Tobacco Control Full Strategy 2020-2022

I am really pleased to introduce our new Tobacco Control Strategy and Action Plan which sets out our ambitions to work towards eliminating tobacco-related harm in our city, improving health outcomes for our residents and bridging the inequality gap between the wealthiest and poorest in our society. At the heart of the strategy is the health and wellbeing of our city residents, and the strategy addresses the opportunities available to improve the health and wealth of our residents. The strategy looks beyond simply helping smokers to quit but highlights how we will support our young people not to start in the first place and identifies the work we need to do to address the wider determinants of tobacco related inequalities, such as reducing exposure to second-hand smoke and access to illicit tobacco.

Significant progress has been made in recent years to support Leicester residents to achieve healthier outcomes and these include:

• a year on year reduction in both prevalence of smoking within Leicester and in the number of young people taking up smoking
• smoke free parks for children to play without risk of smoke exposure
• effective enforcement of smoke free legislation
• an increase in the number of options for smoking cessation support to those most at risk of health inequalities

However, despite these efforts Leicester’s smoking rate remains higher than the national average and tobacco-related health inequality continues to disproportionately affect some groups, such as those with mental ill-health and those in routine and manual occupations. There are opportunities to be innovative in our approach, for example by exploring the role of new technologies, such as electronic cigarettes, and we will embrace them.

The strategy recognises the importance of providing people with freedom of choice over their life choices whilst also acknowledging that tobacco use is an addiction which requires specialist support and encouragement to overcome. It also aims to protect those who are adversely affected by second hand smoke, such a young children, by offering guidance and support to those caring for them to bring them up in a smoke free environment.

The progress made to date could not have been achieved without the support of a range of partners and the strategy highlights how we will continue to work collaboratively with our partner agencies to achieve great outcomes together. I would like to thank everyone who has contributed to this strategy, particularly the Health and Wellbeing Board, the Young People’s Council, the Learning Disability Partnership Board and the Mental Health Partnership who have taken the time to ensure our strategy meets the needs of our local residents. We look forward to taking great strides together over the next three years and achieving the goals set out in this strategy.

Councillor Vi Dempster, Assistant City Mayor

Smoking remains the leading modifiable cause of ill health and death in our society, claiming the lives of almost 80,000 people in the UK each year, leading to more deaths alone than from obesity, drug use, road accidents, suicide, traffic accidents and HIV combined.

Tobacco use affects every sector of our society. Beyond the well-recognised detrimental effects on health, tobacco also plays a role in perpetuating poverty, deprivation and health inequality. Tobacco use is declining both nationally and locally and smoking is increasingly confined to the poorest communities, thus widening health inequalities. The difference in life expectancy between smokers and non-smokers (irrespective of wealth) is approximately 10 years. The poorest in our society, and therefore the least able to afford to smoke, represent the greatest proportion of the smoking population.

This strategy will identify the need for ongoing tobacco control within Leicester City, and will highlight the national and local aims and ambitions. The strategy will be supported by a Tobacco Control Action Plan for Leicester City which will act as a dynamic document, in that it will be reviewed and amended as appropriate on a quarterly basis.

There are approximately 330,000 Leicester City residents (2011 census), with an adult smoking prevalence of 15.4% (PHE fingertips - 2019), and whilst Leicester has seen a year on year decline in smoking prevalence it is still higher than the national average of 13.9% (NHS digital - 2018). Local data estimates that there are approximately 56,000 adult smokers in the City and that approximately 400 lives are lost each year through smoking related illness (Leicester JSNA - 2018) and many more Leicester City residents spend years of their life in poor health from smoking attributable illness. The rate of hospital admissions for smoking attributable illnesses is significantly above the national average, as are smoking attributable deaths. National drives to reduce smoking prevalence have been highly effective, and local work supplementing this has supported a reduction in the prevalence of smoking in Leicester City from 21.7% in 2013 to 15.4% in 2019/20. However, prevalence across the City is not balanced, with prevalence ranging between 14% and 25% dependant on ward (Health and Wellbeing survey - 2018). This is linked to factors including social deprivation and ethnicity which are both sources of health inequalities.

