developing a smoke-free organisation
TRANSCRIPT
Developing a smoke free
organisationJane Beenstock,
Public Health Consultant
Lancashire Care NHS Foundation Trust (LCFT)LCFT provides health and wellbeing services for a population of around 1.5 million people within the Lancashire and South Cumbria footprint, including specialist commissioned services for the wider population of the North West region.
Our range of services includes a portfolio of integrated physical and mental health services, with both inpatient and community provision, across children and adults.
We currently employ around 7,000 staff across more than 400 sites.
The map shows the footprint of LCFT and the CCG boundaries along with the local authority boundaries.
CCG Key Lancashire North
East Lancashire
Greater Preston
Fylde & Wyre
Blackpool
Chorley & South Ribble
West Lancashire
Blackburn with Darwen
Major causes of death in England
5
Burden of disease attributable to 20 leading risk factors for both sexes in 2010, expressed as a percentage of UK disability-adjusted life-years
Source: Murray et al Lancet 2013; 381: 997–1020
Corporate
Corporate
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Source: Public Health England
44,000 fewer deaths would
occur if people with SMIs had the
same mortality rate as the
general population
(1) Chang C-K, Hayes RD, Perera G, Broadbent MTM, Fernandes AC, et al. (2011) Life Expectancy at Birth for People with Serious Mental Illness and Other Major Disorders from a Secondary Mental Health Care Case Register in London. PLoS ONE 6(5): e19590. doi:10.1371/journal.pone.0019590(2) Brown S, Kim M, Mitchell C et al (2010) Twenty-five year mortality of a community cohort with schizophrenia. British Journal of Psychiatry 196:116-21.
The untold storyThis corresponds to LE in
1950s in general population!
Chin-Kuo Chang et al May 2011
Corporate
Smoking-related diseases accounted for 70% of the excess natural
mortality in the cohort.
How? The components of implementationEvaluationAgreement Communication
& engagementTraining & support
EstatesPolicy & procedures
Agreement from executive team to implement NICE guidance and become completely smokefree,
establish budget and project lead. Establish
implementation team and plan
Establish detailedcommunication plan (internal and external stakeholders). Gather
baseline views of staff to help with developing
briefings
Monitor the impact of implementation and refresh as and
when required
Develop policies and procedures,
seeking legal advice if required
Develop smokefree
champion training and support,
deliver training to staff across the
trust
Remove all smoking shelters and bins. Erect
signs across trust buildings and sites
Timeline - based on the Scottish plan*
*Nicholson, N. 2011. Smoke-free mental health services in Scotland Implementation guidance. NHS Scotland. Accessed 20.6.14 http//www.healthscotland.com/documents/5041.aspx
How we got there: the challenges and successes
Internal
Staff views of the policy Training and NRT Service users’ views E-cigarettes
External
The media The local community
Challenges: staffPersonal and professional
The therapeutic relationship Restrictive practice Capacity issues Right to choose? Personal smoking habits Cultural beliefs about smoking Inconsistent approach across
sites Inconsistent NRT prescription Conflict of leave prescriptions
Challenges: training and NRT Time to release staff Knowledge and skills to use NRT
Corporate
Our culture
Staff animation
Corporatehttp://www.youtube.com/embed/-5yYbVDw_dw
Challenges: service users
Subversion of security
Challenges: e-cigarettes
External challenges: the media
Successes
Regular meetings with local residents
Wards no longer store nicotine products
Leave is only prescribed for therapeutic purposes (consultants charter)
Positive feedback from staff and service users
Staff report when they have been exposed to secondary smoke
Service users told us…Over the course of the first three
months of giving up I had help and support from staff on the ward,
their encouragement helped me. I also used several forms of art that I completed on the ward to distract
myself from the cravings.
Life on the ward, before the
ban revolved around smoke
breaks and each time, a
member of staff shouted
“SMOKES”.I can remember telling myself
that “nothing was more important than my health –
that’s why I MUST stay quit”.
5th January 2015 Nicotine Management Policy introduced
“Staff and other service users supported and helped me first give up cigarettes and then reduce my addiction to nicotine. They
believed in me and eventually so did I. I say “I can beat cigarettes they no longer own me!” (Guild service user)
Feedback from service users has resulted in policy updates
Quit rate: 26% of service users (n=95) at Guild Lodge who were seen in clinic
Service users who had quit smoking were presented with a certificate and
vouchers by the Trust’s Chief Executive Heather Tierney-Moore,
who said:“It was a delight to be able to present the service users with their awards
and mark such a fantastic achievement. To be able to stop
smoking is a great achievement. It was good to hear about their stop smoking journeys and the reasons
behind wanting to quit, which included both health and financial benefits.”
Celebrating success
Challenges: reframing
An addiction is not a choice
Service user animation
https://youtu.be/sPq6Z9yWP3Y