Smokefree and mental healthNICE guidance and the importance of self-assessment

Dave Jones – Tobacco Control Manager, PHE

Smoking and mental health• Smoking is the largest single preventable cause of morbidity, mortality and

inequalities in health in England

• Accounting for about half of the difference in life expectancy between the lowest and the highest income groups

• People with mental health problems smoke significantly more and are more dependent on nicotine

• Prevalence is about three times that of the general population

• Physical health harms of smoking and benefits of stopping are well reported

• There is evidence to suggest that smoking is detrimental to mental health and that stopping smoking improves mood and reduces stress

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NICE guidance PH48 – Secondary Care• NICE public health guidance PH48 recommends that all NHS funded

secondary care sites should become completely smokefree

• PHE survey of NHS E commissioned low and medium secure mental health units revealed;

• 83% were smokefree within buildings and allowed within secure gardens

• 9% of units had also implemented smokefree grounds

• Admission to a secure mental health unit can be an opportunity to intervene to reduce smoking with interventions that are welcomed and effective

• The guidance is comprehensive in making 71 recommendations under 16 headings

• However it is not necessarily obvious where to start, nor how to measure success

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NICE accredited self-assessment tool• PHE has developed a self-assessment tool for NHS trusts to assess against

NICE guidance PH48, identify gaps and develop action plans

• The PHE self-assessment tool brings all of the recommendations for mental health into one place and presents them under four themes:

• Systems

• Communications

• Training

• Treatment

• On completion of the tool, trusts will have a clear understanding of where there is evidence of delivery and where there are gaps

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What is self-assessment• An opportunity to make a structured assessment of delivery against NICE guidance

• A means to stay on track and demonstrate improvement

• Not an inspection• Not a competition• Not a rating system• Not a tool for conducting appraisals• Not a performance management system

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Introducing the self-assessment tool• A challenging yet easy-to-use questionnaire and the option for peer

review

• Designed for use by mental health trusts as well as individual treatment areas

• All questions are based on NICE guidance recommendations and have an emphasis on providing evidence

• A diagnostic tool, signposting other helpful tools and resources

• A means to stay on track and demonstrate improvement

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Preparing for the assessment

• Nominate a lead assessor who will;

• Develop and agree the proposed agenda for the assessment day

• Circulate the agenda to all assessment team members

• Establish an assessment team

• Review the self-assessment report and agree who will lead each topic

• Review associated documentation

• Discuss and develop areas that require further exploration on the day

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Options for the assessment process

Workshop style assessment

or

Panel style assessment

What are the advantages and disadvantages of these two options?

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9 An introduction to CLeaR assessment

10 An introduction to CLeaR assessment

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Supporting resources• A suite of videos has been produced to inform users of the tool about the

four areas

• The videos are available online and can be used by trusts to support staff and service users in moving towards smokefree

• They build on the experiences of those people and trusts who have already begun their journey to becoming a settled smokefree environment

• There is also a 15 minute video outlining Chester and Wirral Partnership Trust’s journey to smokefree

• All these resources are available by searching - smoking mental health - on the gov.uk website

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In conclusion• Stopping smoking while receiving NHS care represents a significant

opportunity to address the large inequity between people with mental health conditions and the general population

• We must also recognise the role primary and community care have in helping to fully realise these benefits

• We congratulate those trusts which have already become smokefree and encourage all trusts and primary and community care providers to recognise the importance of supporting all people who smoke to become smokefree

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