Agenda item

This is a proposed Medway policy to support clinicians of all types and in all sectors to enable many more people to quit smoking so that they are less likely to develop the avoidable consequences of smoking and that any treatment they receive is less risky and more effective.

Slight adaptation of this policy may be required for its application in community, mental health and social care settings. Work will continue on the policy's appendix, which provides an overview of the evidence-base to support clinicians in discussion with their patients, prior to implementation.

Discussion

The Interim Director of Public Health introduced the report. The Health and Wellbeing Board had, in April 2016, unanimously supported the development of an initiative to encourage people to give up smoking. A policy had been developed, with the focus being on improving the safety and effectiveness of care. The Policy had been formally approved by both Medway Hospital NHS Foundation Trust and by Medway NHS Clinical Commissioning Group. Support would also be sought from the local community health and mental health trusts. Swale CCG had also indicated its intention to adopt the Policy and the Clinical Board of the Kent and Medway Sustainability and Transformation Plan had expressed interest in its adoption across the whole of Kent.

The Policy aimed to provide support and made a request to clinicians of all types and in all settings, to raise the subject of smoking cessation with patients and to refer them to stop smoking services. It was anticipated that the clinicians would discuss with patients the risks of continuing to smoke and the benefits of stopping smoking in the context of their clinical circumstances, whether the patient had a long term condition or was due for elective surgery. There was scope for surgery to be delayed, where clinically appropriate, pending the patient having attempted to give up smoking in order to reduce the considerable risks of being a smoker at the time of surgery. There would be the option for the patient to refuse to try giving up, to opt out during the process or, should they fail in an attempt to give up, to continue with their treatment. The patient would then in effect be giving informed consent to receiving treatment with this increased risk. The Policy also set out quantified risks of smoking and  benefits of quitting. It was noted that many of the benefits of stopping smoking were realised quite quickly.

The Health and Wellbeing Board was invited to comment on and support the Policy.

The Committee raised a number of points and questions as follows:

Medway Foundation Trust (MFT) Smoke Free Policy – A Member of the Board asked if lessons had been learned from the introduction of a smoke free policy at Medway Maritime Hospital. The Chief Executive of MFT said that support and guidance had been received from the Council’s Public Health Directorate. In general, it had proved harder to obtain the co-operation of  staff that it had been of patients. The subject had been approached gently with the emphasis at this stage being on encouragement and support. The hospital has being presented as an exemplar for other NHS organisations to follow. It was considered that the partnership working involved in the introduction of the smoke free policy had helped to make it a success. In relation to the Medway Quit Smoking Policy under consideration, it had already been endorsed by the MFT Board and was due to be submitted to the Clinical Council in order for it to be adopted as clinical policy.

Promotion of Policy to the public – In response to a Member question that queried how the information contained in the policy would be promoted and made accessible to general public, the Interim Director of Public Health advised that work was taking place in relation to this with the Smoking Cessation Team and with Corporate Communications. The information would be made more accessible to smokers and relatives of smokers. It was anticipated that information leaflets would also be developed.

Members of the Board congratulated the Chief Executive of MFT on the introduction of the hospital’s smoke free policy and congratulated the Interim  Director of Public Health and the Public Health Team on the development of the Medway Quit Smoking Policy. A Member felt that development of the Policy highlighted the value of the Health and Wellbeing Board. He also considered that effective use had been made of social media to encourage people to give up smoking.

It was suggested that the Quit Smoking Policy could be discussed further at meetings of Directors of Public Health.

The Chairman of the Board endorsed the thanks to the Public Health Team made by other Members of the Board. He noted that during Summer 2016, a seminar had taken place to discuss smoking during pregnancy. This had involved maternity, midwifery staff and a number of partner organisations, including Council representation. An Action Group had been established to help address this issue, with three meetings having taken place so far. The Chairman of the Board had become Chair of this group.

Decision

i)             The Board supported the Medway wide implementation of the policy to enable more people, in all circumstances, to quit smoking.

ii)            Board members committed to working within their own organisations to ensure that this policy can be effectively and sustainably applied so that front-line clinicians of all types can systematically encourage and enable a much higher proportion of current smokers to quit smoking.