glasgow city chp item no. 8 - nhs greater glasgow and clydelibrary.nhsggc.org.uk/mediaassets/chp...

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Glasgow City CHP Item No. 8 CHP Committee Meeting Date: Tuesday 17th February, 2015 Paper No 2015/004 Subject: Glasgow Tobacco Strategy Presented by: Fiona Moss, Head of Health Improvement (CHP)

Fiona Dunlop , Health Improvement Lead (Tobacco) GGC NHS Recommendation(s)

Members are asked to endorse the new Tobacco Strategy (2015/17) for Glasgow City.

Summary/ Background

The Glasgow Tobacco Strategy has been developed in response to the Scottish Tobacco Control Strategy which aspires to achieving a smoke free generation by 2034.

NHS GGC, Glasgow CHP and Glasgow City Council have been working together to jointly develop the local strategy. Achieving the national ambition in Glasgow will be extremely challenging as the city is still significantly above the 2011 target. However previous reports to Committee have outlined the range of prevention, cessation and protection work being undertaken and progress. The Strategy builds on this with further targeted action over the next two years.

Policy/ Legislative Context

Response to the Scottish Tobacco Control Strategy, and the understanding of the contribution of tobacco to Glasgow’s health inequalities. The Strategy also responds to the anticipated new target for protecting children from exposure to second hand smoke.

Financial Implications

Managed within available resources, some of which are awarded specifically by the Scottish Government for this purpose to GCHP.

Human Resources Implications

This builds on existing delivery arrangements.

Service User/Carer Engagement

The key actions in the strategy build on a number of local programmes involving young people e.g. W-WEST (Why Waste Everything Smoking Tobacco), adults & families and implementation arrangements will continue to involve residents in their design and delivery.

Equalities Implications

A full EqIA was carried out on the previous strategy. As this is a revision, a screening exercise has taken place to ensure no negative impact on those with protected characteristics.

Partnership Implications

Glasgow Tobacco Strategy was approved by Glasgow City Council’s Executive Committee on the 22nd January, 2015; with implementation tracking through the related partnership structure e.g. ASSIST through the Education and Health Improvement Working Group.

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Date Report Prepared: 6th February, 2015

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Glasgow City Community Health Partnership Report To : Glasgow City CHP Committee

Report By:

Fiona Moss, Head of Health Improvement (GCHP) Fiona Dunlop, Health Improvement Lead (Tobacco)

Date:

17th February 2015

Subject:

Glasgow Tobacco Strategy

1. Purpose of report 1.1 To inform the Glasgow City CHP Committee of the priorities contained within the

new Glasgow Tobacco Strategy for 2014-17 which will assist in delivering the health improvement and inequalities priorities within the Strategic Plan for the HSCP within Glasgow City.

2. Introduction 2.1 A key action in the Scottish Government’s Tobacco Control Strategy is the

development of local tobacco control plans to drive forward actions within the national strategy at a local level. Local Authorities and NHS Boards are tasked to work with partners in the voluntary sector and local communities to develop these plans.

2.2 NHS GGC, Glasgow CHP and Glasgow City Council have been working together

to jointly develop a Glasgow Tobacco Strategy to meet this requirement. It has been aligned to Glasgow’s Single Outcome Agreement (SOA) and will be the city’s approach to delivering the Scottish Government’s aspiration of achieving a tobacco-free generation by 2034.

2.3 This report outlines the background to the strategy, the key actions and indicators. 3. Background 3.1 The death toll in Scotland from smoking is approximately 13,000 deaths per

annum, around a quarter of all deaths in Scotland each year. Although progress has been made, smoking continues to be the biggest single preventable cause of disease and premature death in Glasgow. Whilst smoking rates have fallen by 10% over the last 10 years to 27%, smoking rates in Glasgow are still 4% higher

than the Scottish average. There were 14,902 smoking attributable admissions to hospital and 4,039 smoking attributable deaths (over 30% of all deaths) in the Greater Glasgow and Clyde area in 2009.

3.2 A Glasgow Tobacco strategy has been in place since 2005, with the most recent

document running from 2009 – 14. This tobacco strategy updates the previous tobacco strategy, incorporating new guidance and developments and it is intended that this will be in place until 2017 to bring the strategy development in line with the planning processes for the SOA and the Councils Strategic Plan.

3.3 The document has been presented at and approved by the GCC Health and

Social Care PDC and will be presented to the Councils Executive Group at the end of December 2014.

4. Progress to Date: Outline of the Glasgow Tobacco Strategy 4.1 This plan has been aligned to the NHS and Council’s strategic commitments and

is consistent with other plans in the city and is in line with the proposals in the city to move to a “neighbourhood approach” to delivering health improvement.

4.2 Key actions associated with the delivery of this strategy are to identify and engage

with the third sector and voluntary organisations, to delivery targeted action within the city’s most deprived areas and to champion the relevance of tobacco control in reducing inequalities in health. A greater focus is required on reducing health inequalities, in capacity building, in effectively engaging with new and existing partners, and in working collaboratively with communities.

4.3 This document is an overarching tobacco control plan for the city and is

complimented by the NHSGG&C Smokefree Policy 2014. It is proposed that each sector will develop a local tobacco action plan in collaboration with partners and the local community.

5. Priorities within the strategy

Key actions with in the tobacco strategy are arranged under the headings of prevention, protection and cessation, in line with the national tobacco strategy.

5.1 Prevention Balance universal and targeted partnership approaches to support the effective

delivery of tobacco prevention with young people particularly with those most in need. Key actions include

5.1.1 Universal measures: • The ongoing delivery of effective schools based tobacco education programmes

in both primary and secondary schools. • Effective engagement with young people in programme development

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• Encourage schools to address smoking as part of a broader programme addressing the uptake of risky health behaviours in young people.

