Lewisham learning demonstration site Overview Topic: This project aimed to increase the number of Smoking routine and manual smokers accessing and Organisation: quitting with NHS Stop Smoking Services in Evelyn ward. It estimated to have the highest NHS Lewisham smoking prevalence and highest indices of Location: multiple deprivation in the London borough of Lewisham (London) Lewisham. Dates: The project developed partnerships with September 2007 to April 2010 various local organisations, such as Millwall Budget: Football Club and workplaces, to offer stop £55,000 smoking surgeries at popular venues and at Website: more convenient times. Recruitment drives and www.smokefreelewisham.co.uk partnership promotional events were held in the area and a dedicated Recruitment and Contact: Outreach Workers team was set up to engage Gayle Wallace (Project Manager) with all sectors of the community and foster Email: long-term referral opportunities. [email protected] Results: Telephone: 0208 851 5878 Service data indicated a 21.3 per cent increase in the number of Evelyn residents using NHS Stop Smoking Services from 2008 to 2009. This was greater than the 12 per cent increase across Lewisham as a whole, suggestive of the project's impact The proportion using pharmacy services and sessions run by the outreach workers increased between 2008 and 2009, although the proportion using a GP-based service decreased. These services doubled the number of people quitting during this period ShowCase │ Lewisham 1 learning demonstration site NSMC’s Learning Demonstration Sites Scheme. NHS Lewisham selected Evelyn ward for the social marketing intervention, as part of the delivery of the wider North Lewisham Health The national tobacco strategy for England and Improvement Plan (part of Lewisham’s plan to Wales, contained in the 1998 White Paper reduce health inequalities). Other local policy Smoking Kills (superseded in 2010 by A drivers for reducing smoking prevalence levels Smokefree Future), identified smoking as the in the area included the Strategy To Tackle leading cause of preventable death and health Health Inequalities In Lewisham – Draft inequalities. Public Service Agreements (PSAs) 2008/10 and Healthier Lewisham Partnership since 2004 have set targets to increase and Board priorities. support smoking cessation attempts among all adults, particularly in routine and manual Project delivery (R&M) groups. Targets were set to reduce the A steering group was formed to manage and overall proportion of cigarette smokers in guide the project. Members included: England to 21 per cent or less by 2010, with a reduction from 32 per cent to 26 per cent or A representative from the TCNST less among manual occupation groups. Two members from NHS Lewisham (including the SSS Coordinator) Smoking, and its associated health problems, An Associate from The NSMC, who is a particular issue in the ethnically-diverse London borough of Lewisham. At 33 per cent, provided free social marketing guidance rates are higher than the national average and and support there is widespread deprivation. In 2006, only 7 per cent of smokers in Lewisham accessed NHS Stop Smoking Services (SSS) and 45 per cent of these smokers quit. Evelyn ward in Lewisham has the highest deprivation levels and smoking rates (42 per cent) in the borough, as well as a large proportion of the population in routine and manual employment. The smoking cessation team at NHS Lewisham wished to try a new approach to tackle smoking cessation and take advantage of internal interest in social marketing. In November 2006 A project team, trained in social marketing, was the primary care trust (PCT) was selected by formed to help develop and deliver the project. the Tobacco Control National Support Team It included members from the SSS, service (TCNST) of the Department of Health (DH) to providers and community groups. receive support from The NSMC to apply social marketing to increase use of the borough’s SSS. With funding from the TCNST, a formal partnership was developed between the PCT and The NSMC in early 2007 to deliver a pilot smoking cessation project, as part of The ShowCase │ Lewisham 2 learning demonstration site Aims and behavioural goals In order to understand at a local level why people smoke and what the barriers and The aims of the project were to: motivators are to quitting and using NHS SSS, extensive primary research was conducted by Increase the numbers of smokers in the a team of recruitment and outreach workers ward signing up to stop smoking and project workers. Focus groups were held programmes with 32 smokers and interviews were held with Increase the numbers of smokers in the 6 health professionals who provided the SSS in ward successfully quitting Evelyn ward. A further focus group was held in Double the number of four-week quits a local pub in June 2009 with more hardened among R&M workers in the ward smokers, to test their awareness of and Raise awareness of stop smoking provision attitudes towards smoking cessation services. in the area Increase access to stop smoking services in Insights