Camden and Islington aim to provide a high quality, accessible, evidence-based, outcome-focused and cost-effective stop smoking service to all smokers or tobacco users who live, work, study or have a GP in the two boroughs.
The local challenge
The London boroughs of Camden and Islington jointly commission a stop smoking service for smokers and tobacco users in their diverse inner-London population. It’s distinctive name, Breathe – It’s About Living, and branding were co-created in 2017 with smokers, professional stakeholders and community organisations to provide an attractive and accessible profile for the service.
In 2022, prior to retendering the service, detailed research with resident smokers sought to gain further insight into how the service can be improved with a strong focus on inequalities. In response, the service is seeking to fine tune marketing and referrals, maximise the range of places where the service can be accessed, and further tailor the service to the needs and expectations of individual smokers.
The service for smokers
Camden and Islington aim to provide a high quality, accessible, evidence-based, outcome-focused and cost-effective stop smoking service to all smokers or tobacco users who live, work, study or have a GP in the two boroughs. Since 2017 the core of this service has been a three-tier offer based on Professor Robert West’s Stop Smoking+ model [i]. The tiers are designed to ensure that smokers receive the most appropriate support for their needs and preferences:
- Tier 1 Self-support: use of a phone app and online or printed information
- Tier 2 Brief support: a clinical service over a minimum of two sessions provided by trained professionals
- Tier 3 Specialist support: a clinical service offering intensive one-to-one behavioural support over a minimum of six weeks
Tier 1 is for smokers who are interested in quitting without professional help. Tier 2 is a service for smokers who want limited professional support to quit. Tier 3 is for smokers who are highly tobacco dependent, who have had multiple failed quit attempts, and/or have complex needs or are at higher risk of tobacco-related harm. All Tier 2 and Tier 3 users are offered a full course of the available medications plus starter packs of e-cigarettes.
Face-to-face support is provided in a range of accessible community settings in the two boroughs near where users live, work or study. These include GP practices, pharmacies and other healthcare settings, workplaces, community centres, cultural or religious settings such as mosques, children’s centres, young people’ clubs, shopping centres and libraries. Flexible telephone and online video support are offered as alternatives to face-to-face support and Tier 3 users have the option of participating in group sessions.
Referrals are actively sought from all partner agencies including the tobacco dependency services in acute hospitals and mental health trusts. These new NHS services, which build on long-standing partnerships between Public Health in Islington and Camden, the stop smoking service and local NHS trusts, have already significantly increased the number of referred smokers accessing the community stop smoking service
The boroughs’ commitment to tackling inequalities is reflected in KPIs for the stop smoking service to reach:
- smokers with no or low income and smokers living in the most deprived areas
- Black and Minority Ethnic communities especially Black Caribbean, Mixed White/Black Caribbean, Black African, Irish, Turkish, Arab, Bangladeshi, and Pakistani communities
- smokers in routine and manual occupations
- pregnant smokers and their partners
- families with young children under 5 years of age
- young people (ages 12-17 and 18-25)
- mental health service users, particularly those with severe mental illness (SMI)
- smokers living with long term conditions which are made worse by smoking
- Lesbian, Gay, Bisexual, Transgendered, Queer (LGBT+) smokers
- smokers in substance misuse services.
The service seeks to engage with this diverse profile of target groups through many avenues including partnerships with the community and voluntary sector; the regional smokefree pregnancy programme in North Central London; working closely with NHS trusts to deliver the Long-Term Plan commitments; proactive targeted outreach in workplaces and with community and faith groups; and bespoke communications work. An expanded marketing and digital communications strategy builds on the branding work from 2017.
[i] West, R. The very best support for stopping smoking. UCL, London, 2016
Outcomes
Despite the challenges of the COVID-19 pandemic, the Breathe service has consistently met or exceeded corporate targets. The new service aims to support 750 people per year to successfully quit smoking, 55 per cent of the people who access tiers 2 and 3 of the service. Year-on-year improvement is expected for the numbers of quitters in each of the identified high prevalence priority groups.
The social value of the service includes the training of community volunteers and peer advisors in substance misuse service users, and the support given to local VCS organisations through co-location of services.
How is the work sustained?
There is long-standing political commitment to tackling the harms of tobacco in both boroughs due to the clear evidence base of the impact of quitting smoking on the health of individuals and families and on inequalities. Stop smoking service outcomes are included in corporate dashboards
Public health officers leading tobacco control work have strong relationships with lead members and council executives and there is a dedicated officer overseeing implementation of the smoke-free strategy. The Camden and Islington Smoke-free Alliance has brought together partners from across the local health economy for the last ten years.
Lessons learned
Engagement with users and resident smokers has been invaluable to the development and profile of the service. This remains a priority for the ongoing evaluation and development of the service.