Health Inequalities

Health inequalities are preventable differences in health outcomes between population groups, with smoking significantly contributing to health inequalities in Leicester. The highest rates of smoking are consistently found amongst those who are most disadvantaged. Smoking rates are disproportionately higher in low income groups and in Leicester smoking amongst routine and manual workers is 24.2%, which is significantly higher than the City average (Leicester JSNA - 2018). Routine and manual workers in the UK are nearly two and half times more likely to smoke than those in managerial occupations at 23.4% and 9.3% respectively (ONS – Adult smoking habits in the UK 2019). The impact of this is stark: one in two smokers will die from smoking related illness, and half will die before the age of 70 losing an average of 10 years life expectancy (Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ. 2004 Jun 24;328(7455):1519). Often groups who are most vulnerable to health. inequalities, experience poorer access to healthcare services (NHS Long Term Plan), and it is vital that local services which support smokers to quit are accessible to those who are most at risk of being affected by health inequality.

Children and young people

Evidence suggests that children are three times more likely to take up smoking if they have a parent who smokes (Leonardi-Bee J, Jere M, Britton J. Exposure to parental and sibling smoking and the risk of smoking uptake in childhood and adolescence: a systematic review and meta-analysis. Thorax. 2011;66(10):847-855) and in Leicester one in three children have a parent or carer who smokes (Leicester City young people’s health and wellbeing survey - 2016). Young people are heavily influenced by their adult role models, therefore supporting adult smokers to quit is one of the most effective ways to prevent young people from taking up smoking (Towards a Smokefree Generation: A tobacco control plan for England 2017-2022). Children are particularly susceptible to the effects of second-hand smoke and are more likely to suffer second-hand smoke related ill-health such as respiratory infections, asthma, severe ear infections and sudden infant death syndrome (ASH factsheet - Secondhand smoke: the impact on children).

3.5% of young people in Leicester currently identify as regular smokers, however the smoking rate is much higher amongst children in care with approximately 12% of Leicester’s Looked After Children reporting regular smoking (‘A Health Needs Assessment for Looked After Children in Leicester, Leicestershire and Rutland 2019’).

Pregnancy

Smoking in pregnancy is still a major concern in Leicester with 10% of women still recorded as smoking at time of delivery (SATOD) in 2019/20, below the regional average of 14% and the national average of 10.6% (PHE fingertips data - 2019). However, it is important to highlight that Leicester is a very ethnically diverse city and that the smoking rate amongst white British women living in the most deprived areas of the city is significantly higher than the smoking rate amongst some ethnic minority groups. There is a wealth of evidence to suggest that being exposed to tobacco smoke in the womb is responsible for a range of serious health and behavioural issues, and the still birth rate in Leicester City is significantly above the national average at 5.9 per 100 births.

University Hospitals Leicester (UHL) data indicates that smoking at time of booking is approximately 17.6% (April 2019), which shows a reduction from 26.6% in April 2018. The overall SATOD rate between 2015/16 and 2019/20 has remained largely unchanged, despite fluctuations during that time. If the current trend continues the target set out in the national tobacco control plan to reach 6% by 2022 is unlikely to be achieved.

Mental health

Smoking rates are higher in those with mental health illnesses and they increase with the severity of the mental health issues (https://ash.org.uk/) Mental health sufferers are at greater risk of health inequalities, dying an average of 10-20 years earlier than those who do not suffer with mental ill-health and smoking contributes significantly to this. As well as being far more likely to smoke than the general population, those with mental ill-health also tend to smoke much more heavily than other smokers. The number of Leicester City residents who have a poor mental health and wellbeing score has increased since 2015 (Leicester Health and Wellbeing Survey - 2018). 31.5% of adults with a mental health condition report being a smoker (Leicester JSNA - 2018). Quitting smoking has been associated with many benefits to both physical and mental health in those with mental ill-health, including reduced depression, anxiety and stress, and improved positive mood and quality of life (Center for Disease Control US. Vital Signs: Smoking and Mental Illness. February 2013).

Social housing

Smoking rates are much higher amongst social tenants which increases the likelihood of social tenants suffering the effects of smoking-related ill health, or second-hand smoke exposure. Children are particularly vulnerable if they live in a home where smoking is permitted indoors. Financially, social tenants are more likely to suffer from smoking related poverty, spending a significant proportion of their disposable income on tobacco. A cost-calculator tool produced by Action for Smoking and Health (ASH) in 2019 estimates that 20% of social renters in Leicester are living in smoking households, spending on average £39.31 per week on tobacco, and that 32.9% are living in poverty as a result (https://ash.org.uk/). Non-smoking tenants living in other properties can be exposed to smoke drift from smoking properties, for example in blocks of flats where housing is in close proximity, or from communal areas. There is also a significant workforce who are required to carry out works in social tenancies who are at risk of second-hand smoke exposure and the associated health impacts, and employers have a responsibility to ensure that employees are protected from this.

