The Essex Wellbeing Service offers eight weeks of behavioural support in person, by video, or over the phone to any smoker over the age of 12 who lives in the county.
The challenge
Essex has a population of around 1.8 million people who live in a mixture of densely-populated cities, sparsely-populated rural areas and seaside towns such as Jaywick Sands, which is known as the most deprived area in England.
The prevalence of smokers in Essex is 12.3 per cent, just under the average for England, and this population is highly skewed towards disadvantaged areas and communities.
As smoking prevalence has declined, the Council has sought to sustain the number of smokers it successfully supports to quit every year. This is a challenge because the local population of smokers is ever more concentrated among those who have not engaged with the service, many of whom are disadvantaged and likely to be highly addicted to tobacco. Treatment options have also diminished with the withdrawal of Champix and Zyban from the market.
The Essex Wellbeing Service
The Council supports local smokers to quit through the Essex Wellbeing Service. This is a coordinated alliance of organisations offering residents support with diverse health and wellbeing needs including smoking, weight management, social isolation and caring commitments. The advantages of this integrated approach include:
- A single point of access and triage, typically a holistic assessment from one phone call.
- Wider opportunities to reach smokers.
- Immediate support in addressing any unwanted outcomes of quitting such as weight gain.
The Essex Wellbeing Service offers eight weeks of behavioural support in person, by video, or over the phone to any smoker over the age of 12 who lives in the county. Priority groups for the service are pregnant women, workers with routine and manual occupations, residents of deprived areas, young people, Black and Minority Ethnic communities, and people with serious mental illness.
The service reaches into local communities using diverse approaches and settings. For example, the service works with the NHS to reach pregnant women and people with mental health conditions, with housing associations to promote the service in poorer communities, and with the community and voluntary sector to increase the number of smoking cessation support workers in the community. GP practices and community pharmacies continue to make an important contribution to the quit rate across the county.
The expanding offer to smokers within the NHS is an opportunity to reach more disadvantaged smokers and the Council has worked hard to support the development of tobacco dependency treatment services throughout the county. This has been challenging as the county footprint spans three integrated care board (ICB) areas and many NHS trusts. Council officers are involved with all three ICB programmes as well as with targeted lung health checks in the northeast of the county.
Despite the loss of Champix and Zyban, the service offers a range of treatment options including free access to nicotine replacement therapy and vape starter kits and access to Allan Carr EasyWay online seminars for people who prefer a quit route without pharmacotherapy. Essex County Council was one of the first local authorities to work with vape retailers and has seen significant increases in the local quit rate through these partnerships. The Wellbeing Service currently works with two vape shops that have gained a strong standing in their community, particularly during COVID-19 lockdowns, and a new community-based project supports smokers who are homeless or suffering severe multiple disadvantage to switch to vaping.
The Council is also addressing the risks to young people of vaping. Following intelligence from the Trading Standards team about the increase in vaping among young people, a survey of the attitudes and behaviour of young people and their parents has recently been conducted. This will inform future work with schools, parents and the police. Meanwhile, Trading Standards officers continue to crack down on underage sales.
Outcomes
- In the first six months of 2022/3, the Wellbeing Service supported over 3,500 smokers to set a quit date. Many more were supported to quit via the service’s partnerships with the NHS and prisons.
- A more strategic working relationship with primary care has almost doubled referrals from this source.
- The smoking at the time of delivery (SATOD) rate for North East Essex, which has some of the county’s most deprived areas, has reduced from 12 per cent to 9.9 per cent since the introduction of the gold standard in house maternity model.
Beyond the statistics, the individual impact of the service can be transformative. In the words of one service user in North East Essex:
After 27 years of smoking and numerous failed attempts, I know I will never go near nicotine again and that is extremely liberating!
How is the work sustained?
The members of Essex County Council understand that quitting smoking is one of the best things that anyone can do for their health and the health of the community. This shared understanding has been crucial to the ongoing work of the Wellbeing Service to reduce smoking prevalence in Essex.
Lessons learned
In response to the COVID-19 pandemic and the removal of key stop smoking medicines from the market, the Council has sought to offer a more flexible suite of options to smokers and to exploit every opportunity to reach into local communities through the local authority work force and strong partnerships with the NHS and the community and voluntary sector.