Purpose

The Cabinet
Member::
 

1.    
Authorised total spend of £10,000 to Cambridgeshire
& Peterborough Integrated Care Board (ICB) to provide patients
treated under the Treating Tobacco Dependency Programme with
Pharmacotherapy upon discharge.
 

2.    
Authorised the council to enter into a S76 agreement with the
Cambridgeshire & Peterborough ICB for 2 years, commencing
1st February 2024.
 

Reasons for the decision

Background:

 

Community based smoking cessation interventions and the
associated pharmacotherapy is currently funded by the Local
Authority through the Public Health
grant.  

 

Aim: To enable the acute inpatient Treating Tobacco
Dependency Programme to provide NRT (Nicotine Replacement Therapy)
upon discharge to smokers enrolled onto the Treating Tobacco
Dependency Programme. Currently patients who start a quit attempt
in hospital and are then discharged before completing the attempt
do not take any smoking medication home with them.  Their
support will be picked up by community services but there will be
gap between discharge and their first appointment with the
Community Stop Smoking Services. The funding will enable patients
who are smoking to be discharged with a supply of smoking
medications/NRT.

 

                  
Objectives 

 

·      
To increase the number of smokers who start and
complete a quit attempt
successfully. 

 

·      
To enable easy and equitable access to
pharmacotherapies as an aid to stop
smoking. 

 

·      
To contribute to local public health and tobacco
control strategies, which have a commitment to reduce smoking
prevalence. 

 

                  
Delivery Model 

 

·      
All patients admitted to hospital will be screened for
smoking
status.  

·      
All smokers will be referred to in-house Treating
Tobacco Dependency team on an optout basis. NRT will be prescribed
at the referral
point.  

·      
Stop smoking behavioural support will be provided by
the Treating Tobacco Dependency team as per the Acute Inpatient
Smokefree Pathway of each individual
hospital. 

·      
The Smokefree Practitioners will assess the
patient’s readiness and ability to quit, provide initial stop
smoking advice, inform the patient of what support is available to
quit and about withdrawal symptoms and where NRT has been
determined as the most suitable pharmacotherapy intervention they
will facilitate continued access to
this.  

·      
A maximum of 2 NRT products can be supplied at any one
time. NRT provided during the patients admission will
be funded by the NHS.
  

·      
All patients will be offered a referral for continued
smoking cessation support with the Local Authority commissioned
stop smoking service or NHS community pharmacy smoking cessation
service. 

·      
All patients on the Acute Inpatient Smokefree Pathway
who are using NRT will be discharged with 10 days
supply of NRT. The Local Authority grant will contribute to fund
the NRT upon discharge
only. All
NRT products which are licensed as GSL can be requested through
this scheme. Please refer to BNF or each product SPC for full
prescribing information including contraindications cautions and
drug
interactions.  

 

                 
Value for money

 

·      
Competitive tender has not been undertaken as the
hospitals are the only provider able to provide this service to
patients being discharged into the community.

 

·      
Stop Smoking Services fully reflect guidance from the
National Institute for Health and Care Excellence (NICE) and are
highly effective in both cost and clinical
terms.  

 

·      
Smokers are three times more likely to quit using stop
smoking behavioural support and medication than quitting unaided or
using nicotine replacement therapy (NRT) over the
counter.  

 

·      
The NRT provided at discharge is based upon existing
approved formulary which is currently provided through our
Behaviour Change Service commissioned service for Cambridgeshire
& Peterborough.  

 

 

                  
Population
included 

 

·      
A current smoker or has quit smoking in the last two
weeks 

·      
Receiving support to stop smoking through the Acute
Inpatient Smokefree
Pathway.    

·      
Peterborough
resident 

·      
Over the age of 12 years, most NRT products are
licensed for 12-year-olds
plus. 

 

                 
Acceptance and exclusion criteria and
thresholds 

 

·      
Only patients receiving support through the Acute
Inpatient Smokefree Pathway will be issued with NRT upon
discharge. 

 

·      
This grant is to only fund NRT upon discharge for
Peterborough
residents. 

 

 

Approval to transfer £10,000 through a section 76
to Cambridgeshire & Peterborough ICB to provide up to 10 days
Pharmacotherapy on discharge is requested.
 
Reason for the
Recommendation:
 
Community based smoking cessation interventions and the
associated pharmacotherapy is currently funded by the Local
Authority through the Public Health grant. As part of the
Long Term Plan (LTP) new NHS Tobacco Treatment
Services are being implemented across Cambridgeshire and
Peterborough and the ambition by the end of March 2024 is that
every person admitted to hospital will be screened for tobacco
dependence. This will be followed by an optout referral to the
inhouse ‘Treating Tobacco Dependency Team’ who will
initiate tobacco dependency treatment by providing behavioural
support and facilitating access to pharmacotherapy. Pharmacotherapy
will be provided throughout the inpatient stay and upon discharge
so that the person can receive continued smoking cessation support
via their local community stop smoking service or the NHS community
pharmacy smoking cessation service. The pooling together of
financial resources through a Section 76 enables a better service
provision with increased reach than if such services were secured
by organisations independently.
 
 

Alternative options considered

The option to do nothing was considered but
without
a 10-day supply upon discharge there is a risk that patients will
be unable to access Community Stop Smoking Services to obtain
further Pharmacotherapy in time and this will compromise their
ability to quit successfully.