5.1.2 Targeted measures: • The delivery of the 3 year national pilot peer education programme (ASSIST) in

identified Glasgow secondary schools • A focused neighbourhood approach to youth prevention work in partnership with

voluntary/third sector • Develop a programme to reduce uptake of smoking as part of a wider programme

to reduce risk taking behaviour with Looked After and Accommodated Children. • Action to address high levels of smoking in 16-24 age group 5.2 Protection

Smoke-free environments are effective in reducing non-smokers’ exposure to second-hand smoke, may contribute to the de-normalisation of smoking and support smokers’ efforts to quit. Key measures include:

5.2.1 Universal measures: • Smoke-free grounds across local authority and NHS estates by 2015 • Increase availability of outdoor smoke-free places and events in Glasgow • Ensure high levels of compliance with smoke-free legislation 5.2.2 Targeted measures: • Adoption of smoke-free policies in third sector youth organisations working with

vulnerable young people. • Work with low income communities to reduce the availability of and demand for

illicit tobacco • Outline how HMP Barlinnie will move to become smoke-free • Deliver a programme to reduce exposure to second hand smoke in homes in the

most deprived areas along side specific work within adoption, foster, kinship, early years and residential care services (LAAC and the elderly)

5.3 Cessation

The strategy acknowledges the whole range of factors and wider life circumstances which influence someone’s motivation and capacity to quit smoking including the increased usage of e-cigarettes.

5.3.1 Universal measures: • Ensure the ongoing delivery of an integrated stop smoking service in Glasgow

which is based on best practice for all smokers who want to stop smoking. This integrated service includes community pharmacy, community smokefree services, maternity, acute, mental health and youth services.

5.3.2 Targeted measures: • Targeting of services to meet needs of most disadvantaged smokers and those

smokers from specific communities, including extending pre and post quit, supporting tailored services for specific groups including prisons and BME.

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• Development of innovative ways of delivering stop smoking support in partnership with local communities to ensure services best meet their needs within the SOA neighbourhoods.

• Delivery of behaviour change training to those organisations working with vulnerable groups and with the potential to impact on health and well being.

6. Targets and indicators 6.1 The key measurable targets for the Glasgow Tobacco Strategy are: • To reduce adult smoking prevalence in Scotland from 23% in 2011 to 5% by

2034. (17% by 2016, 12% by 2021, 9% by 2026, 6% by 2031). • To reduce the proportion of children in Scotland exposed to second-hand smoke

in the home from 12% to 6% by 2020 • The NHS in Scotland to deliver 12,005 successful quits at 12 weeks post quit in

the 40% most deprived within-board SIMD areas over the 1 year ending March 2015.

6.2 The key measurable outcome indicators for the Glasgow Tobacco Strategy are: • Reduction in overall adult smoking prevalence in Glasgow (Scottish Household

Survey, Health and Wellbeing Survey) • Reduction in adult smoking prevalence in SIMD 1 and 2 in Glasgow (Scottish

Household Survey, Health and Wellbeing Survey • Reduction in smoking in young people in Glasgow (Glasgow Schools Survey and

SALSUS) • Reduction in exposure to second hand smoke in Glasgow (Glasgow Schools

Survey, Scottish Health Survey, investigate the potential to include a question on second hand smoke within the local household survey)

• Percentage of compliance with tobacco control legislation (display ban, smokefree, age related sale) in Glasgow

7. Monitoring 7.1 The Strategy will be monitored by the Glasgow City Council Health Inequalities

and Improvement Group. Performance monitoring will be incorporated into Service Annual Service Performance Improvement Reports (ASPIR) with a similar process sought in NHS GGC. The Health and Social Care Policy Development Committee will receive an annual progress report.

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8. Recommendation 8.1 Effective tobacco control is a key means by which the NHS and Council’s current

activity to tackle health inequalities can be maximised. The strategy builds on previous work centred around prevention, protection and cessation activity but with a renewed focus on inequalities and vulnerable people, in line with national, CHP and City Council priorities.

8.2 The attached Glasgow Tobacco Strategy 2014-17 and Action Plan outlines Glasgow’s

approach in full. The Committee is asked to approve the Glasgow Tobacco Strategy.

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GLASGOW TOBACCO STRATEGY

Strategy and Action Plan

2015-17

Glasgow Tobacco Strategy 2015-17

FOREWORD In recent years, there has been significant progress in reducing the harm caused by tobacco in Glasgow. Local and national initiatives, supported by community projects and a continuing programme of health education in our schools have all contributed to a reduction in the number of adults and young children who smoke. Despite these successes, tobacco use in Glasgow remains higher than the Scottish average and remains the main preventable cause of death. In addition, as the gap in the prevalence of smoking increases between our most and least deprived communities, it is increasingly a contributor to the levels of health inequality we see within the city. This Glasgow Tobacco Strategy marks the latest joint collaboration between the Council and NHS Greater Glasgow & Clyde in driving forward the tobacco control agenda in this city. Our strategy is ambitious and represents the city’s approach to achieving the Scottish Government’s aspiration of achieving a tobacco-free generation by 2034. I want to see a real reduction in health inequalities in Glasgow, and I believe that decisive action on tobacco control is necessary for this to happen. Too many Glaswegians continue to be harmed by smoking. This strategy outlines the city’s collective resolve to create a society where every Glaswegian has the right to the highest attainable standard of life and a city free from the harm caused by tobacco. Councillor Emma Gillan Spokesperson for Health Inequalities

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Contents EXECUTIVE SUMMARY SECTION 1: BACKGROUND

1.1 Introduction 1.2 Background to tobacco control in Glasgow 1.3 National policy context 1.4 Progress to date

SECTION 2: VISION, AIM AND PRINCIPLES 2.1 Vision and aim 2.2 Principles 2.3 Local strategy alignment 2.4 Delivery through partnership working

SECTION 3: PRIORITY AREAS AND ACTIONS 3.1 Strategic tobacco control priorities 3.2 Prevention 3.3 Protection 3.4 Cessation SECTION 4: TARGETS, MONITORING AND FINANCIAL FRAMEWORK 4.1 Targets 4.2 Monitoring and reporting 4.3 EQIA 4.4 Financial framework APPENDIX 1 REFERENCES

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EXECUTIVE SUMMARY 1. The Glasgow Tobacco Strategy sets the joint direction for tobacco work in

Glasgow for 2015-17 between the Council and NHS Greater Glasgow & Clyde (NHS GGC) and will be the city’s approach to delivering the vision of a smoke-free Scotland by 2034.

2. Although progress has been made, smoking remains high in the city’s most

deprived areas and among specific groups, such as people with mental health conditions, those with a limiting long term disability, prisoners and older people. The gap in smoking prevalence between the poorest and most affluent in the city is increasing, leading to an increase in heath inequalities.

3. The key focus of the Strategy will be on reducing health inequalities, capacity

building, effectively engaging with new and existing partners and working collaboratively with communities.