Illicit tobacco and shisha

Taxation on tobacco has increased year on year in an effort to make smoking less affordable, and therefore less desirable. This has supported a reduction in smoking rates, however the availability of illicit tobacco products undermines the impact of taxation and tobacco can be purchased illegally at a more affordable price, therefore perpetuating the cycle of addiction and smoking related poverty. Purchase and use of illicit tobacco in Leicester is of concern, particularly amongst low-income groups who are more likely to access it and who are more at risk of experiencing smoking related ill-health. Cheap tobacco availability also increases the likelihood of young people taking up smoking who would otherwise be unable to afford. There is evidence that the illicit tobacco trade is part of wider criminal activity, and even that it is used to fund terrorism (Source: Illicit Tobacco Partnership).

The number of shisha premises in the city has increased from three in 2004 to 17 in 2020 with a further seven in the application stages, indicating the scale at which shisha use in the city has increased. An operation carried out in the city in 2019 (Operation Falcon) by the city council’s Public Safety Team and HMRC found that shisha tobacco was being sold without UK duty being paid in nine of the 13 premises targeted. Approximately 170kg of shisha tobacco was seized, equating to £21,250 of duty not being paid.

“A smoke free Leicester – to make Leicester smoke free by 2030”.

‘Advancing our health: Prevention in the 2020’s”, the Government Green Paper published in July 2019, outlines an ambitious goal for eliminating smoking in England by 2030. Although this is an ambitious target smoking rates have declined year on year and, and a smoke free generation now feels within reach. Currently 30% of smokers nationally make a quit attempt each year, but if 50% made a quit attempt each year the Government’s ambition could be achieved by 2029 (ASH: The End of Smoking: A brief guide for local authority officers and their partners on Health and Wellbeing Boards).

Leicester’s tobacco control strategy sets out a robust plan to encourage more smokers in the local population to make a quit attempt year on year, particularly focussing on high prevalence groups who are most at risk of tobacco-related harm. If this vision is shared by all key partners and worked towards collaboratively, a smoke free generation can be achieved.

Local estimates indicate there are 56,000 smokers aged 16+ in Leicester.

• Local survey data shows that the following groups are more likely to smoke; males, those aged 20-34, White British and Other White communities, the unemployed and long term sick.
• Rates of smoking differ across the city with those living in the west of the city and those in our most deprived areas more likely to smoke.
• Approximately 400 lives are lost each year through smoking related illness and many more Leicester City residents spend years of their life in poor health from smoking attributable illness.

59% of smokers in Leicester would like to quit altogether.

There are also some vulnerable groups who need close monitoring

• Children are three times more likely to smoke if they have a parent who smokes. A third of young people surveyed in the Leicester young people’s health and wellbeing survey (2018) reported having a parent or carer who smokes,
• Smoking in pregnancy is still a major concern in Leicester with 10% of women still recorded as smoking at time of delivery (SATOD) in 2019/20. Being exposed to tobacco smoke in the womb is responsible for a range of serious health and behavioural issues.
• The number of Leicester City residents who have a poor mental health and wellbeing score has increased since 2015. Nearly a third of adults with poor mental wellbeing report being a smoker.

• Towards a Smoke Free Generation: A Tobacco Control Plan for England 2017-2022
• The Local Government Declaration on Tobacco Control (see Appendix) which is a “statement of a council’s commitment to ensure tobacco control is part of mainstream public health work.” The Declaration was signed by Leicester City Council in October 2014 and commits the council to:
• Reduce smoking prevalence and health inequalities
• Develop plans with partners and local communities
• Participate in local and regional networks
• Support Government action at national level
• Protect tobacco control work from the commercial and vested interests of the tobacco industry
• Monitor the progress of our plans
• Join the Smokefree Action Coalition
• NHS long-term plan – prioritises preventative work, in particular the contribution the NHS can make towards tackling tobacco dependence in hospital inpatients, pregnant women and long-term users of mental health services.
• The Public Health Outcomes Framework’s vision which is to “improve and protect the nation’s health and improve the health of the poorest fastest.” The two high-outcome aims from this are:

1. Increased healthy life expectancy
2. Reduced differences in life expectancy and healthy life expectancy between communities

Leicester is significantly worse than the national average for both life expectancy at birth and healthy life expectancy at birth for both males and females.

