enfield and haringey tobacco control strategy enfield and haringey tobacco control strategy 2012 1.0...

www.enfield.gov.uk

Enfield and Haringey

Tobacco Control Strategy 2012

Enfield Haringey

In partnership with

Enfield and Haringey Tobacco Control Strategy 2012 P.1

Contents

1.0 Executive Summary 2

2.0 Terms of Reference 3

3.0 Why is tobacco use a problem? 8

4.0 National and Local Policy 11

5.0 Vision 12

6.0 Challenge 13

7.0 Tobacco Control in Enfield and Haringey – Role of Partners 14

8.0 Action Plan Work Streams 18

P.2 Enfield and Haringey Tobacco Control Strategy 2012

1.0 Executive Summary

This tobacco control strategy for Enfield and Haringey has been developed to reduce smoking prevalence and other tobacco use in the Boroughs. The strategy supports and seeks to achieve a reduction in tobacco use which is highlighted in the Joint Strategic Need Assessment of both Boroughs (www.haringey.gov.uk and www.enfield.gov.uk)

The Enfield and Haringey Tobacco Control Alliance is chaired by Bob Griffiths (Assistant Director Planning and Environmental Protection) while the Enfield and Haringey Stop Smoking Service Performance meeting is chaired by Dr Fiona Wright (Assistant Director Public Health NHS Haringey). The Alliance consists of a variety of relevant key stakeholders who are committed to reducing smoking prevalence and tobacco use through various avenues including:

❚ Advocacy ❚ Enforcement of Tobacco Regulations ❚ Prevention including reducing where and when tobacco can be used ❚ Reducing availability and supply of illicit tobacco ❚ Reducing exposure to second hand smoke ❚ Smoking cessation support


2.0 Terms of Reference

To reduce the prevalence of tobacco use and reduce health inequalities associated with smoking in Enfield and Haringey.

The Enfield and Haringey Tobacco Control Alliance will achieve the above by both supporting the work of the Enfield and Haringey Stop Smoking Service and by seeking to de-normalise tobacco consumption. It will do this by working through the following principles:

2.1i Objectives

1. To advise the Enfield and Haringey, Health and Well Being Boards on best practise regarding tobacco control, smoking prevention and smoking cessation.

2. To ensure that best practise in relation to tobacco control, smoking prevention and smoking cessation is implemented in Enfield and Haringey.

3. To ensure a co-ordinated approach to different strands of work relating to tobacco control, smoking prevention and smoking cessation.

4. To oversee the development of activities relating to tobacco control, smoking prevention and smoking cessation.

5. To develop, co-ordinate and monitor the implementation of a tobacco control strategy and annual action plans for Enfield and Haringey in line with local, regional and national policy.

6. To receive reports from the Enfield and Haringey Stop Smoking Service in line with their contract.


2.1ii Responsibilities

Information and advice ❚ To respond to requests from the Health and Well Being Boards’ and their partnership agencies for

advice on best practise and evidence ❚ To advise on the implications of national and local policies relating to tobacco control, smoking

prevention and smoking cessation

Strategic development and monitoring ❚ To develop a multi-agency framework for tobacco control and smoking prevention on behalf of

Enfield and Haringey, Health and Well Being Boards and to review and report on progress ❚ To ensure implementation of the Department of Health ‘Excellence in tobacco control: 10 High Impact

Changes to achieve Tobacco Control ❚ To seek funding to implement initiatives that will have an impact across Enfield and Haringey boroughs ❚ To lobby for tobacco control initiatives throughout the boroughs

Co-ordination ❚ To act as a forum to ensure that there is a coordinated approach to tobacco control and smoking

prevention across the range of agencies involved in tobacco control

Oversight of tobacco control and smoking cessation delivery ❚ To oversee and to provide advice and support on the development of tobacco control and smoking

prevention activities, specifically:

❚ Illegal sales of tobacco ❚ Promoting and implementing best practise in reducing illegal sales and tobacco control ❚ Promoting smoke-free places ❚ Smoking cessation ❚ Supporting anti poverty strategies ❚ Targeting particular groups including:

❚ Low socio-economic groups ❚ Pregnant women ❚ Certain BME groups ❚ People with mental health problems ❚ Routine and manual groups

❚ To receive reports on the progress of tobacco control and smoking activities and to ensure added value to new and existing programmes.


2.2 What is a Tobacco Control Alliance?

A Tobacco Control Alliance is a multi-agency grouping including statutory, voluntary and business sector partners. The Alliance develops and supervises the implementation of the local Tobacco Control Strategy and all joint working on this agenda.

❚ Trading Standards ❚ Environmental Health ❚ NHS including representatives such as Smoking Cessation, Mental Health and Respiratory Services ❚ Children and Young People ❚ HM Revenue and Customs ❚ Schools or Education Representatives ❚ Police ❚ Fire Services ❚ Smoke Free Co-ordinators ❚ Locally Elected Members ❚ Local Retailers ❚ Charities with an interest in tobacco control and health issues

In order for the Alliance to be successful, it needs to be equitable, multi-agency and accountable, have a shared goal and a clear delivery plan. It is very important that all partners are dedicated to the Alliance to ensure that it is successful.