4. The Strategy acknowledges the need for universal services and programmes

to reduce smoking prevalence in Glasgow. However, in line with the Council Strategic Plan 2012-17, the biennial report of the Joint Director of Public Health and the Single Outcome Agreement, this plan will focus the majority of actions on activity which targets the most vulnerable and disadvantaged in Glasgow.

5. Tobacco control is the cross cutting, internationally recognised, evidence

based approach to tackling the harm caused by tobacco. Supporting people to stop smoking is the most well known tobacco control measure. Equally important however, are actions to prevent young people from starting to smoke and protecting people from the harm associated with smoking.

6. The Glasgow Tobacco Strategy outlines a range of measures to reduce

tobacco related harm in Glasgow, including:

• Implement smoke-free grounds policy across NHS GGC estates by March 2015 and begin to implement a programme of smoke-free policies across Council grounds and events from 2015-2016. Priority areas for the Council include the entrances to Council buildings, smoke-free outdoor areas where children and families congregate (play areas) and smoke-free family outdoor events.

• A programme to reduce uptake of smoking amongst Looked After and Accommodated Children (LAAC) as part of a wider programme to reduce risk taking behaviour.

• Ensuring advice on creating a smoke-free home is a feature of all adoption, foster, kinship care and residential care services.

• Deliver the A Stop Smoking in Schools Trial (ASSIST) peer education programme in 10 secondary schools in the most deprived areas and with the highest smoking prevalence in Glasgow.

• Continuing to support trading standards officers to implement a more rigorous enforcement on existing tobacco sales laws.

• Identify and form new partnerships in order to expand opportunities for tobacco control interventions, with a particular focus on the third sector.

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The key priority areas are grouped as follows:

Summary of Glasgow Tobacco Strategy 2015-17 Priority Areas

Strategic Planning Protection

Prevention Cessation

Identify new partnerships

Implement smoke-free

grounds

ASSIST pilot in 10 Secondary

Schools

Universal, evidence based stop smoking

service

Work with LAAC

16-24 year olds – apprentice/

employment schemes

Develop area based action plans

Illicit Tobacco

Rigorous enforcement of

tobacco laws

Increased smoking cessation in the most

deprived areas

Meet the needs of specific communities – BME,

homeless, mental health issues

Advice on second-hand smoke –

vulnerable families

Sustain local leadership

Youth Justice

SECTION 1: BACKGROUND

1.1 Introduction 1.1.1 The focus in this Glasgow Tobacco Strategy is the relationship between smoking and

health inequalities. The strategy will build on work to date and the lessons learned from previous strategies in order to embed and standardise good practice and allow opportunities to learn from new approaches such as co-production and asset based work with communities.

1.1.2 Tobacco control is the cross cutting, internationally recognised, evidence based

approach to tackling the harm caused by tobacco. Supporting people to stop smoking is the most well known tobacco control measure. Equally important, however, are actions to prevent young people from starting to smoke and protecting people from the harm associated with smoking.

1.1.3 Tobacco control brings together these different components under the broad

headings of Prevention, Protection and Cessation and seeks to work through partnerships with public, private and voluntary groups in order to provide an effective mechanism for driving down smoking prevalence. Research has shown that no single measure will be successful in isolation and that integrated, partnership working is required.

1.1.4 The Scottish Government’s Tobacco Control Strategy has placed responsibility on

local authorities to drive forward the tobacco control agenda through the development of a local plan. Our plan which will be delivered jointly by Glasgow City Council and NHS Greater Glasgow and Clyde (NHS GGC) will be a key element in reducing health inequalities in the city.

1.1.5 This is a three year tobacco plan (2015-17) to fit in with the timescales of the

Council’s Strategic Plan 2012-17 and is aligned to Priority 4 – A City that looks after its Vulnerable People. There is a focus on partnership working targeted to disadvantaged groups and communities where smoking prevalence is greatest. A key priority within our three year programme is to further engage with a broader range of community planning partners (CPP), particularly the third sector. The strategy also links with the overarching vision of Glasgow’s Single Outcome Agreement 2013 (SOA).

1.1.6 As well as a package of measures which will assist in meeting our aspiration of

achieving a smoke-free Glasgow by 2034, there will be concerted action to shift social attitudes to protect young people in the city from behaviour and messages that promote smoking as a normal activity.

1.2 Background to tobacco control in Glasgow 1.2.1 The death toll in Scotland from smoking is approximately 13,000 deaths per annum1,

around a quarter of all deaths in Scotland each year. 1.2.2 Although progress has been made, smoking continues to be the biggest single

preventable cause of disease and premature death in Glasgow. Whilst smoking rates

1 http://www.scotpho.org.uk/downloads/scotphoreports/scotpho120626_smokingreadyreckoner.pdf

http://www.scotpho.org.uk/downloads/scotphoreports/scotpho120626_smokingreadyreckoner.pdf


have fallen by 10% points over the last 10 years to 27%, smoking rates in Glasgow are still 4% points higher than the Scottish average and 10% points higher than in Edinburgh. There were 14,902 smoking attributable admissions to hospital and 4,039 smoking attributable deaths (over 30% of all deaths) in the Greater Glasgow and Clyde area in 2009.

1.2.3 Smoking levels remain highest in the city’s most deprived areas and among specific groups, such as people with mental health conditions, those with a limiting long term disability, prisoners and older people. In 2012, 37% of adults in the most deprived areas of Glasgow smoked compared to 19% in the rest of Glasgow (Figure 1 below). The gap in smoking prevalence between the poorest and most affluent is increasing, leading to an increase in heath inequalities in the city. Figure 1: Adult smoking by Scottish City and deprivation 2012 (Understanding Glasgow)

Adult (16+) smoking, by Scottish city and deprivation, 2012 Source: Scottish Household Survey

19

36

2529

16

36

20

37

0

10

20

30

40

50

60

70

80

90

100

20% most deprived 80% least depirvedArea Deprivation

% o

f the

adu

lt po

pula

tion

(16+

yea

rs)

who

cur

rent

ly s

mok

e

Glasgow Dundee Edinburgh Scotland

1.2.4 The highest correlation evident in the profile of smokers and non-smokers is by socio-economic status and the deprivation index of the area in which people live.