the area A high proportion of the Evelyn population The behavioural goals of the project were for worked in R&M jobs and so required smokers in Evelyn ward to register with NHS services that fit around their working SSS and successfully quit smoking. patterns. Evening surgeries close to transport links were therefore needed Routinely-collected PCT data of smoking Smoking among R&M workers was often a prevalence and quit rates were used as a core part of their social interactions with baseline and indicator for the project. Data for friends, family and colleagues. Removing the implementation period was compared with the smoking habit would therefore have an data in the previous year to assess impacts of isolating impact on these relationships the interventions on smoking prevalence, In a deprived ward like Evelyn, issues of recruitment to the SSS and quit rates. debt, housing and money management contributed towards people’s high stress levels. Smoking was often considered a refuge and form of stress relief Evelyn ward had experienced a variety of social, economic and housing regenerations schemes, which tended to be short-lived. This contributed to cynicism within the Initial research community of new interventions delivered with external funding. In promoting and Secondary research was completed by The raising expectations of new and improved NSMC in June 2007 to gather existing data on smoking cessation services, it would be demographics, current service provision and essential to integrate these into existing smokers’ motivations and barriers to quitting, mainstream service provision, to ensure that based on national research. Health they did not cease with the end of the improvement programme research was also project. It would also be important to build carried out by NHS Lewisham in 2008. relationships with local people and Intended to gain an overview of local issues organisations, to gain trust and increase from a health perspective, it looked at health referral rates inequalities, contributing factors and local and Some smokers resented being lectured all national health statistics. the time and expected health professionals to be disapproving non-smokers who do not ShowCase │ Lewisham 3 learning demonstration site understand how hard it is to stop. Those Illegal sales of cheap imported cigarettes who had used a service complained about Marketing of cigarettes the wait for a first appointment and sessions Private (non-NHS) stop smoking services being too short, with no support ‘to fall back on’ in the longer term. An ideal service The project team sought to counteract this would be like a supermarket – open every competition by: day, all day. There was no perception of the service as a Highlighting the short- and long-term cost unified whole with different options from savings that can be made by quitting which to choose, either by potential smoking customers or advisors. People wanted a Highlighting the rising trend of smoking choice of intensity, model and location of cessation and the opportunity for quitters to service be part of a social movement towards a Mapping the ward’s existing provision smoke-free society showed obvious gaps. There were two GP Effective advertising and promotion of the practices in the ward – one did not offer an NHS SSS to the target audience advisory service and one had limited nursing time for smoking cessation. Of the Segmentation three local pharmacies, one had no advisor Initially, the target groups for the project were: in the shop on Wednesday market day and two did not open on Saturdays Male and female smokers aged 35 to 44 expressing a desire to quit Exchange The health benefits for people within this The barriers and costs of exchanging smoking age bracket are highly significant and habits for a smoke-free lifestyle included: beneficial for the long-term health of those who quit Isolation from peers, family members and Smokers with children of primary school other social groups age Not having a legitimate excuse for regular Young children can be highly effective in breaks from work gaining an insight into health options and Having to deal with everyday stresses their influence to motivate parents is without the relief of cigarettes extremely strong Psychological impact of breaking well- Adult smokers in R&M employment established habits and behaviours The prevalence of smoking within R&M Potential weight gain employment is higher than in other socioeconomic groups. The impact of Benefits of quitting smoking included: reducing smoking prevalence within this target group would therefore be significant Improved health in this ward, due to the proportion of the Financial savings and being able to treat population employed in these fields yourself with the money saved Sense of achievement However, through the scoping phase it became apparent that working with such a wide Competition audience would require a large number of strategies, resources and interventions, and it The project’s main competitors were: would be unrealistic to try to deliver these within the timescale of the project.