Alliances provide an opportunity to increase the effectiveness of smoking prevention and cessation activities by co-ordinating the work of those organizations, thereby gaining maximum impact.

To achieve excellence in partnership, it is important that all aspects of this work is addressed:

❚ Purpose and Leadership – share a common vision and purpose ❚ Culture and Communications – promote ‘can do’ values and effective communications at all levels ❚ Managing Performance – put in place necessary practices and resources and manage the changes

needed to achieve partnership goals ❚ Learning and Innovation – seek improvements in activities and working practice, learning from each

other and elsewhere ❚ Outcomes and Customer Focus – focus on the results and satisfying the needs and expectations

of customers

Success in partnership can only be secured when relationships are built and trust is gained between partners. This is a continual process and is assisted by the application of appropriate skills, tools and techniques from the partnership.


2.3 Excellence in Tobacco Control

The Department of Health has issued an evidence-based resource for local Alliances titled ‘Excellence in Tobacco Control1 10 high impact changes to achieve tobacco control’ Table 1. The Enfield and Haringey Tobacco Control Alliance will seek to deliver its action plan through local high impact objectives.

1: Work in partnershipEffective partnerships are central to moving the tobacco control agenda forward. Partnerships need to be strategic and create a joined-up approach to tackling the public health issue of tobacco as a shared priority. This requires senior leadership, developed Tobacco Control Alliances and positioning of these within the framework of strategic local partnerships.

2: Gather and use the full range of data to inform tobacco controlCollecting robust data to determine the scale of the challenge in a given area will inform local tobacco control goals, helping to ensure that efforts are focused in the right places. The available knowledge can then be translated into informed planning and commissioning.

3: Use tobacco control to tackle health inequalitiesA locality committed to addressing health inequalities will need to intelligently commissioned tobacco control if more significant reductions in smoking-related inequalities are to be achieved. Interventions targeted at the substantially untapped group of smokers within the routine and manual group must be a priority as this is the main means of tackling health inequalities.

4: Deliver consistent, coherent and co-ordinated communicationBringing communications into the local strategic approach to tobacco control increases the effectiveness of national and local smoke free campaigns, is central to social marketing and is fundamental to tobacco control advocacy.

5: An integrated stop smoking approachThe local NHS Stop Smoking Service should be viewed as just one element of an overall strategic and comprehensive programme rather than the sole agency delivering tobacco control at a local level, albeit acknowledged as a function that underpins many other parts of a comprehensive programme.

6: Build and sustain capacity in tobacco controlCapacity building is a long-term process but in order to maintain progress and momentum in tobacco control it is essential that local capacity is strengthened and sustained. Successful tobacco control will require infrastructure, resources and political will.

7: Tackle cheap and illicit tobaccoTobacco smuggling seriously undermines the impact of other tobacco control measures. There needs to be greater effort to reduce both the demand and supply of cheap illicit tobacco. This is a cross-cutting issue that requires engagement from all partners in a local Alliance.

8: Influence change through advocacyTobacco control advocacy is about changing the political, economic and social conditions that encourage tobacco use and gaining public, political and media support for tobacco-related issues.

9: Helping young people to be tobacco freeSmoking prevalence among 11–15 year olds has remained at 9% in recent years, but at age 15, 16% of boys and 24% of girls are regular smokers. Youth prevention should be part of a comprehensive tobacco control programme based on demoralising smoking across the wider population.

10: Maintain and promote smoke free environmentsA concerted effort is required to sustain the profile of tobacco control and maintain the momentum provided by the Smoke free legislation of July 2007 if the significant benefits to be had from de-normalising smoking are not to be lost.

1 www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_084847


2.4 Frequency of Meetings

The Group will meet bi-monthly to oversee the delivery of the action plan, directing and allocating resources to ensure objectives are met.

Delivery of key parts of the action plan may be through formation of sub groups of the alliance, which will report accordingly to these bi-monthly meetings.


3.0 Why is tobacco use a problem?

Tobacco use remains one of our most significant public health challenges. While rates of smoking have continued to decline over the past decades, around 21% of adults in England still smoke.

Smoking is the primary cause of preventable morbidity and premature death, accounting for 81,400 deaths in England in 2009.2 In England, deaths from smoking are more numerous than the next six most common causes of preventable death combined (i.e. drug use, road accidents, other accidents and falls, preventable diabetes, suicide and alcohol abuse).

Smoking rates are much higher in some social groups, including those with the lowest incomes. These groups suffer the highest burden of smoking-related illness and death. Smoking is the single biggest cause of inequalities in death rates between the richest and poorest in our communities. Consequently, tackling tobacco use is central to realising the Government’s commitment to improve the health of the poorest, fastest.

Treating smoking-related illnesses was estimated to have cost the NHS £2.7 billion in 2006/07, or over £50 million every week.2 In 2009/10, some 467,423 hospital admissions in England among adults aged 35 and over were attributable to smoking.3

In Enfield the NHS helped 1,531 people to stop smoking in 20011/12, while in Haringey the NHS helped 2,124 people to stop smoking. During 2009/10 in Enfield, smoking is estimated to have caused over 2,028 hospital admissions with a resultant cost of over £5.8m.3 In 2009/10 in Haringey there were 1,527 smoking related hospital admissions, with a resultant cost of over £4.3m. Figure 2 highlights the cost of smoking to society in the Boroughs.