1.2.5 Ethnicity does not appear to be a strong indicator of the prevalence of smoking, as

most ethnic minorities have a lower incidence of smoking than the average for Glasgow as a whole. However, there is anecdotal evidence that smoking shisha is becoming increasingly popular within the Pakistani community in Glasgow where it is viewed as a form of socialising. As the shisha culture continues to grow, it has been suggested that shisha cafes are also now being used by a cross-section of the community2.

1.2.6 Action on Smoking and Health (ASH) Scotland cites evidence that smoking rates are

higher within the Lesbian, Gay, Bisexual and Transgender (LGBT) communities, with research suggesting that particularly among young people the daily stress of

2 Marisa de Andrade, “ NHS Greater Glasgow and Clyde, Black Minority Ethnic (BME) Feasibility and Ethnographic Study in the Southside of Glasgow”, University of Stirling, 2014

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homophobia and discrimination undermines a person’s ability to avoid pressures to drink and smoke3.

1.3 National Policy Context 1.3.1 There have been a number of national tobacco control initiatives, backed up with

local enforcement, including the introduction of smoke-free legislation in 2006, increasing the age for tobacco sales from 16 to 18 in 2007, overhauling tobacco sale and display laws as well as ongoing investment in NHS smoking cessation services.

1.3.2 In 2013, the Scottish Government launched their new tobacco strategy for Scotland, ‘Creating a Tobacco-Free Generation’ with the aspiration of creating a tobacco-free generation by 2034, defined as a smoking prevalence among the adult population of 5% or lower, and with a clear focus on those communities at greatest risk of unequal health outcomes.

1.3.3 In 2014, the Scottish Government launched a ‘Consultation on Electronic Cigarettes

and Strengthening Tobacco Control in Scotland’. This calls for views on a range of measures to protect young people, including an age restriction on the sale and purchase of e-cigarettes; additional action to control the advertising and promotion of the devices; and legislation to prohibit smoking in vehicles with children on board. This consultation closes in January 2015.

1.4 Progress to Date 1.4.1 Glasgow can be proud of its long standing commitment to reducing the health impact

of tobacco in the city through the work of Glasgow 2000, Glasgow Alliance Tobacco Strategy (2005 - 09) and the Glasgow Tobacco Strategy (2009-2014) which has helped contribute to a steady decline in smoking prevalence rates in adults and children. Successes in tobacco control include: • A comprehensive tobacco control programme in place in the city since 1983 with

the Council and NHS GGC jointly delivering a broad range of actions on cessation, protection and prevention.

• A steady decline in the proportion of adults who were current smokers in Glasgow City over the last 10 years from 35% in 2000 to 27% in 2012 (Scottish Household Survey) (Figure 2 below).

• A reduction in current smoking in Glasgow secondary school children from 10% in 2008 compared to 8% in 2010 (Glasgow Schools Survey).

• High achieving NHS stop smoking services, with services surpassing smoking cessation targets set for NHS GGC by Scottish Government since 2008.

• An effective tobacco training programme in place, including training on health related behaviour change, brief intervention, intensive support, second hand smoke and smoking and young people.

• Tobacco control programmes offered to all primary and secondary school children in Glasgow linked to the Curriculum for Excellence.

• Effective implementation of tobacco control legislation including the legislation on age restricted sales, smoke-free legislation, and the tobacco display ban.

3 http://www.ashscotland.org.uk/media/3858/LGBT.pdf

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http://www.ashscotland.org.uk/media/3858/LGBT.pdf


Figure Two: Adult smoking trends by Scottish City 2000 – 2012 (Understanding Glasgow)

1.4.2 Glasgow City Council and NHS GGC have made a clear and continued commitment to improve health and tackle the health inequalities that exist within the city. Health is a cross cutting issue that impacts significantly across all aspects of the Council Strategic Plan. Glasgow’s Single Outcome Agreement prioritises tackling inequalities within specific neighbourhoods, through a thriving places approach. The NHS Corporate plan 2013–16 and combined equalities review and action plan, ‘A Fairer NHS Greater Glasgow and Clyde’ both emphasise the importance of tackling inequalities in health.

1.4.3 Steps have already been taken to tackle the root causes of poor health, such as

poverty and income, through the creation of a Poverty Leadership Panel and the Healthier Wealthier Children programme as well as focused action on the wider environmental causes such as the quality of housing, employment opportunities and education.

1.4.4 Tobacco control was identified in the Marmot review on health inequalities as central

to any strategy to tackle health inequalities. The life expectancy and health of Glasgow citizens can be improved through decisive action on smoking.

1.4.5 The effect of ‘place’ on health is well established. People living in poverty are more

likely to maintain risk behaviours because of inequality of opportunity, constrained choice of consumption patterns, psychosocial stress and cultural norms. The Council recognises its key role in creating good public spaces that promote people’s health, happiness and wellbeing.

1.4.6 It is recognised that by addressing health inequalities by tackling the wider determinants of health there will be a positive impact on smoking prevalence. In Glasgow this will be complemented by targeted action on tobacco, prioritising the needs of certain disadvantaged groups. The Glasgow Tobacco Strategy prioritises certain population groups identified in the Director of Public Health Report 2013-15 including looked after and accommodated young people, the prison population and youth health.

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SECTION 2: VISION, AIM AND PRINCIPLES OF THE GLASGOW TOBACCO STRATEGY 2015-17

2.1 Vision and Aim 2.1.1 The new Glasgow Tobacco Strategy 2015-17 is a crucial step in supporting the vision

of a Smoke-free Scotland by 2034. 2.1.2 Our vision replicates that of the SOA in seeking to ensure that:

“Glasgow is a thriving, inclusive and resilient city; a city where all citizens can enjoy the best possible health and well-being and have the best opportunity to meet their potential”.

2.1.3 Our aim of reducing the impact of tobacco in Glasgow, particularly targeting areas

and populations of greatest need is a clear way of working towards achieving the vision of the SOA.

2.1.4 The objectives of the strategy are threefold and are aimed at:

• Prevention: Creating an environment in Glasgow where young people choose not to smoke.

• Protection: Protecting people from second-hand smoke. • Cessation; Helping people to quit smoking.

2.1.5 These objectives are more fully developed in the priority areas described below. 2.2 Principles 2.2.1 The following principles underpin the development and implementation of this

strategy: 2.2.2 A population approach - focus on improving the overall health status of the

community, delivering sustained, effective and comprehensive programs that promote and support healthy living for all.

