicate the benefits to my team.

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

- If you’re new to tobacco dependency, get to know it thoroughly because you will need to be a subject expert in order to promote the service and champion the continuation of it.

- Find a staff group who are interested in the subject to engage with first, bring them on board and educate them, and then use them to champion the service.

- Ask, ask, ask! If there’s something you don’t understand find someone who does or who can point you in the right direction. There are a number of resources and forums (e.g. NHS Futures) that can answer questions you have or provide examples of areas they may have already covered.

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

Our Trust is in its infancy with the tobacco dependency programme, but already we have had examples of patients welcoming the opportunity to discuss making a quit attempt and have started recording patient’s successful outcomes following discharge.

In the longer term I hope that the benefit to the Trust will be that tobacco use becomes a routine topic of conversation for staff to enter into with patients and to approach the topic stigma-free, and keen to help.

Do you have any plans on how to maintain and sustain the programme to ensure it is embedded within the trust?

Our service is still evolving and while we do not have a long-term plan in place, an important factor will be keeping tobacco dependence, and it’s benefits at the top of the agenda across our whole workforce. I am hoping we can make VBA training mandatory for all staff working at our Trust as this will help to make sure each Division has staff that are confident to start a conversation with patients. I also intend to visit the wards regularly and maintain close communication with staff so that I am aware of issues and difficulties quickly, alongside the successes too.

To really sustain the service long term we have to prove the benefits (e.g. opportunity to address avoidable health inequalities, financial benefit, wider education of workforce) in order to secure longer term service funding.