• The Joint Health and Wellbeing Strategy for Leicester, into which tobacco control has several links:

Theme	Area of action plan	Role of tobacco control
Healthy Places	Action 4.b – “Influence environmental factors that enable residents to feel sufficiently safe within their communities to actively participate in positive health choices”	Keeping play areas smoke free for the benefit of children’s health, and to denormalise smoking
Healthy Minds	Action 2 – “Improve emotional resilience to sustain mental wellbeing among working age adults”	Addressing and acting on links between smoking and poor mental health
Healthy Start	Action 1.b – “Help more women and their families to have a healthy pregnancy by stopping smoking, and reducing harm to mother and baby” Action 2.b – “Reduce risk factors for infant mortality by providing timely information and support”	Helping pregnant women and their partners/families to stop smoking Promoting smoke free homes
Healthy Lives	Action 1.d – “Continue to support people to stop smoking within the home and public places to limit illness and health conditions associated with smoking and passive smoking”	Continuing to support people to stop smoking Promoting smoke free homes
Healthy Ageing	Action 4 – “Support older people to manage and protect their health and wellbeing”	Continuing to support older adults to stop smoking and promoting smoke free homes

• The Joint Strategic Needs Assessment for Leicester 2018 highlights the financial and health implications of smoking to local residents, and to healthcare systems.

The Tobacco Control Strategy for Leicester will be scrutinised by the joint City/County Tobacco Control Alliance to ensure that no opportunity to reduce tobacco-related harm in Leicester is missed and will be governed by the Health and Wellbeing Board for Leicester City. The strategy will be reviewed fully in 2022 when the national Tobacco Control Plan for England is likely to be updated. There will be an additional yearly interim review to ensure the plan still meets local priorities, which will be corroborated by quarterly updates to the supporting Tobacco Control Action Plan for Leicester City.

Effective interventions will require a collaborative approach and will involve working with a range of key partners including but not limited to: Leicester City Council and Leicestershire County Council, University Hospitals Leicester, Leicestershire Partnership Trust, Leicestershire Fire and Rescue Service, Leicestershire Police, Public Health England, Trading Standards, Public Safety Team, Housing, The University of Leicester and DeMontfort University, Children’s Centres, the Voluntary Sector, local businesses, schools, and local media.

A Tobacco Control Plan for England was published in 2017 titled “Towards a Smoke-free Generation” which outlined the priorities for addressing tobacco control nationally. The tobacco control strategy for Leicester City is underpinned by the four key priorities set out in the national strategy which are:

1. The first smoke free generation
2. Smoke free pregnancy for all
3. Parity of esteem for those with mental health conditions
4. Backing evidence-based innovations to support quitting

A Tobacco Control Plan Delivery Plan 2017-2022 was developed to identify how national and local areas should work towards meeting these aims and comprises of four key areas of focus:

1. Prevention first
   • Supporting people not to start smoking
   • Eliminating smoking in under 18’s
   • Reducing smoking in pregnancy
2. Supporting smokers to quit
3. Eliminating variation in smoking rates
   • Targeting populations where smoking prevalence remains high
   • Using mass media campaigns to promote smoking cessation and raise awareness of harms
   • Protecting people from the harms of second-hand smoke
   • Ensuring strategies are effective and evidence-based

4. Effective enforcement
   • Comprehensive enforcement of tobacco regulation
   • Improving the use and effectiveness of sanctions
   • Monitoring the development of novel products

Leicester’s Stop Smoking Service is nationally recognised as a leader in the field, having become the first stop smoking service nationally to become “e-cig friendly” and is often called upon to share expertise with other areas.

Despite a national decline in use of stop smoking services Leicester have continued to engage smokers and have maintained a high success rate. Access to the stop smoking service amongst high prevalence groups was 81% in 2018/19, demonstrating that services are targeted appropriately and are meeting local need.

