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Topic on a Page - Smoking Reduction in Adults

Data Sources:

PHE:

Local Tobacco Control Profiles

Data Profiles: Youth Smoking Estimate (Ward Level)

CLeaR local tobacco control assessment

Further Data Sources:

Scroll to the bottom of the page to view and compare further datasets

Supporting Information:

NHS Evidence:

Passive Smoking

Smoking Cessation

Tobacco Control

Public Health England (PHE):

Health Matters: Smoking and Quitting in England Published: September 2015

Resources: Smoking

Alcohol, drugs and tobacco: commissioning support pack

Stoptober campaign evaluation

Health Matters: preventing ill health from alcohol and tobacco use (October 2017)

NICE:

Guidance: Smoking: Harm Reduction [PH45]

Quality Standard: Smoking: reducing and preventing tobacco use [QS82]

Local Government Briefing: Tobacco [LGB24]

Stop smoking interventions and services [NG92]

Dept of Health & Social Care:

Tobacco Delivery Plan 2017-2020

Towards a smoke-free generation: tobacco control plan for England

ASH:

Smokefree skills: an assessment of maternity workforce training

University College London:

Quit success rates in England 2007-17

House of Commons:

Tobacco control policy overview: House of Commons Library Briefing Paper

British Thoracic Society

Smoking Cessation Quality Improvement Tool

Linked Topics:

Topic last reviewed: Jan-19

JSNA Topic: Smoking Reduction in Adults

Background

Smoking remains the biggest cause of premature mortality in England, accounting for around 80,000 deaths each year, approximately 1,200-1,300 in Lincolnshire. Tobacco use also imposes a significant economic burden on society. In addition to the direct medical costs of treating tobacco-induced illnesses there are other indirect costs including loss of productivity, fire damage and environmental harm from cigarette litter and destructive farming practices. The total burden caused by tobacco products more than outweighs any economic benefit from their manufacture and sale.

There are stark health inequalities between people who smoke and do not smoke. Smoking is a fundamental contributor to health inequalities, accounting for half the difference in life expectancy between richest and poorest. A study published in the BMJ in 2009, titled 'Effect of tobacco smoking on survival of men and women by social position: a 28 year cohort study' concluded that:

"Among both women and men, never smokers had much better survival rates than smokers in all social positions. Smoking itself was a greater source of health inequality than social position and nullified women’s survival advantage over men. This suggests the scope for reducing health inequalities related to social position in this and similar populations are limited unless many smokers in lower social positions stop smoking."
(Source: Gruer, L. et al. (2009), BMJ)

Lincolnshire’s smoking prevalence in adults is gradually reducing and continues to mirror the trend across England. However, there are geographical differences across the county in terms of prevalence and diseases/deaths attributable to smoking, along with inequalities relating to factors such as deprivation, mental health and pregnancy. On average a smoker reduces their life expectancy by 10 years; the earlier a smoker quits smoking gives the potential for more life years saved. It is widely accepted that more people in routine and manual occupations smoke, where culturally smoking is more socially acceptable. Smokers who live in the most deprived areas tend to be more addicted and smoke more.

Tobacco control is a field of international public health science, policy and practice dedicated to addressing tobacco use, with the aim of reducing the morbidity and mortality smoking causes. Tobacco control is a priority area for the World Health Organisation (WHO), through the Framework Convention on Tobacco Control. The success of tackling tobacco control is heavily reliant on partnership working with joined up solutions, which focus on quitting together with the regulation of supply and demand, legislation, education campaigns, media work and harm minimisation interventions.

Context

National Strategies, Policies & Guidance

In July 2017 the Government published their revised national tobacco control plan for England – 'Towards a Smokefree Generation', the plan sets a number of national ambitions;

  • The first smokefree generation
  • A smokefree pregnancy for all
  • Parity of esteem for those with mental health conditions
  • Backing evidence based innovations to support quitting.

These will be achieved through the following four main themes;

  • Prevention first
  • Supporting smokers to quit
  • Eliminating variations in smoking rates
  • Effective enforcement.

