Creating a smoke-free South Yorkshire and Bassetlaw Integrated Care System

Key benefits and outcomes

It is hoped that the programme will contribute towards:

• decreased prevalence of overall adult smoking rates
• reduction in standardised mortality rate for deaths attributable to smoking
• reduction in the incidence of cancer
• reduction in the harm to children from second-hand smoke exposure
• reduction in the life expectancy gap between the most deprived and the most affluent communities and between the general population and those with a severe mental illness.

What the system faced

Smoking is the largest preventable cause of cancer worldwide, with research showing that quitting smoking leads to improvements in mental and physical health. Smokers are more likely to quit successfully with support, such as through tobacco treatment advisers and tobacco addiction medications.  Within South Yorkshire and Bassetlaw, nearly 200,000 people smoke, of which more than half will die prematurely (losing on average ten years of life) from smoking-related illnesses. Supporting people to stop smoking is one of the most effective actions within the power of the NHS to reduce health inequalities. Reducing the prevalence of smoking is a key priority within the South Yorkshire and Bassetlaw Integrated Care System (SYB ICS) as stipulated within key commitments in the 2019 NHS Long Term Plan.

What the system did

In 2021, to address this challenge and save lives, SYB ICS launched the QUIT programme in partnership with Yorkshire Cancer Research, five local authorities and local Stop Smoking Services. The programme aims to saves lives, decrease health inequalities and reduce hospital readmissions by making effective treatment for tobacco addiction part of the routine care offered in hospitals.

QUIT stands for the key principles in the treatment pathway for tobacco addition:

Q - ask the question

U - understand their addiction

I - inform patients

T - initiate treatment.

Established on evidence from successful schemes in Ottawa and Greater Manchester, QUIT aims to transform the way smoking is tackled in the region. Smoking is recognised not as a lifestyle choice but as tobacco addiction in NHS trusts across the ICS and therefore treated as a medical condition as part of a patient’s routine physical and mental health hospital care. The aims of the tobacco reduction harm SYB ICS QUIT programme were:

• Every health care professional is aware of the smoking status of every patient they care for and the competence / confidence to offer help to stop smoking.
• The interventions will support smokers to quit smoking for the duration of their hospital stay (mitigation of withdrawal symptoms; linked to smoke free hospital policy), and to support a long term quit attempt.
• Smokers are systematically identified on admission and referred  within the hospital to the QUIT team on an opt out basis. A tobacco treatment adviser visits them on the ward to provide advice and behavioural support during their admission.
• Pharmacotherapy is offered, such as nicotine replacement therapy (NRT), varenicline or bupropion.
• After hospital discharge, patients’ tobacco addiction treatment is continued in the community by the community stop smoking service (CSSS).
• People admitted to the mental health trusts are offered NRT / vapes and behavioural support for the duration of their hospital stay. The trust’s tobacco treatment adviser continues to provide support for the duration of the person’s quit attempt.
• All the hospitals in SY&B become institutions of health promotion and truly smoke-free zones.

Results and benefits

It is hoped that the programme will contribute towards:

• decreased prevalence of overall adult smoking rates
• reduction in standardised mortality rate for deaths attributable to smoking
• reduction in the incidence of cancer
• reduction in the harm to children from second-hand smoke exposure
• reduction in the life expectancy gap between the most deprived and the most affluent communities and between the general population and those with a severe mental illness.

Evidence from the Ottawa model for smoking cessation demonstrated that acute trusts treating tobacco dependency leads to an 11.1 percentage point increase in long-term quit rates and a 40 per cent reduction in risk of death over two years. Within the UK context, data from Wythenshawe Hospital in Greater Manchester, which had adopted the Ottawa model for smoking cessation, had a quit rate of 42 per cent at four weeks.

The QUIT Programme will be evaluated across the South Yorkshire and Bassetlaw Integrated Care System. Yorkshire Cancer Research have commissioned University of Sheffield (ScHARR) to externally evaluate QUIT. This will also require data collection and sharing, and participation in an action research set and other forms of qualitative review.

Overcoming obstacles

QUIT is a comprehensive secondary care programme that builds treatment for nicotine addiction into patient’s routine care while they are in hospital. As a complex programme of work, it is essential to allow sufficient time for planning, implementation, and evaluation. Senior multi-directorate managerial and clinical support is essential to facilitate the culture change of treating tobacco addiction as a disease, rather than a lifestyle issue. The creation of IT solutions that are interoperable and allow rapid intelligence / feedback on the progress of the service has been very challenging, as will the evaluation. The programme was also only possible following the approval of the business case, which includes £1.8 million of external funding from Yorkshire Cancer Research to fund the 45 tobacco treatment advisers.

Takeaway tips

1. Early internal engagement and commitment from senior leadership is essential.
2. The service must include supported smoking cessation for staff, as well patients.
3. From the outset, create robust measurement and outcomes framework to evaluate impact.
4. Co-create the programme with local stakeholders.

Further information

For more information on the work, please visit www.sybics-quit.co.uk