Tobacco use is the major cause of preventable death in England and harms not just smokers but the people around them, through the damaging effects of secondhand smoke. Smoking is an addiction that takes hold largely in childhood and adolescence, with the vast majority of smokers starting to use tobacco regularly before the age of 18. Given the level of harm caused by tobacco, it is appropriate to use a range of behaviour change interventions. Tobacco control measures cover all of the public health interventions set out in the Nuffield Council on bioethics’ “intervention ladder”, that shows the potential approaches that can be used to promote positive lifestyle changes. Examples from this plan are shown in Figure 1.

2 Healthy Lives, Healthy People: A Tobacco Control Plan for England 20113 www.lho.org.uk/lho_topics/analytic_tools/TobaccoControlProfiles/profile.aspx


Figure 1: Tobacco control actions across the Nuffield Ladder of public health interventions

Eliminate choice: We will continue to support the enforcement of age of sale laws, building compliance so that young people cannot access tobacco products.

Restrict choice: We will continue to promote the enforcement of smokefree legislation in communities in order to remove the hazard of secondhand smoke from enclosed work and public places.

Guide choice through disincentives: We will continue to follow a policy of using tax to maintain the high price of tobacco products at levels that impact on smoking prevalence.

Guide choice through incentives: We will support local areas to use behavioural insights in order to develop incentives, such as positive recognition for smokers that take voluntary action to make their homes and family cars smokefree.

Guide choice through changing the default policy: We will work with health and social care professionals to help them to engage with smokers about quitting and to offer referrals to local stop smoking services, unless a smoker opts out.

Enable choice: We will support local stop smoking services to extend the range of services they offer so that tobacco users are presented with a range of choices about how to quit and can choose one that suits their needs and wishes.

Provide information: We will provide information to people about the risks of using tobacco and signpost the help available for smokers who want to quit.

Monitor the current situation: We will examine the impact that the advertising and promotion of smoking accessories, including cigarette papers, has on promoting the use of tobacco products and consider whether further action is needed.

3.1 Challenges in the Boroughs

Overall cost to society is set out in the graph below.

Figure 2: Estimated cost of smoking (£ millions)

£1.8m

£2.7m

£3.7m

£13.1m

£14.2m

£15.2m

£21.5m

£1.8m

£2.7m

£3.8m

£13.3m

£14.3m

£15.4m

£21.8m

£0m £5m £10m £15m £20m £25m

Smoking litter

Domestic fires

Passive smoking*

Sick days

NHS care

Smoking breaks

Output lost fromearly death

Enfield

Haringey

*Passive smoking: lost productivity from early death (not including NHS costs and absenteeism)

Source: ASH Figures for 2010/2011


Smoking is also a key driver of health inequalities. Smoking prevalence is highest in deprived communities; however, reductions in smoking prevalence have been slower in these communities than other population groups. Reducing the prevalence of smoking among routine and manual workers, some minority ethnic groups, and disadvantaged communities will help reduce health inequalities more than any other measure to improve the public’s health. A high level of intervention is vital to deliver effective, cross-social group reach on this, the biggest single public health issue.

Smoking prevalence in Enfield is approximately 20% compared to the London and England average of approximately 22%. In the Turkish population smoking prevalence is estimated at 45% for women and 55% for men.

Stop smoking services aim to reduce the number of smokers by providing evidence-based treatment and behavioural support to smokers who are ready to stop smoking. The delivery for the service will reduce levels of smoking related illness, disability, premature death, and health inequality.

NHS Enfield has helped over 6,000 people stop smoking over the past 5 years. In 2010-2011 the stop smoking service again exceeded its target by helping 1,568 smokers to stop while in Haringey the figure was 1,936, again exceeding its target. In NHS Haringey 2006-2011 over 10,000 people were helped to quit smoking. Someone who uses NHS services is approximately 4 times more likely to stop smoking than someone who tries to stop by themselves.

A new provider (Innovsion Health & Wellbeing CIC) trading as Smoke Free Enfield and Haringey was appointed during 2010-11 to provide a joint Stop Smoking Service for Haringey and Enfield. Although overall smoking prevalence has been falling, rates remain high in deprived communities and in certain ethnic groups. The service is therefore focused within deprived communities and has a specific health inequalities target.

3.2 Factors associated with the uptake and maintenance of a tobacco habit

The uptake and maintenance of a tobacco habit is influenced by personal, individual, physiological, social and cultural factors. Smoking is considered ‘a lifestyle choice’. Personal beliefs about image, control/independence, stress relief, relaxation, weight control and freedom of choice influence uptake and maintenance of a tobacco habit.

