Agenda item

Jo Atkinson (Consultant in Public Health, Leicester City Council) and Andrea Thorne (Public Health Project Manager, Leicester City Council) will present a report on the evaluation of the CURE programme, which is a tobacco dependency treatment service within acute, mental health and maternity hospital settings, since it’s implementation.

Jo Atkinson (Consultant in Public Health, Leicester City Council) and Andrea Thorne (Public Health Project manager, Leicester City Council) gave a slide-desk presentation, to accompany the document in the agenda pack, on the evaluation of the CURE programme since its implementation. The CURE programme was a tobacco dependency treatment service within Acute hospital settings, mental health inpatient settings (within LPT) and maternity hospital settings – but this evaluation was only about the Acute inpatient arm of the service delivered within University Hospitals of Leicester NHS Trust (UHL). It was noted that:

·         The service launched gradually due to the Covid-19 pandemic.

·         Thanks were noted to the small project team under Andrea Thorne, and to partners/leads in UHL, ICB and Leicestershire Partnership Trust (LPT).

·         Smoking was the leading cause of premature preventable deaths – and this programme was part of the NHS Long Term Plan to address that.

·         Smoking prevalence in Leicester adults was reported as 12.8% in 2021.

·         The NHS Long Term Plan had a target for all inpatients being offered support to stop smoking by 2023/4.

·         East Midlands Tobacco Alliance funding helped with the set-up costs for the first phase in Glenfield Hospital in April 2021. The Leicester Royal Hospital came on board in Summer 2022, and finally Leicester General Hospital in April 2023.

·         The pathway was described as:-

o   Admission to hospital

o   A Making Every Contact Count (MECC) assessment being completed by UHL staff.

o   A smoking status in the MECC assessment generates an automatic referral to the Tobacco Dependency Advisers (TDAs) within CURE.

o   A TDAs see the patient at their bedside and offers support.

o   Nicotine Replacement Therapy was prescribed.

o   On leaving the hospital the patient was offered continued support for a further 12+ weeks within the community Local Authority smoking cessation teams (City or County as appropriate).

·         The focus of the paper in the agenda pack was the evaluation conducted in collaboration with Dr Shilpa Sisodia (Public Health Registrar at the time of the project) using the RE-AIM methodology*.

·         *RE-AIM stood for Reach, Effectiveness, Adoption, Implementation and Maintenance.

·         REACH;

o   3615 clients were referred between October 2022 and February 2023. There was an average referral rate of 700-800 per month.

o   At the time of the evaluation 31% of the referrals were seen at bedside; this was low due to staff sickness at that time. By April 2023 this had improved to 40% and is currently sitting at 50%. 100% will never be achievable as the staff only work Monday to Friday 9am-5pm – but the team are aiming for 60%. The pilot in Glenfield Hospital achieved 73%.

o   53% of the clients were from Quintiles 1 and 2 – and this indicated the project was reaching the most deprived cohort.

·         Effectiveness;

o   65% of those supported maintained a quit at four weeks; this was higher than the community rates (55-60%) and may have been due to the personalised support by the TDAs.

o   75% received pharmacotherapy.

o   84% of those seen at bedside accepted the offer of a transfer to the community smoking cessation services.

·         Adoption; adoption was highest in Glenfield Hospital (possible reasons are listed in the report in the agenda pack).

·         Implementation;

o   The biggest key challenge/barrier was the number of different IT systems involved (two for UHL, one for City Community, one for County Community and one for Pharmacies). A Data Working Group was set up to tackle this – and a new over-arching and simplified system was set to commence from January 2024. This would stop the current need for the team to be manually inputting onto a spreadsheet on a daily basis. Thanks were noted to Saadia from the LLR STP Digital Innovations Hub for her assistance around the IT challenge.

o   Another barrier/challenge was the pharmacology provision – and a Medicines Management Steering Group was established to address issues. Special mention went to Jo Priestly (UHL Pharmacist).

o   Another barrier was the governance structures involved; the LTP funding comes into the Integrated Care Board, the team were employed by the City Council but based in UHL offices using Honorary contracts.

o   Another barrier was the lack of uncertainty around recurrent funding.

o   Other facilitators were the seed funding (see above), clinical leadership, joint working and the national mandate.

·         Feedback from interviews had suggested the following areas for improvement:-

o   Greater patient/public involvement

o   See more clients (whilst noting the increasing costs of NRT without the corresponding increase to the budget).

·         Recommendations were noted as:-

o   Staff make better use of translation services. This had improved since the recommendation was made.

o   Speed up the time it took for a patient to receive NRT. The national target was two hours. Quality improvement work had seen this target getting closer.

o   Finalise one IT system to make efficiencies (see above for details).

o   Make the MECC assessment a mandatory field (this was being progressed).

o   Continue to evaluate and monitor impact on prevalence rates and deaths in the longer term.

·         In addition to the recommendations above (which are all being worked on), other next steps were noted as:-

o   More quality improvement projects.

o   Have conversations regarding LTP funding.

o   Influence a cultural change to get tobacco dependence treated as a disease.

Comments and questions from the Board:-

-       Members of the Board thanked everyone involved - and noted that this was a project which shows true partnership working.

-       Members of the Board commented that it would be helpful for return-on-investment data to be gathered, as longer-term economic analysis would allow the project to be prioritised for extension/expansion in the future. 

-       Members of the Board asked to see projection data on equity, lifestyle, generational and financial impacts.

-       A Member of the Board asked why the CMG MECC Assessment was not listed in the report.

-       A Member of the Board asked whether external assistance would be useful to make links with the Community Pharmacists. Jo Atkinson explained that there was a Community Pharmacy arm to CURE – and there was a separate Task Group working on this. Progress had been slow to date – but the ICB had just employed a Project Manager to increase engagement with Pharmacies.

-       Members of the Board suggested that the new Occupational Health Lead within UHL could help reach the UHL workforce and expand resources. In addition, information about the project could be shared more publicly through UHL Senior Leadership Pathways.

RESOLVED:

1.    That the Board thanks Officers for the report.

2.    That the UHL representative present will speak with Andrea Thorne about making better links with the new Occupational Health Lead in UHL.

3.    That UHL leads will share the information about the project through Senior Leadership Pathways.

4.    That the Board would welcome sight of further analysis and return-on-investment data.