1. Tobacco Control: How local authorities can make best use of diminishing resources Ailsa Rutter, Director, Fresh: Smokefree North East

2. “…the burning injustice that if you’re born poor you will die on average nine years earlier than others.” Prime Minister Theresa May, July 2016

4. Current situation • Smoking rates have reduced considerably over the last 20 years, by a third amongst adults and two thirds amongst children. • However, smoking remains the largest cause of preventable and premature death in England killing nearly 80,000 per year. • Preventative tobacco control work is hugely cost effective, but funding is being cut.

5. Burning Injustice • APPG Inquiry into the state of local and national tobacco control. • Published in January 2017. • Contains recommendations for the government, local authorities and the NHS. http://ash.org.uk/download/burning-injustice/

6. National leadership and action • New cross-government Tobacco Control Plan that includes ambitious new targets to reduce rates of smoking for all groups • Levy on tobacco companies to support investment nationally and locally

7. Taken from Better Health for London, the report of the London Health Commission

8. Local impact • Local activity on smoking contributes to local outcomes: • Children the best start in life • Boosting the income of our poorest social groups • Tackling crime • Reducing social care and NHS costs • Increasing productivity of the local workforce • NICE has estimated that for every £1 invested £2.37 will be saved through treating smoking-related disease and lost productivity.

9. Burning injustice recommendations • The report contains 7 specific recommendations for local authorities. • These focus on: • Creating budgets informed by Public Health • Developing local tobacco control plans • Developing roles for HWBB to oversee implementation of local plans and facilitating coordination with local NHS organisations. • Reliance on current evidence of the impact and cost-effectiveness of different interventions. • Prioritising provision of specialist services for vulnerable groups when budgets prevent provision of a universal service. • Collaboration across boundaries in forming regional partnerships • Commitment to sharing best practice and exploring joint working and commissioning

10. Strategic local tobacco control

11. Local action: Support to quit • Attempting to quit with the support of a stop smoking service is 4 times more effective than quitting unaided and highly cost effective • Stop smoking services have experienced budget cuts alongside other TC activities • Budgets are under pressure BUT complete removal of services likely to be a false economy in the long-run. • New models such as ‘Stop Smoking +’ offer a more strategic deployment of limited resources • Hugh untapped potential of the NHS primary and secondary care. Explored through STP

12. Local action: Harm reduction • NICE guidance on tobacco harm reduction: quitting best BUT if you can’t then nicotine alternatives better than smoking • Massive rise in use of e-cigarettes now 2.9 million users in GB – just over half ex-smokers • Locally need to maximise benefits and minimise risks e.g. ‘Ditch or Switch’ message

13. Local action: Trading Standards • Effective enforcement by trading standards is essential to successful tobacco control work. • One of the most important areas is illicit. • However, trading standards has experienced a 12% decline in staff since 2014. • Joined up models of working shown to be effective and can deliver value

14. Local action: Youth Prevention • Smoking is an addiction of childhood with two thirds starting smoking before age 18. • This may make youth prevention work seem attractive. • However, an NCSCT evaluation found that the return from school-based youth prevention is minimal compared to adult smoking cessation services.

15. Regional Partnerships • Working at a regional level is an effective way to deliver tobacco control. • The North East has had a locally commissioned comprehensive regional programme since 2005 – Fresh. • The evidence for regional partnerships is illustrated by the above average decline in smoking prevalence in the NE – 9.1 percentage points compared to 6 across England.

16. Comprehensive/ efficiencies Change in regional smoking prevalence 2005-2014

17. Figure 2.3 Projection of smoking prevalence in England to achieve prevalence of less than 5% in all socio-economic groups by 2035

18. For more information ASH Ash.org.uk 0207 404 0242 enquiries@ash.org.uk @ASH_LDN FRESH Freshne.com 01913337141 info@freshne.com @FreshSmokeFree