2.2.3 Reducing inequity – address the differences in health status in the community by

recognising and responding to the special needs of groups whose health is poorest, ensuring scale and intensity of programmes proportionate to level of disadvantage.

2.2.4 Working in partnership – recognise that many factors that influence health are

outside the direct control of the Council/NHS and developing strategic partnerships across government, industry, business, unions, voluntary and third sector organisations, research institutions, youth groups and communities as required.

2.2.5 Capacity building – focus on organisational change, workforce development,

resource allocation and leadership that incorporates advocacy and relies on partnerships. By working across sectors, there is potential to build individual skills, strengthen community action and empower organisations to promote sustainable health behaviours and support healthy environments.

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2.2.6 Engaging communities – engage with people where they live, work and play and

informing, enabling and supporting people to make healthy choices. Relevant settings may include home, work, school, youth centres, workplaces and community.

2.2.7 Ensuring effective implementation – provide a strong infrastructure that supports

individuals and communities in making and sustaining healthy choices and measures progress in achieving targets.

2.3 Local Strategy Alignment 2.3.1 The Council is already committed to a number of strategies which seek to tackle the

social determinants of poor health in Glasgow, as well as measures to promote healthy lifestyles of the population at both a universal and targeted level. The Council will ensure the direction and actions are consistent with other plans in the city including: • GCC Strategic Plan 2012-17 (Vulnerable People Theme) • Glasgow’s Single Outcome Agreement 2013 (Vulnerable People Theme) • Glasgow’s Integrated Children’s Services Plan 2013-15 • Poverty Leadership Panel – Glasgow’s Action Plan for Change 2013 • Strategic Direction for the Glasgow CHP Health Improvement Workforce 2013 • Building Momentum for Change, Biennial report on population health in NHS

Greater Glasgow and Clyde 2013-15

2.4 Delivery Through Partnership Working 2.4.1 Key actions associated with the delivery of this strategy are to identify and engage

with new partners, focussing on third sector and voluntary organisations, targeted action within the city’s most deprived areas and champion the relevance of tobacco control in reducing inequalities in health.

2.4.2 As the strategy progresses there will be further communication with Community

Planning at a citywide and local level to agree their role and to increase engagement with local communities.

2.4.3 The achievement of the ambitious target of a Smoke-free Scotland by 2034 and the

associated challenging 5 year milestones will require renewed efforts in implementing Glasgow’s tobacco control programme. A greater focus is required on reducing health inequalities, in capacity building, in effectively engaging with new and existing partners and in working collaboratively with communities.

2.4.4 The Strategy acknowledges the need for universal services and programmes to

reduce smoking prevalence in Glasgow. However, in line with the Council Strategic Plan and the SOA, this plan will focus the majority of actions on activity which targets the most vulnerable and disadvantaged in Glasgow.

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SECTION 3: PRIORITY AREAS AND ACTIONS

3.1 Strategic Tobacco Control Priorities 3.1.1 In order to deliver effective actions in prevention, protection and cessation at a

community level, it is important that the right partnerships are in place at the outset and are considered in relation to ongoing health and social care integration.

3.1.2 Area based action plans will be developed detailing local delivery of the strategy by

Glasgow Community Health Partnership (GCHP) staff and through appropriate engagement.

3.2 Prevention 3.2.1 Research indicates that effective youth smoking prevention requires a

comprehensive approach. Sustained and integrated effort is required as short-term and one-off or limited focus interventions targeting young people are unlikely to have lasting results. Actions balance universal and targeted partnership approaches to support the effective delivery of tobacco prevention with young people particularly with those most in need.

3.2.2 Universal measures:

• Ensure the ongoing delivery of effective schools based tobacco education

programmes in both primary and secondary schools.

• Increase capacity within schools to deliver the tobacco element of health improvement programmes, as part of the Health and Wellbeing in the Curriculum for Excellence.

• Engagement of young people in the development of tobacco programmes.

• Encourage schools to address smoking as part of a broader programme addressing the uptake of risky health behaviours in young people. (Scottish Government (SG) Action 11)

• Ensure high levels of legislative compliance (age restricted sale, display ban).

3.2.3 Targeted measures: • Support the delivery of the 3 year national pilot peer education programme

(ASSIST) in identified Glasgow secondary schools and dependant on outcomes, consider the future for the programme. (SG Action 12)

• In partnership with young people and relevant organisations develop a more targeted neighbourhood approach to delivering prevention work with young people.

• Build on previous tobacco work and research with Looked After and Accommodated Children to develop a programme to reduce uptake of smoking as part of a wider programme to reduce risk taking behaviour in this group. (SG Action 11)

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• Undertake actions at a local level to address high levels of smoking in 16-24 age group, including working with social work, local tertiary education establishments, apprentice/training schemes and youth service providers.

3.3 Protection

3.3.1 Smoke-free environments are effective in reducing non-smokers’ exposure to

second-hand smoke and it is argued that they contribute to the de-normalisation of tobacco smoking. Smoke-free environments are also beneficial for smokers by supporting their efforts to quit and reducing the consumption of cigarettes as smoke-free environments provide fewer opportunities to smoke.


• Implement smoke-free grounds across all NHS estates by 2015. Using a

partnership approach to share learning and experiences of policy development. (SG Action 34), the Council will begin a rolling programme of introducing smoke-free grounds and events from 2015-2016 taking a planned approach and making best use of existing resources.

• Priority areas for the Council include the entrances to Council buildings, smoke-free outdoor areas where children and families congregate (play areas) and smoke-free family outdoor events. Glasgow Life has already introduced smoke free family events and Land & Environmental Services (LES) has implemented a number of smoke free play areas.

• Ensure high levels of compliance with smoke-free legislation (SG Action 19/21)

3.3.3 Targeted measures: • Drive the adoption of smoke-free policies in third sector youth organisations

working with vulnerable young people, using the recently produced guidance from NHSGGC and ASH Scotland.

• Using a co-production model, working with local communities to develop an approach to reduce the availability of and demand for illicit tobacco based on the recent local illicit tobacco research. (SG Action 19)

• Develop a plan that outlines how HMP Barlinnie will move to become smoke-free building on current work by NHS GGC with the prison.

