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Sustained efforts to ensure mental health services are smoke free are reaping rewards for patients, visitors and staff

ByDave Stopher

Jun 15, 2018

New research published today shows that the number of patients in mental health hospitals who smoke in the North East is falling thanks to a sustained approach by partner organisations.

The evaluation report looks at the work undertaken to drive down smoking across two NHS Trusts to improve the health and well-being of patients, staff and visitors.

Early deaths among people with serious mental illness are more than three times higher than the general population and smoking is known to be a big contributory factor.

In March 2016 two mental health trusts in the region; Northumberland, Tyne and Wear NHS Foundation Trust and Tees, Esk and Wear Valleys NHS Foundation Trust, went fully smoke free.

To monitor and understand the impact of this change researchers at Teesside University and Fuse, the Centre for Translational Research in Public Health, were invited to speak to staff, patients and carers to gain a greater understanding of people’s attitudes and what could be done to provide more support to help people quit smoking.

Public Health England analysed the data from the Trusts to track the number of patients who smoked. The smoking status of over 3,000 patients was summarised every six months over a three year period. It found there was a considerable drop in smoking prevalence recorded across both organisations.

In one Trust, clinical audit showed that the proportion of inpatients that smoked fell from 43% in 2015 to 21% in 2018. Within the other Trust, routine performance data showed that the proportion of inpatients who smoked at admission fell from 51% in 2016 to 42% in 2017 and the proportion that smoked at discharge fell from 50% to 44% over the same period.

The report highlights the preliminary work undertaken to prepare for the smoke free policy and noted that both Trusts had prepared 18 months in advance and introduced a range of measures to aid successful implementation. This included training staff to give advice on quitting smoking and appointing stop smoking advisors on every unit. Initiatives such as that at Tees, Esk and Wear Valleys NHS Foundation Trust, where Nicotine Replacement Therapy was provided to patients within 30 minutes of admission, were also introduced.

Sue Jones, Research Associate in Teesside University’s School of Health & Social Care, said: “It is clear from the process evaluation that there were areas in the Trust where there was a notable reduction in smoking. Patients who did succeed in quitting, after a while, felt more relaxed and it gave them the opportunity to improve their physical health, spend more time at the gym, take part in other activities and have more money in their pockets for other purchases.

 “Ensuring that everybody complied with the smoke free policy was a challenge – some people appreciated the opportunity for support to quit, but others did struggle.”

Sue believes that more detailed data on patient stop smoking journeys is required but, following the trend in wider society, limiting areas where smoking is permitted goes hand-in-hand with supporting people to quit.

She added: “We would like to see improved mental and physical health for people with mental health conditions and introducing smoke free policies is one step in this direction.”

Dr Damian Robinson, Group Medical Director for Safer Care at Northumberland, Tyne and Wear NHS Foundation Trust, said: “The Trust is delighted that the evaluation has demonstrated that there has been a real reduction in the number of service users who are smoking and an associated improvement in their quality of life.

“We would like to acknowledge the considerable work undertaken by our staff which has resulted in such a positive outcome and look forward to continually working to reduce health inequalities.”

Dr Ahmad Khouja, Medical Director of Tees, Esk and Wear Valleys NHS Foundation Trust, said: “We are really pleased with the evaluation results. A wide range of staff and service users were involved in the development of our smoke free policy and the implementation has been a whole Trust approach. Its success is testament to the hard work and support of our staff, as well as the understanding and buy-in of our service users, carers and visitors. This is an ongoing project that has moved from an initial focus on our wards and hospital sites, into our community services and we are continuously working to support staff and service users to reduce smoking levels and improve people’s physical health, as well as their mental wellbeing.”

Ailsa Rutter OBE, Director of Fresh North East, said: “The NHS Five Year Forward View and the government’s Tobacco Plan for England have underlined the importance of the NHS doing all it can to help more smokers to quit. Treating tobacco dependency can help reduce hospital admissions and tackle our number one cause of death and preventable illness.

“We supported the Mental Health Trusts in their move to go smoke free in 2016 and we welcome this report. It shows that going smoke free is about far more than smoking in hospital grounds but supporting every smoker to stop. Evidence is clear that NHS staff on our wards can play an important prevention role in motivating people to quit and supporting them to do so. We hope to now see the same commitment made across all the Acute Trusts in the North East.”