The previous national and local tobacco control strategies focussed on six key strands, and a selection of the achievements which were made towards them are highlighted below.

1. Stopping the promotion of tobacco
   • There have been targeted promotional campaigns around e.g. shisha, smokeless tobacco, to highlight the negative effects of such products where there were gaps in knowledge locally

2. Making tobacco less affordable 
   • The Stop Smoking Service has worked collaboratively with Trading Standards to identify how illicit tobacco use can be addressed
   • A joint operation between the Public Safety Team and HMRC was carried out to ensure tobacco sold in shisha premises was UK duty paid.

3. Effective regulation of tobacco products
   • The Stop Smoking Service has worked collaboratively with the Public Safety Team

4. Helping tobacco users to quit
   • The Stop Smoking Service became the first to be ‘e-cig friendly’ demonstrating an understanding of the direction needed to meet the changing needs of the service users
   • Smoking prevalence has declined in Leicester each year down to its lowest ever level of 15.4% in 2019.

5. Reducing exposure to second-hand smoke
   • The Step Right Out scheme which promotes smoke free homes has been a huge success with over 10,000 pledges to keep homes and cars in the city smoke free signed to date, showing how widely the message has been spread across the city
   • Mental health units were supported to successfully become smoke free in 2018 for the benefit of patients and staff, and e-cigarettes were provided to support this
   • Signage has been placed in all children’s play areas to highlight that they are smoke free zones for the benefit of children’s health.
   • Training has been offered to all health professionals who have contact with pregnant women/young families as part of their mandatory training programme, and this has been recognised as a priority area for midwives and health visitors for several years
   • The Public Safety Team have worked with shisha premises through monitoring visits to ensure compliance with smoke free legislation, and have successfully prosecuted shisha premises which have continued not to be compliant.

6. Effective communications for tobacco control
   • A Tobacco Control Coordination Group comprised of the Stop Smoking Service, Trading Standards, Public Health and the Public Safety Team (formerly Environmental Health) met quarterly to ensure progress was made against the tobacco control plan
   • Leicester City lead on the Leicestershire Partnership Trust (LPT) steering group addressing smoking and smokefree policies within LPT
   • The Stop Smoking Service have worked closely with University Hospitals Leicester (UHL) e.g. supporting their smoke free policies by proving signage to highlight smoke free areas
   • The Stop Smoking Service have worked with local vape shops to enhance knowledge of vaping as more information has become available on their benefit as a quitting aid

A pilot project carried out with Action Homeless clients was run in 2018. The higher rate of smoking amongst the homeless, combined with the additional physical and mental health issues they were suffering with made them particularly high risk, but traditional appointment-based stop smoking services were not well accessed. Clients were offered an e-cigarette starter kit, provided free of charge by a local vape shop, and behavioural support on a ‘drop-in’ basis at Action Homeless, rather than having to make an appointment at a clinic. The pilot project proved very successful at supporting people who wouldn’t ordinarily use traditional stop smoking services, and many of the service users were able to quit or demonstrably reduce smoking-related harm. The project has been extended to Turning Point with the hope that similar successes can be repeated.

Despite the many positive achievements to date, in order to reach the ambitions set out in the national Tobacco Control Plan, Leicester City will need to be ambitious and innovative in its approach. The key aims locally will therefore be:

• Partnership working to address tobacco control within Leicester City
• Achieving a smoke free generation
• Smoke free pregnancy for all
• Reducing the inequality gap for those with mental ill-health

Partnership working to address tobacco control within Leicester City

Achievement of the aims of the tobacco control plan cannot be done in silo, rather a collaborative approach across agencies will be required. Previously a Tobacco Control Coordination Group was established in Leicester City which comprised key members of Public Health, Trading Standards, the Public Safety Team and the Stop Smoking Service, working together to achieve targets set out in the national tobacco control plans. An early priority for tobacco control in Leicester City will be to re-establish a Tobacco Control Alliance to engage key partners who can support the delivery of the aims, and without whom many of the previous achievements would not have been possible. Achieving this aim will involve:

• Involving a wide range of stakeholders, including senior leadership, who can support raising the profile of tobacco control.
• A robust communications strategy to ensure wider delivery of key messages both within and beyond Leicester City Council, and to the public.
• Aligning with MECC Plus to ensure that no opportunity to support a smoker to quit or reduce harm is missed.