• Deliver a targeted programme to reduce exposure to second hand smoke in the homes of those in the most deprived areas as well as specific work within adoption, foster, kinship, early years and residential care services (LAAC and the elderly). (SG Action 26)

3.4 Cessation 3.4.1 The strategy acknowledges the whole range of factors and wider life circumstances

which influence someone’s motivation and capacity to quit smoking. It is important that a whole range of services that impact on a person’s health and wellbeing offer support and encouragement to stop smoking.


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• Ensure the ongoing delivery of an integrated stop smoking service in Glasgow is based on best practice for all smokers who want to stop smoking.

3.4.3 Targeted measures:

• Tailor services to meet needs of most disadvantaged smokers and smokers from

specific communities, including extending pre and post quit support, tailored services for specific groups including prisons and BME.

• Develop innovative ways of delivering smoking cessation support in partnership with local communities to ensure services best meet their needs.

• Deliver behaviour change training to those organisations working with vulnerable groups and with the potential to impact on health and well being including Social Work Services, Financial Inclusion, NHS and GCC Credit Unions, Housing Associations and third sector organisations. (SG Action 11)

SECTION 4: TARGETS, MONITORING AND FINANCIAL FRAMEWORK

4.1 Targets 4.1.1 The Council and NHSGGC are committed to creating a smoke-free Glasgow by 2034

which supports the Scottish Government’s aspiration for a tobacco-free Scotland by 2034 (an adult smoking prevalence of 5% or lower). The target is to reduce adult smoking prevalence from 23% in 2011 to 5% by 2034. (Intermediary targets: 17% by 2016, 12% by 2021, 9% by 2026, 6% by 2031).

4.1.2 Given the clear inequalities dimension to smoking prevalence rates, the Scottish

Government have also included 5-year milestones setting out how prevalence needs to reduce by SIMD quintile to achieve the 2034 target (Table 1).

4.1.3 In 2014, the Scottish Government introduced a new target to reduce the proportion of children in Scotland exposed to second-hand smoke in the home from 12 per cent to six per cent by 2020. This is the first target of its kind anywhere in the world.

4.1.4 The NHS in Scotland has been set a target to deliver 12,005 successful quits at 12

weeks post quit in the 40% most deprived within-board SIMD areas over the 1 year ending March 2015.

4.1.5 The key measurable outcome indicators for the Glasgow Tobacco Strategy are:

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• Reduction in overall adult smoking prevalence in Glasgow (Scottish Household Survey, Health and Wellbeing Survey)

• Reduction in adult smoking prevalence in SIMD 1 and 2 in Glasgow (Scottish Household Survey, Health and Wellbeing Survey).

• Reduction in smoking in young people in Glasgow (Glasgow Schools Survey and Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS)).

• Reduction in exposure to second-hand smoke in Glasgow (Glasgow Schools Survey, Scottish Health Survey, investigate the potential to include a question on second-hand smoke within the local household survey).

• Percentage of compliance with tobacco control legislation (display ban, smoke-free, age related sale) in Glasgow.

4.2 Monitoring and reporting 4.2.1 The Health Inequalities and Improvement Group (HIIG), chaired by Councillor Gillan

reporting to the Health and Social Care Policy Development Committee will take the lead in coordinating and monitoring the implementation of the Strategy across Glasgow. A review of progress towards the targets and implementation of actions will be undertaken in 2016, including reporting on population level indicators of smoking prevalence and other key indicators from the Strategy.

4.2.2 Within the Council, progress will be reported as part of the Annual Service Plan and

Improvement Report (ASPIR) process. The intention is that this will reduce the requirement for separate reporting on activity, with Tobacco Strategy actions fully mainstreamed into existing service performance reporting systems. Progress reports from the NHS will be provided within the same timeframes.

4.2.3 The Tobacco Strategy sets out long term goals and outcomes. It is expected that the Council and NHS GGC progress between 2015-2017 will reflect the early work to realise these long term goals.

4.3 EQIA 4.3.1 An initial equalities screening exercise has been undertaken to identify areas where

there is a clear equalities dimension in relation to the delivery of this strategy. This found that the main correlations of smoking prevalence were in relation to deprivation, older people, mental health and long term limiting illness. There is also anecdotal evidence to suggest that smoking may be more prevalent among the LGBT community.

4.3.2 Further research and individual Equality Impact Assessments will be undertaken as

required throughout the implementation of this strategy. 4.4 Financial Framework 4.4.1 Tobacco control funding, allocated to NHS GGC annually, is contained within a broad

“Effective Prevention” budget, where funding for a number of specific programmes including tobacco control is aggregated into one budget. Health Boards can use this flexibly to deliver the programme outcomes as agreed with Scottish Government within the scope of the budget. The bulk of the funding is used to support the

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delivery of NHS stop smoking services. However it is also used for other specific programmes and a funding proposal for specific tobacco work with Looked After and Accommodated Children has recently been approved by the NHS GGC Tobacco Planning and Implementation Group.

4.4.2 Tobacco control funding supports Boards to take safe, effective, person-centred action to reduce the level of tobacco-related deaths and preventable illness, help people stop smoking and prevent uptake of smoking.

4.4.3 Scottish Government also funds 4 tobacco control officers based in Land and

Environmental Services within the Council, who have responsibility for ensuring compliance with tobacco control legislation.

4.4.4 To meet existing and future challenges, improved efficiency and effective partnership

working will be required to ensure the most efficient use of available resources. Therefore, any investment stated or implied within this document will be met within existing resources.

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APPENDIX 1 ACTION PLANS 2015-17 The actions identified to meet the outcomes of the Strategy have been grouped into the priority areas identified earlier in the document. Objective 1: Strategic Planning (Building partnerships and developing localised action plans) Objective Action – What will we do? Output measures/indicators –

What will we monitor to show that we have done this?

Outcome measures/indicators – What will this achieve and what will we monitor to demonstrate this?