Smoking cigarettes and other tobacco use (for example smoking tobacco, shisha or chewing tobacco (paan)) are considered normal activity within some groups and are within them socially accepted behaviours that lead to addiction. The power of addiction is grossly underestimated, especially by young people who explore these products. The younger a person starts a tobacco habit the more likely they are to become more heavily addicted, for longer. Young people are three to five times more likely to smoke if they come from a household where either a parent or older sibling smokes. Clever marketing by the tobacco industry has attracted people to smoking for decades. Well designed point of sale displays, colourful and well lit cigarette counters at supermarkets, product placement in films, television and sporting events and the use of celebrities to promote smoking and other ‘exotic’ tobacco are well known tactics to attract smokers.


4.0 National and Local Policy

The government has set three national ambitions to focus tobacco control work in which local authorities are encouraged to develop partnerships in tobacco control where anyone who can make a contribution is encouraged to get involved.4

❚ Reduce smoking prevalence among adults in England: To reduce adult (aged 18 or over) smoking prevalence in England to 18.5% or less by the end of 2015, meaning around 210,000 fewer smokers a year.

❚ Reduce smoking prevalence among young people in England: To reduce rates of regular smoking among 15 year olds in England to 12% or less by the end of 2015.

❚ Reduce smoking during pregnancy in England: To reduce rates of smoking throughout pregnancy to 11% or less by the end of 2015 (measured at time of giving birth).

The Enfield and Haringey Tobacco Control Alliance is committed to the joint development of a co-ordinated and strategic approach to reducing smoking prevalence and tobacco use in line with the national aspirations. The achievement of smoking cessation targets remains a key priority area for NHS Enfield and Haringey and enforcement of smoke free legislation and restrictions relating to the packaging, sale and promotion of tobacco are contained in the Council’s service plans. Reducing smoking prevalence is a longstanding priority to improve public health and the biggest contributor to differences in life expectancy. The Health and Well Being Strategy for Haringey and Enfield (www.haringey.gov.uk/hwbstrategy and www.enfield.gov.uk) sets “Reduce Smoking” as a key priority of the strategy. This strategy and action plan supports the delivery plan of this priority. From 2013 councils will be responsible for health and well being and elements of the public health function and reducing smoking will be a key priority.

4.1 Strategies to reduce smoking prevalence

The United Kingdom has been ranked as the leader in Europe for tobacco control and has managed to halve smoking prevalence to 21% over the past decade. Measures to reduce prevalence have included:

❚ Reducing exposure to second-hand smoke ❚ Communications and education ❚ Reducing availability and supply of cheap tobacco ❚ Support for smoking cessation ❚ Reducing tobacco promotion ❚ Tobacco Regulations

It must be noted that great differences in smoking prevalence between different social groups still persist both nationally and locally with a notable variance between the West and East of the borough of Enfield and Haringey. Routine and manual workers have the highest smoking rates along with those from certain minority and vulnerable groups and others e.g. people with enduring mental health problems.

Building on the above national Six Strands Strategy which seeks to incorporate the successful approaches of other jurisdictions such as California, it is expected that smoking prevalence will be further reduced through:

❚ Stopping the inflow of young persons recruited as smokers ❚ Motivating and assisting every smoker to quit ❚ Protecting families and communities from tobacco related harm

4 Healthy Lives, Healthy People: A Tobacco Control Plan for England 2011


5.0 Vision

The Enfield and Haringey Tobacco Control Alliance has been set up in the last 12 months. The group is well supported and has seen the involvement of additional essential key stakeholders who have contributed to this document and who are also committed to implementation of the accompanying action plan.

In April 2011, an Enfield Tobacco Control Alliance participated in an ‘Outcomes and Impacts’ workshop to map the work of all the stakeholders. Collectively the Alliance produced the following vision of a borough:

1. To ensure that the number of smokers and smoking related deaths and illnesses are reduced

2. To tackle the perception that smoking and tobacco use are normal activities

3. To educate people to know the dangers of smoking and second hand smoke

4. To ensure that young people feel empowered to make informed choices to say no to tobacco use

5. To demonstrate that the combined efforts of the group leads to a better living environment and improved health with measurable outcomes

6. Throughout this vision there will be a focus on reducing health inequalities

This is being adopted by the joint alliance.

5.1 Aims

The ultimate aim of the strategy in Enfield and Haringey is to reduce smoking prevalence and tobacco use. It is expected that this will also contribute significantly to a reduction in health inequalities which exist in the Boroughs and to the protection of future generations from the impact of tobacco related harm.

The aims will be achieved through delivery of priorities which tackle perceptions, health issues and supply and demand elements related to tobacco consumption (see action plan). These are broadly aligned to the national priority work streams.5 Through this plan, the Government supports comprehensive tobacco control in England across the six internationally recognised strands, which are mentioned above.

5 Healthy Lives, Healthy People: A Tobacco Control Plan for England 2011


6.0 Challenge

The environment is becoming more challenging, in part due to the stress and uncertainty created by the current economic climate. The partnership however will also look for opportunities to help people to stop smoking who may be motivated by having less disposable income. The national ambition, set out in the recently published Tobacco Control Action Plan, is to reduce smoking prevalence from its current level of 21% to 18.5% or less by the end of 2015, equating to around 210,000 fewer smokers a year. A key focus for national marketing activity therefore will be to maintain the importance of quitting at the forefront of people’s minds, reminding people of their reasons for wanting to quit and seeking opportunities to increase the number of quit attempts among all who smoke.

