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Saving lives by helping smokers to stop. Robert West. University College London 2010. Outline. Achievements of the Stop Smoking Services Challenges ahead How we can meet those challenges and improve the service we provide. Performance of stop smoking services 2001-2008.
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Saving lives by helping smokers to stop Robert West University College London 2010
Outline • Achievements of the Stop Smoking Services • Challenges ahead • How we can meet those challenges and improve the service we provide
Calculating impact • Impact (I) • The proportion of all smokers in the local population helped by the stop smoking services to stop for 4 weeks • Effectiveness (E) • The proportion of smokers who set a quit date with the stop smoking services who stop for 4 weeks who would not have stopped with medication alone • an estimated 25% would have stopped with medication alone, so subtract 25% from CO-verified 4-week quit rate • Reach (R) • The proportion of the local population who set a quit date with the services I = E x R
Impact of stop smoking services 2008-9 Lewisham Impact=(CO-verified 4-week quit%-25%)*Number treated per 100,000
The challenges • To improve the impact of less effective services by improving success rates • better configuration of setting • better blend of type of service provision • wider use of most effective medication options • improved skills and knowledge of frontline staff • To ensure that new commissioning model works to maintain or improve standards • establishing minimum standards for services in terms of structure, settings, medication, type of provision and staffing • ensuring that ‘cost-per quitter’ takes account of catchment and local staff costs
Improving skills and knowledge of front line staff • NHS Centre for Smoking Cessation and Training (NCSCT) • find out what skills and knowledge are required • develop and implement methods to assess these • develop, provide and commission training to ensure all staff have these competences • provide ongoing support and continuing professional development
What skills and knowledge are required? • Stop smoking specialists need to be skilled at delivering a behavioural support programme that consists of a set of ‘behaviour change techniques’ (BCTs)
Classification of BCTs by function BCTs Focus on specific behaviour Address motivation Maximise self-regulation Promote adjuvant activities General aspects of interaction intervention content that directly promotes abstinence maximise motivation to abstain or minimise motivation to smoke intervention content that promotes activities that indirectly facilitate abstinence promote mental and physical activities that either reduce exposure to motivation to smoke or help with resisting that motivation competences necessary for effective delivery of specific BCTs and adjuvant activities
BCTs emphasised in treatment manuals of more effective services • Address motivation • Strengthen ex-smoker identity • Provide rewards on stopping smoking • Measure CO • Maximise self-regulatory capacity and skills • Facilitate relapse prevention and coping • Advise on changing routine • Promote adjuvant activities • Advise on stop-smoking medication • Ask about experiences of stop smoking medication • General • Elicit client views • Give options for additional and later support 31
The future • Every stop smoking specialist should: • know his or her throughput and CO-verified success rates • have a treatment protocol that they work to that involves specific behaviour change techniques • be able to demonstrate a minimum level of knowledge and skills required for the role • work within a service and a national support programme that disseminates best practice on the basis of current evidence • The NCSCT is working to help achieve this • The Stop Smoking Services have been a huge success story but are always potentially under threat; being able to demonstrate quality of service and professionalism of staff is the best protection