Lead and partners

Strategic Planning

Identify and form new partnerships in order to expand opportunities for tobacco control interventions within a range of settings

Engage more effectively with Third Sector through the Third Sector Forum Better linkage with Community Planning structures in the city

Partnerships and joint working developed between relevant agencies by December 2016

Number of tobacco training sessions delivered Number of tobacco control interventions piloted within organisation

Glasgow City Council (GCC) Chief Executive’s Office Glasgow Community Health Partnership (GCHP)sectors NHS Greater Glasgow and Clyde (NHS GGC) Community Planning Partnership (CPP)

Agree a mechanism within each sector as to how strategy will be implemented

Develop a localised action plan and agree a mechanism within each Community Health Partnership (CHP) sector as to how strategy will be implemented

Production of a localised action plan within each CHP sector

A clear programme of tobacco control activity within each sector

NHS GGC GCHP sectors

Strategy is adopted by the Strategic Plan of the Integrated Health and Social Care Partnership

Work with Shadow Integration Board to ensure strategy is adopted by the Health and Social Care Partnership Strategic Plan.

Work with Integrated Joint Board as they develop Strategic Plan.

Glasgow Tobacco Strategy adopted by the Integrated Health and Social Care Partnership Strategic Plan.

Integrated Health and Social Care Partnership GCC Chief Executive’s Office

Glasgow Tobacco Strategy 2015-17 Objective 2: Prevention (Creating an environment in Glasgow where young people choose not to smoke) Objective Action – What will we do? Output measures/indicators –



Lead and partners

Prevention (Universal)

Increase capacity in schools to deliver the tobacco element of health improvement programmes within Curriculum for Excellence

• Evidence based curricular linked tobacco education programme available for all primary, secondary and special education needs (SEN) schools in Glasgow, supported by resources and training

• Promote programmes

• Appropriate resources and training available to all schools to support programme delivery

• Uptake of programmes

Reduction in prevalence of smoking in Children (Glasgow Schools Survey/Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) local reports)

GCC Education Services Glasgow CHP NHS GGC

Encourage schools to address smoking as part of a broader programme dealing with the uptake of risky health behaviours in young people

• In partnership, develop a streamlined, co-ordinated plan to address risk taking behaviours (alcohol, drug and tobacco use) in schools

• Review outcomes of Social, Emotional and Education Development (SEED) pilot project

• Plan in place • Evidence of alignment of

substance misuse policies • Substance misuse toolkit • Review undertaken of SEED

Reduction in prevalence of smoking in Children (Glasgow Schools Survey/SALSUS local reports)

GCC Education Services NHS GGC Young people

Create environments within schools, tertiary organisations and youth settings to discourage young people from taking up smoking focusing on areas of deprivation

• Implement tailored and negotiated No Smoking Policies within schools, tertiary organisations and youth settings, in partnership with young people

• Explore potential areas for partnership working with Glasgow Life

• Number of youth facilities and organisations with tailored smoke-free policies


CHP sectors

Ensure appropriate engagement of young people in the development of tobacco programmes.

• Health Summits • Develop means of effective

engagement with young people in Glasgow on tobacco issues

• Evidence of mechanisms for youth engagement


Education Services NHS GGC GCHP sectors

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Prevention (Targeted)

Manage the implementation of national pilot of the ASSIST peer education programme in Glasgow

• Over 3 years deliver the ASSIST programme in 10 secondary schools in most deprived areas and with the highest smoking prevalence in Glasgow

• 10 schools participating in the programme

Reduction in prevalence of smoking in Glasgow school children Outcome of national evaluation

NHS GGC GCC Education Service

Implement a programme to reduce uptake of smoking amongst Looked After and Accommodated Children (LAAC) as part of a wider programme to reduce risk taking behaviour

• In line with existing plans develop and implement a tobacco control plan for LAAC (and kinship care, foster care, adoption and residential services), linked to wider risk taking behaviours

• Increase capacity of SWS to contribute to tobacco control work

• Plans in place • Training delivered • Negotiated SF policies in place

specific to individual units

Creation of an exemplar smoke-free residential uniy Smoking prevalence within LAAC&YP (under development)

GCC Social Work NHS GGC GCHP

In partnership with young people and relevant organisations develop a targeted, neighbourhood approach to delivering prevention work with young people

Options being developed with CHP Options being developed with CHP Reduction in prevalence of smoking in Children (Glasgow Schools Survey/SALSUS local reports)

GCHP sectors

Address high levels of smoking in 16-24 age group particularly those from most deprived backgrounds

• Through apprentice/employment agencies ensure a structured tobacco control component to youth training programmes

• Develop effective tobacco control programmes within tertiary education

• Identify relevant third sector partners and develop relationships

Training and resources provided and tobacco control component being delivered

Reduction in prevalence of smoking in 16-24 group

GCC DRS. Jobs and Business Glasgow GCHP sectors NHS GGC

Develop and implement strategies for young people in custody or within the youth justice system

• Develop a programme of work with Intensive and Youth Justice Services

• Explore potential to link with proposals in relation to alcohol brief interventions with those on Community Payback Orders

Training and resources provided and tobacco control component being delivered

Reduction in prevalence of smoking in 16-24 group

GCC SWS NHS GGC

Ensure the effective implementation of the Enhanced Tobacco Sales Enforcement Programme

• Maintain enhanced test purchase programme for tobacco

• Ongoing partnership with HMRC in intelligence led joint operations.

Maintain 20% test purchase visits Increase in levels of compliance with age restricted sale legislation

GCC LES Police Scotland HMRC

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Glasgow Tobacco Strategy 2015-17 • Compliance with e cig restrictions

Objective 3: Protection (Protecting people from second-hand smoke) Objective Action – What will we do? Output measures/indicators –



Lead and partners

Protection (Universal)

• Implement smoke-free grounds across all NHS estates by 2015, and begin to implement appropriate smoke-free policies across Council grounds and events.

