Corporate

Developing a smokefree

organisation

Jane Beenstock,

Public health

consultant

Developing a smokefree organisation

Why? How? The challenges

Corporate

Lancashire Care NHS Foundation Trust (LCFT)LCFT provides health and wellbeing services for a population of around 1.5 million people within the Lancashire and South Cumbria footprint, including specialist commissioned services for the wider population of the North West region.

Our range of services includes a portfolio of integrated physical and mental health services, with both inpatient and community provision, across children and adults.

We currently employ around 7,000 staff across more than 400 sites.

The map shows the footprint of LCFT and the CCG boundaries along with the local authority boundaries.

CCG Key  Lancashire North

  East Lancashire

  Greater Preston

  Fylde & Wyre

  Blackpool

  Chorley & South Ribble

  West Lancashire

  Blackburn with Darwen

Corporate

Major causes of death in England

Corporate

Corporate

Why?

CorporateSource: Public Health England

44,000 fewer deaths would

occur if people with SMIs had the

same mortality rate as the

general population

(1) Chang C-K, Hayes RD, Perera G, Broadbent MTM, Fernandes AC, et al. (2011) Life Expectancy at Birth for People with Serious Mental Illness and Other Major Disorders from a Secondary Mental Health Care Case Register in London. PLoS ONE 6(5): e19590. doi:10.1371/journal.pone.0019590(2) Brown S, Kim M, Mitchell C et al (2010) Twenty-five year mortality of a community cohort with schizophrenia. British Journal of Psychiatry 196:116-21.

The untold storyThis corresponds to LE in

1950s in general population!

Chin-Kuo Chang et al May 2011

Corporate

Source: Public Health England

Smoking prevalence

20

Mins

Your blood pressure and pulse rate return to normal

8

Hours

Nicotine and carbon monoxide levels in your blood half, oxygen levels return to normal

24

Hours

Your lungs start to clear out mucus and carbon monoxide is eliminated.

48

Hours

There is no nicotine in the body. Ability to taste and smell is greatly improved

72

Hours

Your breathing becomes easier and energy levels increase

3-9

Months

Improvement with coughing, wheezing and breathing, lung function is increased by up to 10%

5

Years

Risk of stroke falls to about the same as a non-smoker

10

Years

Risk of lung cancer falls to half that of a smoker and risk of heart attack falls to the same as a non-smoker

Corporate

Corporate

How? The components of implementation

Corporate

EvaluationAgreement Communication & engagement

Training & support

EstatesPolicy & procedures

Agreement from executive team to implement NICE

guidance and become completely smokefree,

establish budget and project lead. Establish implementation

team and plan

Establish detailedcommunication plan

(internal and external stakeholders). Gather

baseline views of staff to help with developing

briefings

Monitor the impact of implementation and refresh as and

when required

Develop policies and procedures, seeking

legal advice if required

Develop smokefree champion training

and support, deliver training to staff across the trust

Remove all smoking shelters and bins. Erect signs across

trust buildings and sites

Timeline - based on the Scottish plan*

14*Nicholson, N. 2011. Smoke-free mental health services in Scotland Implementation guidance. NHS Scotland. Accessed 20.6.14. http://www.healthscotland.com/documents/5041.aspx

Challenges

Training and NRT Culture - mixed views among staff

and service users The media Relations with neighbours Reframe smoking e-cigarettes

Corporate

Challenges: training and NRT

Time to release staff Knowledge and skills to use NRT

Corporate

Challenges: culture

• animation

Corporate

Corporate

http://www.youtube.com/embed/-5yYbVDw_dw

Challenges: the media

Corporate

Challenges: relations with neighbours

Corporate

Challenges: reframing

Corporate

Corporate

An addiction is not a choice

Corporate

Corporate

Challenges: e-cigarettes

Corporate

Successes

Service user engagement New ways to communicate

Corporate

Service user involvement

• Focus groups held to discuss the policy

• Animation designed by service users for service users

• Posters designed by service users

Image designed by a service user and used on posters to promote the trust going smokefree

5th January 2015 Nicotine Management Policy introduced

“Staff and other service users supported and helped me first give up cigarettes and then reduce my addiction to nicotine. They believed in me

and eventually so did I. I say “I can beat cigarettes they no longer own me!” (Guild service user)

Feedback from service users has resulted in policy updates

Quit rate = 26% of (95) service users at Guild Lodge who were seen in clinic as attempting to quit

Service users who had quit smoking were presented with a certificate and vouchers

by the Trust’s Chief Executive Heather Tierney-Moore, who said:

“It was a delight to be able to present the service users with their awards and mark such a fantastic achievement. To be able

to stop smoking is a great achievement. It was good to hear about their stop

smoking journeys and the reasons behind wanting to quit, which included both

health and financial benefits.”

Acknowledgments Andy Hesketh, Human Resources Advisor Barbara Hummer, Brian Lawson, Staff Side Lead Rep, Staff Governor Caroline Waterworth, Deputy Clinical Director, Children and Families Dawn Kenyon, Quality Improvement and Experience Senior Officer Gareth Lewis, Clinical Specialist Nurse Gillian Penson, Psychologist Heather Harrison, Stop Smoking Service Lead Jacquetta Hardacre, now Tania Derbyshire, Project Manager for Medical Directorate John Pascoe, Programme manager for fire, H&S, estates and facilities Tracy Topham, Stop Smoking Service Lead Julie Trezise, Stop Smoking Service Manager Lorna McGlynn, Physical Health Care Lead Nafisa Motora, Administration Support to Consultants in Public Health Pam Tester, NICE Implementation Lead Paul Morris, Risk Manager and Staff Governor Sarah Regan, Communications Officer Catherine Harding, Lead Pharmacist Yvonne Guilfoyle, Practice & Quality Development Lead, Adult Mental Health Network

Corporate

32

Service user animation

https://youtu.be/sPq6Z9yWP3Y

How? The components of implementation

Corporate

EvaluationAgreement Communication & engagement

Training & support

EstatesPolicy & procedures

Agreement from executive team to implement NICE

guidance and become completely smokefree,

establish budget and project lead. Establish implementation

team and plan

Establish detailedcommunication plan

(internal and external stakeholders). Gather

baseline views of staff to help with developing

briefings

Monitor the impact of implementation and refresh as and

when required

Develop policies and procedures, seeking

legal advice if required

Develop smokefree champion training

and support, deliver training to staff across the trust

Remove all smoking shelters and bins. Erect signs across

trust buildings and sites