There is a strong international evidence base for the impact of marketing on reducing smoking prevalence. Marketing activity over the last few years has centred on three key objectives: reinforcing smokers’ motivation to quit, triggering action and making quitting more successful by signposting people to the support available. Targeted groups have been smokers who work in routine and manual jobs, because of the high prevalence of smoking in these groups – (28%) which is double that of professional and managerial groups.

Smokers are up to four times more likely to be successful if they quit with local Stop Smoking Services.


7.0 Tobacco Control in Enfield and Haringey – Role of Partners

Activities by various partners to tackle tobacco use have taken place in Enfield and Haringey over the last few years. This strategy sets out to develop a shared vision and co-ordinated approach to reducing smoking prevalence and tobacco use by co-ordinating all partners. It is proposed that delivery of the aims of the Tobacco Control Strategy be managed by project work undertaken by specific sub-groups.

Sub-groups have previously met on an ad hoc basis to address specific issues such as ‘age of sales’ legislation. The key difference with this proposal is that the sub-groups will now be the main groups responsible for the implementation and delivery of project work.

Sub-groups will consist of members from partner organisations with a defined project lead for each, who attend the Tobacco Control Alliance meetings to represent each project. An example might be a project to develop the communications strategy. A sub-group would meet to take forward the work and might include representatives from: LFB; Local Authority Environmental Health/Housing; Community Health Trainers. It is hoped that the formation of sub-groups to carry out distinct project work will facilitate engagement of a wider range of partner organisations, where it is not practical to invite them all to the Tobacco Control Alliance meetings.

The areas of work on which sub-groups focus will be determined by the key aims in the action plan of the Tobacco Control Strategy. These groups will continue to meet for as long as their particular project is running and be responsible for implementation of project work. The frequency of their meetings will be decided by members.

7.1 Smokefree Enfield and Haringey

Currently the Enfield and Haringey Stop Smoking Service provides free smoking cessation support and advice with the support of pharmacists, general practitioners and other community based providers.

The provision of high-quality Stop Smoking Services is a high priority for the NHS. Stop Smoking Services commissioned or provided by the NHS have already helped many people to stop smoking successfully and are a key part of tobacco control and health inequalities policies both at local and national levels. Stop Smoking Services should be seen in the same way as any other clinical service and offered to anyone who expresses an interest in stopping.

The core elements of the service are the provision of behavioural support and pharmacotherapy, and success is assessed after 4 weeks.

Interventions are delivered by a stop smoking advisor, who has received stop smoking service training that meets the published NICE guidelines for one-to-one and/or group support. At a national level, the core objectives of Stop Smoking Services are to provide a stop smoking support service that:

❚ is equitably accessible to all smokers ❚ targets specific client groups ❚ offers the most effective, evidence-based treatments available supports people to successfully quit

smoking ❚ achieves high levels of Service User satisfaction


At a local, Enfield/Haringey level, the core objectives of a Level 2 and Level 3 Stop Smoking Service provider are to provide a stop smoking service that, in addition to the national objectives:

❚ Provides project management support for Primary Care service providers, works in partnership with others, such as other service providers, local GPs, pharmacies, acute trusts, health professionals, Enfield and Haringey Council, the Metropolitan Police and voluntary and private groups, to help reduce smoking prevalence across Enfield and Haringey

❚ Delivers Level 2 smoking cessation services across the Boroughs, working through collaboration with GP practices and pharmacies

❚ Delivers specialist Level 3 smoking cessation services across the Boroughs. To maintain strong links with other providers to ensure that service users are sign posted to the most appropriate level of treatment to help them quit smoking

❚ Adopts an active and participative approach in supporting the Enfield and Haringey Tobacco Control Alliance – including the implementation of its strategy and action plan.

The service will support people to successfully quit smoking for 4 weeks. It is anticipated that many of these service users will permanently stop smoking and as a result, will have improved health outcomes and lower levels of healthcare utilisation.

Level 2 smoking cessation advisors across Enfield and Haringey Stop Smoking Service provide support on a one-to-one basis while Level 3 advisors work with more challenging clients referred by Level 1 and 2 services.

7.2 Regulatory Services Enfield and Haringey

Regulatory Services implement smoke free legislation in Enfield and Haringey food establishments, pubs, clubs and commercial premises. They also enforce many of the regulations that control the retail supply of tobacco products locally though under age test purchasing, illicit tobacco sales, the responsible retailer scheme and various other projects.

Enforcement is an example of a key intervention that contributes to tobacco control and Trading Standards Services are responsible for the following:

❚ Regulation of the age of sale ❚ Regulation of tobacco trading and counterfeit/non-duty paid tobacco products. ❚ Regulation of the point of sale for tobacco ❚ Regulation of advertising and sponsorship

Trading Standards, or indeed, any enforcement organisation, cannot afford to work in isolation and must endeavour to tackle the subject in conjunction and co-operation with the various partner agencies whose remit also covers wider issues of tobacco control. Important areas of tobacco control covered by other agencies include:

❚ Education and awareness raising to increase public knowledge ❚ Smoke-free workplaces (including continued work with legislation exemptions) ❚ Smoke-free cars and homes ❚ Cessation services ❚ Reducing health inequalities ❚ Helping those who cannot stop smoking ❚ Protecting children and young people from smoking ❚ Preventing people (including children) from taking up smoking


7.3 Role of Trading Standards in Tobacco Control

The UK Government has committed to carrying out a public consultation on plain packaging of tobacco products. The purpose of using standardised packaging is to ensure that packs:

❚ are less attractive, particularly to young people; ❚ make the health warnings stand out more; and ❚ reduce the ability of the packaging to mislead consumers about the harms of smoking.