Glasgow City Council • Develop new Health and Safety

Management Standard for Tobacco • Focus on smoke-free entrances • Increase the provisions of smoke-free

outdoor areas (play parks). Ensure smoke-free policies link to new Park Management Rules

• Identify, implement and promote smoke free family outdoor events

NHS GGC • Maintain programme of enforcement

and promotion to ensure compliance with smoke-free grounds by March 2015

• New H&S Management Standards developed, endorsed and implemented

• Number of smoke-free events • Compliance with the

requirement for smoke-free grounds

Reduction in adult smoking prevalence in Glasgow

Land and Environmental Services Community Safety Glasgow GCC Chief Executive’s Office NHS GGC

Maintain the enforcement of smoke-free legislation

• Enforcement programme for smoke-free legislation

• Develop programme of work with Shisha café owners

• Number of enforcement visits • Programme in place with

Shisha café owners

% compliance with smoke-free legislation

Land and Environmental Services Police Scotland NHS GGC

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Glasgow Tobacco Strategy 2015-17 Objective Action – What will we do? Output measures/indicators –



Lead and partners

Protection (Targeted)

Drive the adoption of smoke-free policies in organisations working with vulnerable people

• Youth smoke-free policies (see prevention section)

• Residential care homes for the elderly: Scope out issues with staff and residents, including issue of people with dementia who smoke

• Number of policies in place Reduction in prevalence of smoking in Children (Glasgow Schools Survey/SALSUS local reports)

GCHP sectors SWS (elderly)

Using a co-production model, implement an approach to reduce the availability of and demand for illicit tobacco

• Based on previous research/engagement develop and use toolkit to increase community engagement on illicit tobacco

• Ongoing partnership action addressing illicit supply of tobacco

• Toolkit and report produced, promoted and circulated

• Monitor use of toolkit

Narrowing of prevalence gap between most and least deprived groups

NHS GGC LES HMRC

Outline how HMP Barlinnie will move to become smoke-free

• In partnership, as part of the move to smoke-free prisons across NHS GGC, develop a co-ordinated plan based on current evidence, staff and prisoner consultation to move to a Smoke-free HMP Barlinnie

• Literature and best practice review conducted

• Consultation with staff and prisoners completed

• Plan developed and signed off

Decrease in the smoking prevalence in prisoner population

NHS GGC Smoke-free Services Scottish Prison Service

Deliver a targeted programme to reduce exposure to second-hand smoke (SHS) in the homes of those in the most deprived areas

• Deliver training on SHS with organisations working with vulnerable families (Health Visitors, SWS, Joint Support Team)

• Use resources (Dylos/Big Tiny web based programmes) to engage with community organisations on SHS

Development of a family based work programme. Number of training sessions delivered with staff and number of people attending

Increased understanding among parents and carers of smoking related harm

NHS GGC Education Services Social Work Services

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Glasgow Tobacco Strategy 2015-17 Objective 4: Cessation (Helping people to quit smoking) Objective Action – What will we do? Output measures/indicators –



Lead and partners

Cessation (Universal)

Deliver a universal, evidence based stop smoking service in Glasgow

Ensure evidence based stop smoking service available to all smokers

Stop smoking service activity Reduction in adult smoking prevalence

GCHP sectors NHS GGC

Ensure the stop smoking services is in line with national recommendations

Incorporate recommendations from the Review of NHS Smoking Cessation Services into future service planning.

NHS GGC services in line with national recommendations

Reduction in adult smoking prevalence


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Glasgow Tobacco Strategy 2015-17 Objective Action – What will we do? Output measures/indicators –



Lead and partners

Cessation (Targeted)

Maximise the potential of community stop smoking services to meet needs of most disadvantaged smokers and smokers from specific communities (unemployed, homeless, those with mental health issues, alcohol and drug dependency, BME, LGBT)

Review current service delivery model to ensure best fit for those with greatest need Shift intensive support to areas of greatest need Develop new partnerships and maximise existing partnerships

Increased engagement with relevant organisations Achievement of HEAT 6

Narrowing of prevalence gap between most and least deprived groups Reduction in adult prevalence in SIMD 1 and 2


Work with partners to develop innovative ways of delivering smoking cessation support in local communities to ensure services best meet their needs.

Develop service models that incorporate emerging evidence on stop smoking support (i.e. cut down to quit, rolling groups, extended support, non-traditional partners and venues)

Increase in numbers from SIMD accessing services and successfully quitting

Narrowing of prevalence gap between most and least deprived groups in Glasgow Decrease in prevalence of smoking in SIMD 1 and 2


Strengthen partnerships and build capacity with organisations working with vulnerable groups (social services, mental health, drug and alcohol agencies)

Provide training in best practice smoking cessation (particularly brief interventions) to a range of health professionals (drug and alcohol workers, mental health) and other relevant groups including non-health sector professionals who work with disadvantaged populations

Monitor training levels within targeted groups

Narrowing of prevalence gap between most and least deprived groups in Glasgow Decrease in prevalence of smoking in SIMD 1 and 2

NHSGGC Social Work Services DRS Jobs and Business Glasgow

Under Healthy Working Lives, ensure stop smoking support offered to all staff in NHS/Council and to other workplaces particularly those working with people on low income

Offer a range of stop smoking support to staff across GCC, Glasgow CHP focusing on lower paid staff Promotion of stop smoking support within Council apprenticeship schemes

Numbers of staff accessing NHS stop smoking support and successfully quitting

Reduction in adult prevalence in Glasgow

Healthy Working Lives

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References 1. ASH Scotland (2011). Tobacco use and LGBT Communities. Available from: http://www.ashscotland.org.uk/media/3858/LGBT.pdf 2. ASH Scotland (2014). Tobacco use, ethnicity and health. Available from:

http://www.ashscotland.org.uk/media/6143/tobaccouseethnicityandhealth.pdf 3. ASH Scotland (2014). Smoking in Scotland where are we now? Key facts,

figures and trends. Available from: http://www.ashscotland.org.uk/media/5980/Smoking_in_Scotland_Jan2014.pdf

4. Marisa de Andrade, “ NHS Greater Glasgow and Clyde, Black Minority Ethnic (BME) Feasibility and Ethnographic Study in the Southside of Glasgow”, University of Stirling, 2014

5. Peto R, Watt J, Boreham J. Deaths from smoking. Clinical Trial Service Unit &

Epidemiological Studies Unit (CTSU), University of Oxford. Available from: http://www.ctsu.ox.ac.uk/deathsfromsmoking/

6. Scottish Public Health Observatory (ScotPHO). (2012). ScotPHO Smoking

Ready Reckoner - 2011 Edition. Available from: http://www.scotpho.org.uk/downloads/scotphoreports/scotpho120626_smokingreadyreckoner.pdf

7. Scottish Government (2013). Creating a Tobacco-Free Generation. A

Tobacco Control Strategy for Scotland. Edinburgh. Available from: http://www.scotland.gov.uk/resource/0041/00417331.pdf

8. Understanding Glasgow. The Glasgow Indicators Project. http://www.understandingglasgow.com/

http://www.ashscotland.org.uk/media/3858/LGBT.pdf

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http://www.ctsu.ox.ac.uk/deathsfromsmoking/



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http://www.understandingglasgow.com/

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