Achieving a smoke free generation

A smoke free generation will be achieved when the number of smokers in the population reaches 5% or less. The national tobacco control plan sets out a plan to achieve this which helps to focus tobacco control across the whole system, and to achieve a smoking prevalence of 5% or less in Leicester City tobacco control needs to become ‘everybody’s business.’ Achieving a smoke free generation will serve to significantly reduce health inequalities and to improve health outcomes from birth and beyond. Achieving this aim will involve:

• Tackling the supply of illicit tobacco
• Effective enforcement of smoking legislation
• Raising awareness of harms related to other tobacco products, i.e. shisha, oral tobacco
• Supporting all smokers to quit with focus on high prevalence groups, those admitted to hospital and pregnant women
• Supporting smoke free workplaces, mental health units, hospital sites and prisons, and encouraging smoke free homes.
• Permitting the use of innovative technologies which minimise the risk of harm
• Identifying which groups are most vulnerable to the detrimental effects of smoking and ensuring that additional resource is dedicated to supporting these groups. E.g. those with mental health illness, children and young people, those with a learning disability. This includes considering the practical needs of these groups, for example providing information in a format which is accessible.

Smoke-free pregnancy for all

Women who smoke during pregnancy risk significant harm to themselves and their baby, including miscarriage, still birth, placental complications, growth restriction and premature birth. The impact of these conditions can be lifelong for the baby and perpetuate the cycle of tobacco dependence from generation to generation. Prevalence of smoking in pregnancy varies according to wealth status and age, thus widening the inequality gap. If women, and their families, can be supported to quit during pregnancy a smoke free generation will be achieved faster. Achieving this aim will involve:

• Providing all pregnant smokers access to specialist stop smoking support
• Working with healthcare and other professionals who have contact with pregnant women to raise awareness of risks and provide brief advice

Reducing the inequality gap for those with mental ill-health

Smoking and mental health have a complex relationship, with smoking rates known to be greatly increased amongst those with mental health conditions. Smoking is also linked to an exacerbation of some mental health conditions, such as anxiety. Smokers with mental health conditions are at risk of significant physical ill-effects from smoking, and due to their mental health conditions are less likely to seek support, and therefore more likely to develop chronic ill-health. Furthermore, one third of all cigarettes smoked in the UK each year are smoked by smokers with poor mental health, and therefore the increased amount of money spent on smoking amongst this group limits the alternative activities which could better support both physical and mental wellbeing.

Achieving this aim will involve:

• Identifying how support can be delivered more effectively to those suffering with mental health issues, e.g. harm reduction
• Continuing to support mental health units to maintain smoke free premises
• Identifying where support to quit can be offered more widely to support the needs of those with mental health issue, e.g. carers and staff

Below highlights the four national priorities, the work which has already taken place in Leicester City towards meeting these priorities, and the ongoing ambitions for the city.

 

National ambitions

1. The first smoke free generation

• Reduce the prevalence of 15 year olds who regularly smoke from 8% to 3% or less by the end of 2022.
• Reduce smoking prevalence amongst adults in England from 15.5% to 12% or less by the end of 2022.

Current status

• 5% of young people in Leicester City are regular smokers (PHE fingertips, WAY survey 2015).
• 4% of adults in Leicester City are current smokers, above the national average of 13.9% (PHE fingertips).
• Smoking prevalence amongst routine and manual workers in Leicester City is 24.2%
• 85% of homes in Leicester City are smoke free, i.e. smoking is not allowed smoking inside.

Ambitions

• To work towards a prevalence of 5% or less by 2030.
• Encouragement of the ‘annual quit attempt’ as per guidance in “The End of Smoking”
• To reduce the supply of, and demand for, illicit tobacco in the city, and to ensure public premises in the city adhere to smoke free legislation by working closely with partners in Trading Standards and the Public Safety Team.
• To increase the percentage of smoke free homes in the City to 95% or more.
• To embed tobacco control communications across all relevant systems so that tobacco control becomes ‘everyone’s business’.

National ambitions

2. A smoke free pregnancy for all

• Reduce the prevalence of smoking in pregnancy from 10.7% to 6% or less by the end of 2022.

Current status

• Overall SATOD has remained almost static over the last 3 years (10.2% 2016/17 compared to 10% 2019/20).