Trading Standards officers are committed to regulating tobacco control through tackling illegal and underage availability. This includes:

❚ Reducing Supply and Availability – targeting underage sales ❚ Regulating Tobacco Trading – targeting counterfeit/illicit products ❚ Reducing Tobacco Promotion – enforcement of advertising and sponsorship restrictions ❚ Regulating Tobacco – packaging and labelling requirements (including smokeless products)

This is achieved through advice, enforcement and engagement in both local and national initiatives, including:

❚ Providing support/educating retailers and representative organisations, through joint or corporate training events, to enable them to trade within the law

❚ Test purchasing ❚ Educational campaign on the increase in age restriction for tobacco ❚ Promotion of No ID No Sale ❚ Promotion of Challenge 21/Challenge 25 policies ❚ Press releases and radio interviews ❚ Routine inspections (statutory notice/advertising ban compliance) ❚ Developing partnership

7.4 School Services – Drug Action Team

School services for the Boroughs are responsible for the implementation of schools policy through the drugs action team and PSHE co-ordinators. Established links with Enfield and Haringey Stop Smoking Service. School-based drug education can have an impact in reducing or delaying tobacco use. Delivering the message on the adverse effects of tobacco use within health education at key stages in youth development improves effectiveness. Schools should seek to influence behaviour in the short term, since early substance use predicts later problems; delaying use can have a significant positive impact.

The best programs are interactive and provide information that students can readily put into use. They focus on developing practical skills on how to negotiate social situations or deal with stress, for example – reinforced across a period of years. Schools can also play a role in other aspects of tobacco control. They can promote messages and programs that support students who want to quit smoking. This can be as simple as providing highly visible information about resources that assist students to quit.


7.5 London Fire Brigade

London Fire Brigade visit both domestic and commercial properties as part of their routine work to advise and enforce the fire regulations. With an estimated cost of £2.7m a year due to fires caused by cigarettes the fire officers can, in addition to dealing with fire provisions, offer level one advice on the adverse effects of smoking.

7.6 Mental Health and Community based services

Although some severe cases of mental illness are treated in psychiatric hospitals, some 90% of patients with mental health difficulties are managed entirely in primary care. The ‘care in the community’ approach has led to a move away from long-term hospitalisation for mental illness where possible. As well as primary and secondary care, people with mental health problems use a range of services, including supported accommodation, day centres and drop-in centres, provided by both the statutory and voluntary sector.

All those working in primary and secondary care, including community workers and midwives, should be trained in the importance of delivering interventions in line with National Institute of Clinical Excellence (NICE) guidelines.


8.0 Action Plan Work Streams

The action plan below sets out how we will take forward the vision and priorities identified by the Alliance. It is line with national priorities, ensures delivery of the key actions identified in the Haringey Health and Well Being Strategy and supports the Stop Smoking Service for Enfield and Haringey to achieve its Key Performance Indicator.

It is outlined under four key themes:

❚ Stopping the Inflow of young people recruited as smokers ❚ Making it easy to get help to stop ❚ Ensuring no one is exposed to second hand smoke ❚ Communication

The Tobacco Control Alliance will co-ordinate and implement the action plan and review it annually.


1. Stopping the Inflow of People Recruited as Smokers by Making it Harder to Start

Objectives Key Outcomes Sought over next 3 years – 2012-2015 Year One Priorities – 2012-2013

Key Performance Indicators Lead Partner and Support Agencies(refer to TCA membership list for contacts)

Build a strong coalition around prevention of tobacco use in children and young people

❚ Assist schools to deliver key messages and facilitate referrals of identified cases and families.

❚ Smoking prevalence at years 6 and 11

School ServicesPublic Health/Healthy School leads (PSHE/School) / Stop Smoking Service (SSS)

Increase awareness of the harms of tobacco among young people in Enfield and Haringey through school and college activities

❚ Encourage schools to integrate anti-smoking messages into the curriculum*

❚ Smoke Storm’ introduced as an educational and social marketing tool to Secondary PSHE Co-ordinators. Follow up information and reminders disseminated to schools.

❚ Dissemination to Sec PSHE Co-ordinators

❚ Number of Schools registering on Smoke Storm Site

School ServicesPublic Health/Healthy School leads (PSHE co-ordinators /Secondary Schools) / SSS

❚ Deliver the smoking harm message to all year 6 children through the Junior Citizenship programme.

❚ November 2012 ❚ Number of children attending Junior Citizenships and receiving smoking related harm messages.

Regulatory Services Stop Smoking Service / Police / Public Health

❚ New Revised DFE Drugs Advice for Schools Jan 2012 sent out to all schools.