Ambitions

• To achieve the national ambition of 6% or less in Leicester City by the end of 2022.
  To deliver a robust pathway of support for pregnant smokers which runs throughout antenatal care and extends to postnatal care, including inpatient support.
  To support all families to live in smoke free environments and prevent pregnant women from being exposed to harmful second-hand smoke risks.

National ambitions

3. Parity of esteem for those with mental health conditions

• Improve data collected on smoking and mental health to help us to support people with mental health conditions to quit smoking.
• Make all mental health inpatient services sites smoke free by 2018.

Current status

• 17% of Leicester residents have poor mental health– an increase from 14% in 2015.
• Adults with a serious mental health issue are significantly more likely to smoke – more than double the likelihood than the general population. 31.5% of adults in Leicester with a mental health condition are current smokers, double the city average.
• Mental health sites at LPT are all smoke free since 2018.

Ambitions

• To reduce the prevalence of smoking in those with mental ill-health.

• To develop pathways to ensure people with mental ill-health receive continuity of care throughout their journey to be smoke free.

National ambitions

4. Backing evidence-based innovations to support quitting

• Help people to quit smoking by permitting innovative technologies that minimise the risk of harm.
• Maximise the availability of safer alternatives to smoking.

Current status

• Live Well is an ‘e-cig friendly’ stop smoking service – a report published by Public Health England in 2015, which was corroborated by an independent expert evidence review in 2018, identified that e-cigarettes are at least 95% less harmful than tobacco smoking.
• Leicester City has a Stop Smoking Service which provides licensed nicotine replacements therapies and prescription stop smoking medications to service users for a 12 week period.

Ambitions

• Continue to be an ‘e-cig friendly’ service.
• Continue to provide service users with up to date evidence-based advice on, and promote, less harmful quitting aids.

Leicester City Council and Leicestershire County Council Tobacco Control Action Plan

1.Local action: Effective communications for tobacco control Key partners: Frontline workers, Businesses, The health community, Leicester City Council, Leicestershire County Council, Voluntary Sector, Media contact, Schools, Colleges, Public Health,

1.1 Maintain high level of brand recognition, and use the stop smoking services as a vehicle for communication on other prevalence-reducing messages

1.2 Communicate tobacco control issues to senior leaders in NHS community, Leicester City Council and Leicestershire County Council, including elected members

1.3 Smoke free UHL/LPT – look at measures to ensure adherence to policy

Ensure relevant communications around tobacco control and literature aimed at supporting quit attempts is also provided in a format which is accessible e.g. to those with a learning difficulty or lower literacy level.

Local action: Helping users to quit with the aim of meeting the national ambitions of reducing smoking in pregnancy to 6% or less, reducing smoking in young people to 3% or less and reducing smoking prevalence in adults to 12% or less by the end of 2022. Reducing the inequality gap between those in routine and manual occupations and the general population. Key partners:   Organisations with frontline contact with potential service users, Lifestyle Services, Public Health Analysts, Children’s Centres, Health Visitors, QIPP lead, UHL, Midwifery Service, Smoke Free Pregnancy Network (regional)

2.1 Achieve agreed number of smokers supported to quit at 4 weeks

2.2. Maintain programme of audit, evaluation and review to provide assurance of an effective service-user led service

2.3. Ensure that all patients who smoke, using secondary care services, are referred to the stop smoking services.

2.4 Pregnancy - Aim: to reach the national TC agenda ambition of for 6% or less by the end of 2022

2.5 Pregnancy - Inpatient care – ensure pregnant women who are admitted to hospital are offered appropriate nicotine replacement medication to minimise withdrawal symptoms and support attempts to quit.

2.6 Pregnancy – Ensure midwives are adequately informed to engage pregnant women in conversations around quitting smoking.

2.7 Pregnancy – Provide monthly feedback to midwifery teams on the numbers of pregnant women seen, including those who cannot be contacted. The carbon monoxide (CO) readings and treatment provided are recorded onto pregnant women’s notes at consultation.