❚ Dissemination at PSHE Network meetings/ Email

❚ All Schools have copy of DFE Drugs Advice

School ServicesDAAT (Drug Action Team) / Young People Drug Advisors / Public Health

❚ Schools to provide information and support for smokers to encourage staff and parents/ carers to quit. Posters and smoking cessation leaflets sent into schools.

❚ ‘Smoke free’ NHS materials sent into Schools

❚ Number of posters sent into Schools

School ServicesPSHE / Stop Smoking Service

❚ Pilot project with identified Secondary Schools taking part in Christopher Winter project Drugs Education programme including Tobacco.

❚ Identify Schools and set up in year one

❚ Pilot project report completed

School ServicesPSHE / secondary schools

❚ Schools deliver smoking and its related health messages including peer pressure from the PSHE Scheme of work.

❚ All Schools ❚ Number of primary Schools receive lesson plans for staying safe and recognising dangerous situations. This includes tobacco education

School ServicesPSHE/ primary schools

❚ Schools located in defined deprived areas to have had a smoking prevention event-

❚ 20% PA of Schools identified Stop Smoking Service (SSS)

*Relates to Haringey HWB Strategy: A reduced gap in life expectancy (applicable to both Boroughs)




Supporting under 18s to stop smoking

❚ Development of an in-house stop smoking specialist in secondary schools, sixth form centres, colleges and other young persons organisations e.g. children’s homes, youth offending services etc, for 12-18 year olds.

❚ Train school health advisors to level 1-2.

❚ Recruit and train adult Stop smoking ambassadors (trusted adults) in each secondary school and college to signpost to services and provide in house level 2 work

❚ Number of schools with service and numbers trained

❚ Increased number of level 2 advisors

Stop Smoking ServiceSchools/Public Health/ DAAT/Drug Advisors

❚ Development of Stop Smoking Service support for 12-18 year olds outside of school, e.g. children’s homes, youth offending services etc.

❚ Number of 4 week quits Stop Smoking Service

Control of sales and access to products

❚ Target tobacco product retailers in Enfield and Haringey for enforcement on an intelligence basis:

❚ Align Enforcement policy for Enfield and Haringey

❚ Number of visits /actions taken, including % of ARS

Regulatory Services

❚ Maintain a programme of enforcement and advisory visits to businesses for age restricted sales (ARS)

❚ Agree use of joint resources and level of enforcement

❚ Report on findings, sanctions taken

HMRC / Police

❚ Link with HMRC to obtain intelligence on breaches of sales regulations / identify illicit and counterfeit tobacco

❚ Develop strategy to deal with storage of illicit products within large storage providers

❚ Report on findings and sanctions

❚ Stop the increase in the number of premises offering tobacco shisha smoking and develop plans to deal with niche tobacco*

❚ Align policy with London. Develop focused campaign of public information and enforcement

❚ Hold a one day training course on shisha bars

❚ Secure additional funding through LGA, London Trading Standards Association (LOTSA) to participate in regional projects.

❚ Participate in all regional projects

❚ Number of campaigns/ enforcement for the year



2. Making it easy to get help to stop



Increase the demand for the Stop Smoking Service.

❚ High profile communication of service and marketing campaigns (see communications section)

❚ Link to National campaigns

Stop Smoking Service

❚ Utilisation of Web link to Council services, NCL and Smokefree Enfield and Haringey

❚ Set up web links ❚ Number of web site hits Enfield and Haringey Councils

Focus on people in routine and manual occupations as improving performance in this area will demonstrate progress in reducing health inequalities and improving life chances for local residents.

❚ Stop Smoking Service to target people in routine and manual occupations

❚ Evidence of targeting people in routine and manual occupation

❚ > 15% of smokers who set a quit date having their socio economic status recorded


❚ Continue to strengthen the stop smoking service to target groups at risk (groups include those living in the east, people with mental health problems, pregnant women and certain black and minority ethnic communities) and in accessible service locations, for example primary care, pharmacies and workplace settings*

❚ Concentration on post codes N8,N15, N17, N22 and EN1, N9 and N18

❚ 30% of total number of clients using the service to reside in these postcodes


❚ Targeting people living in deprived areas ❚ Concentrate on those with low incomes and on those whose health is most at risk

❚ 10 community venues located in defined deprived areas to have had a smoking prevention event

Public Health

❚ Reducing levels of workplace smoking through increasing the referrals of employees from large employers and small and medium enterprises

❚ Target known groups ❚ 10-20% of total number of clients using the service being referred from their workplace


❚ Increasing number of BME using the Stop smoking service

❚ 40% of total number of clients using the service who define themselves as belonging to an ethnic group


❚ Run brief intervention training for front line Council staff (Trading Standards, Environmental Health) to have level one training

❚ Provide bite size training to level 1

❚ Total number of staff trained Stop Smoking Service





Integrating tobacco cessation into hospital/community based services

❚ Increasing number of clients from Mental Health services using the service

❚ Raising awareness with service providers

❚ % of total number of clients using the service who are referred from Mental Health services