2.8 Pregnancy - Seek opportunities to learn and share with other regional stop smoking services on the progress of SiP and reducing SATOD

2.9 Pregnancy - Work with partners who have involvement in the care of pregnant women and women of childbearing age to engage smokers in quit attempts, taking a whole-family approach

2.10 Young people – Discourage the uptake of smoking, create awareness of the harms of smoking and other tobacco products, e.g. shisha

2.11 Young people – support vulnerable children, e.g. Looked After Children not to take up smoking.

2.12 District Leads to help QuitReady (QR) in the identification of workplaces with high prevalence of smoking in particular targeting routine & manual workforces. QR to offer support at workplace health events and provide behavioural intervention and support to staff for employers who have a high number of people interested in stopping smoking.

2.13 Assist users of smokeless tobacco to understand the health harms of using products such as paan, gutkha, and support them to quit.

2.14 City only- Explore options for permitting the use of innovative technologies which minimise the risk of harm, i.e. e-cigarettes

Local action: Supporting people with mental health issues to quit Key partners: LPT Smokefree Lead, LPT (Helen Perfect), Ann Jackson (Consultant Nurse- LPT), Community Mental Health Services, QuitReady, Livewell Leicester.

3.1 LPT to strengthen their smoke free policy implementation and provision for smokers.

3.2 LPT to recruit a full-time smokefree lead to assist in providing ongoing support to all in-patients together with bridging the link with Community Mental Health Teams and community stop smoking services.

3.2 LCC arranged for a deep-dive (Public Health England- self-assessment tool) to help create baseline data for LPT and to provide guidance on the work that needs progressing. This work will be led by the recruited smokefree lead for the Trust.

3.3 Identifying how support can be delivered more effectively to those suffering with mental health issues, e.g. harm reduction

4. Local action: Smokefree homes and cars Key partners: Leicester City Council, Leicestershire County Council, District Health Leads (DLs), Leics Fire & Rescue Service, Schools, Early Years Community volunteers, Community Health Development Coordinators, Tenancy and Housing Associations/Housing Department, UHL Childrens Hospital, School Nursing & Health Visitors, Midwives, Children’s Centres, Early Start Team, Safeguarding teams, STAR teams and County Programme Delivery Team.

4.1 Work with partners to increase the understanding of the harms of second-hand smoke within the home, particularly for vulnerable babies, children and people with respiratory conditions.

4.2 Support people living in priority wards to change their behaviour in relation to smoking in homes and cars

4.3 Increase the number of homes with children participating in the Leicester smoke free homes programme, particularly in the priority wards

4.4 Explore options for considering smoke free social housing.

4.5 County Service- Smoke free housing – Districts, housing partners and LFRS and other identified partners to help support the promotion of the smokefree home package which includes training for professionals and the leaflet resource which includes the pledge to keep homes and cars smokefree. All partners to identify key contacts for potential brief advice training interventions for staff. District leads to support the review on policies for smokefree homes in tenancies and social housing in particular where one or more children are living at the address. Carry out a scoping exercise in the form of a survey working with housing/ tenancy teams to ascertain information on smoking in social housing within the county. Train housing staff and other relevant partners to help promote the smoke free homes message and encourage engagement of tenants. Promotion of smoke free homes by housing partners.

Local action: Tackling unlawful supply of tobacco and enforcement of smoke free legislation Key partners:  Trading Standards (Ron Ruddock for City, Karen Retallic for County), HMRC.  GPs, Local media, Public Safety Team.

5.1 Reduce the supply of illicit, non-duty paid, cigarettes and hand-rolling tobacco

5.2 Reduce public demand for illicit tobacco in Leicester

5.3 Reducing the supply of tobacco products to persons under 18.

5.4 Reduce the number of premises that are not smokefree and remove risk of secondary smoking inhalation

5.5 County Tobacco Control supports the employment of a Trading Standards officer in tobacco enforcement. County Trading standards to provide reports on a quarterly basis to the group to outline any enforcement activity.

5.6 Public Safety Team officers to immediately prohibit smoking in commercial premises (shisha premises, pubs, restaurants etc) until such time that they are 50% open to stop the secondary smoking inhalation.

5.7 Public Safety Team officers to take robust action against business owners to flout smokefree legislation requirements to reduce risk of secondary smoking inhalation and act as a deterrent to others

5.8 All prosecutions of businesses taken by Public Safety Team officers to be widely publicised as deterrent to others.

5.9 Continued joint partner agency disruptive visits (Public Safety Team/HMRC) to ensure premises are compliant, duty has been paid, customers/employees are not at risk from second-hand smoke.