Stop Smoking ServiceMetal Health Trust

❚ Increasing number of pregnant smokers using the service

❚ GP Practice Baby Clinics and children’s centres to have Stop Smoking clinics

❚ 5% of clients using the service who are smoking whilst pregnant

Anti-natal clinics/Children Centres/SSS

❚ Community anti-natal clinics / children’s centres to have a smoking prevention event

❚ Increased referrals and support

❚ 25% of clinics to have had a smoking prevention event

Public Health/ NHS/SSS

❚ Monitor implementation of NHS North Central London’s commissioning for quality and innovation scheme (the ‘CQUIN’) with healthcare providers to increase their smoking cessation interventions within key settings e.g. outpatients and residential units and with mental health users.*


❚ Number of referrals (report on actions to implement CQUIN)


❚ Further develop the NHS Health Trainers (who are trained to help people make positive lifestyle changes, including stopping smoking)


❚ % of clients referred into the service by either health trainers or local sports facilities

Stop Smoking ServicePublic Health

❚ Pick up on NHS Health Check Programme, linking Stop Smoking Service to scheduled Community NHS Health Check events in supermarkets etc

❚ Number of referrals Stop Smoking Service

Route 2 Quit (R2Q) ❚ Implement fines for dropping cigarette butts which can be reduced if person attends the stop smoking programme*

❚ Increase number of fines for litter and produce bespoke penalty notice

❚ % of offenders taking up the Stop Smoking Programme having been issued a ticket

Regulatory ServicesStop Smoking Service

Increase access routes ❚ Signposting at dental premises, pharmacies, children’s centres etc

❚ Maintain current SSS clinics Public Health

Voluntary Sector Engagement

❚ Raise the profile on the Stop Smoking Service to the Over 50’s age group

❚ Increase the number of voluntary sectors that have links to the TCA

❚ % of total number using the service

Age UK Enfield HAVCO (Haringey) Stop Smoking Service



3. Ensuring no one is exposed to second hand smoke



Smoke free Workplaces and Public areas

❚ Education and enforcement at licensed premises ❚ Use of licence review for the prevention of harm to children

❚ Number of reviews linked to ARS offences

Regulatory Services

❚ Enforcement in public areas for smoking and litter drops ❚ Zero tolerance for cigarette litter

❚ Number of enforcement tickets issued

Stop Smoking Service ❚ Enforcement of planning permission for smoking shelters ❚ Promotion of best practice during HS inspections of businesses

❚ Ensure the council work force is a healthy workforce through Council workforce policies by proactive occupational health service (Ensure workplace non-smoking policies are in place and enforced)*

❚ Smokefree workplace polices to be refreshed and enforced

Regulatory ServicesOccupational Health/Public Health/ NHS/ Regulatory Services

❚ Promote smoke free Enfield and Haringey through Council workplace policies such as no smoking for staff within 50m of all council premises*

❚ Smokefree workplace polices to be refreshed and enforced

Occupational Health /Regulatory Services / Public Health

❚ Promoting no smoking in parks (in particular in children’s areas) and bus shelters*

❚ No smoking in parks and enforcement of bush shelters

❚ Number of locations with scheme

Parks Services /Facilities/TFL

Smoke free Homes ❚ Develop starter packs for new occupiers on benefits of quitting

❚ LFB to give out SSS leaflets

❚ 5% of clients to be referred into the service by local Smokefree Homes

Regulatory ServicesEnfield Homes / Homes for Haringey/SSS

❚ Develop housing policy of smoke free communal areas ❚ Develop policy with London Fire Brigade (LFB) re smoke detectors and reduction in fires due to smoking

❚ LFB officers to have level 1 and level 2 training

❚ Number of LFB officers trained

RSL’s / LFB / Stop Smoking Service

❚ Work with nurseries, schools, health visitors and under 5 co-ordinators to promote smoke free homes and cars

❚ Health visitors to be trained to level 1 and level 2 for SSS

❚ Number of health visitors trained


Smoke Free Vehicles ❚ Communication of harm of second hand smoke associated with indoor smoking and linkage with smoking cessation

❚ Enforce Regulations on Smoke Free Vehicles

❚ Achieve 100% compliance for NHS and LA staff

❚ % of premises regulated by enforcement officers

Regulatory ServicesEnfield and Haringey Councils/Public Health/NHS



4. Marketing / Social Media – Getting the message out



Review Available Media Material

❚ Ensure consistency of message delivered by all partners ❚ Ensure awareness of partner roles in delivering the message

❚ Policy matching for LA and NHS ❚ Visiting Environmental /Trading Standards to give out SSS leaflets as part of their daily work

❚ Develop Marketing of Tobacco Control Alliance

❚ Marketing Strategy Agreed Enfield and Haringey Enforcement/Public HealthEnfield and Haringey Press OfficeSub Group – Press and communications

Use of Social Marketing ❚ Use social media to reach groups with low uptake of tobacco cessation services and/or higher prevalence of tobacco use

❚ Link social media to national agenda for pregnant mums, students, ethnic groups

❚ Increase use of web services, message boards

❚ Consider social media routes to reach less engaged groups

❚ See above Stop Smoking Service

Enfield and Haringey Press OfficeSub Group – Press and communications



www.enfield.gov.uk

Enfield Haringey

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