Health Matters: Smoking and quitting in England (2015). This guidance sets out Public Health's ambition for a tobacco free generation by 2025. It provides insight into what works to help people stop smoking.

The Public Health Outcomes Framework, Improving Outcomes and Supporting Transparency (2012), introduced the overarching vision for public health, desired outcomes and the indicators that will help understand how well we are improving and protecting health. PHE Tobacco Control profiles provide a summary of tobacco related indicators, outcomes and treatment data.

In 2014 the National Centre for Smoking Cessation and Training (NCSCT) together with Public Health England (PHE) published the Local Stop Smoking Services, Service and delivery guidance 2014.

The National Institute for Health and Care Excellence (NICE) provides guidance and advice to improve health and social care, on a range of evidence based best practice interventions that have been shown to work. NICE: Pathways: Smoking prevention and cessation overview

In January 2019 the Government launched the NHS Long Term Plan, 2019 - 2029. The plan focuses on improving services outside hospitals and moving towards more joined-up, preventive and personalised care for patients.

Local Strategies & Plans

The Joint Health and Wellbeing Strategy, approved by the Health and Wellbeing Board in June 2018, includes a strong focus on prevention and supporting people to improve their own health and wellbeing.

Lincolnshire's Better Births Strategy aims to provide a range of universal and targeted public health interventions including stop smoking services that support the best start for women and children from preconception to school age.

The Tobacco Control activity is now led by Safer Communities in Lincolnshire County Council (LCC), working across departments their annual Action Plan brings together education, enforcement, legislative and stop smoking service elements. In addition the Public Health lead continues to work with external partners to further enhance tobacco control activities across the County.

What is the picture in Lincolnshire?

What the data is telling us

Nationally, smoking prevalence among adults continues to drop; the proportion of the population who smoked cigarettes in Great Britain has fallen gradually over the past 40 years, from 46% in 1974 to 21% in 2009 as reported in the General Household Survey, (ONS).

In recent years adult prevalence rates have been disaggregated into localities; using the new Annual Population Survey (APS) England's adult prevalence has fallen to 14.9% in 2017. Lincolnshire is following a similar downward trend however the rate remains significantly higher than England with 22.1% adults smoking in 2009 down to 16.3% of adults smoking in 2017. (Source: Public Health England)

Variations in smoking prevalence are also evident across the county and between different groups. All Lincolnshire districts, apart from South Kesteven report adult smoking prevalence rates 0.5% - 5.6% higher than the England average. In addition, the smoking prevalence in the general population is between 4% – 16% lower than that of people in routine and manual (R&M) occupations. (Source: Public Health England)

When looking at the socio-economic gap in current smokers, Lincolnshire records a gap of 2.60% which is similar to the national gap of 2.44% and the regional gap of 2.25%. However when looking at Lincolnshire districts, West Lindsey has the highest gap in the East Midlands region with 8.25%. North Kesteven has the lowest Lincolnshire gap of 1.44%. (Source: Public Health England)

Nationally, the number of people setting a quit date through the NHS stop smoking services continues to fall and in 2017-18 was down by 11% on the previous year. Lincolnshire's experience is comparable with the number of people accessing the Stop Smoking Service declining year on year since 2012-13.

Lincolnshire has a rate of 271 per 100,000 population for smoking attributable mortality for the period 2015-17. This is higher than England (262.6) and the East Midlands (268.7). (Source: Public Health England)

Pregnancy
Data collection issues have meant that the national reporting of pregnant women smoking at time of delivery (SATOD- the national indicator) in Lincolnshire is currently unreliable; but the 2017 estimate shows Lincolnshire having a significantly higher amount of women smoking at time of delivery (16.7%) to the national average (10.8%). This accounts for 1,090 women. (Source: Public Health England)

Mental Health
Nationally the smoking prevalence rates for smokers that have a long term mental health condition is reported in the PHE Local Tobacco Control Profiles. In 2017/18 England's rate was 27.8%, compared to Lincolnshire's rate of 27.5%.

Long term Conditions
Smokers are much more likely to suffer from a long term condition (LTC). Among heavy smokers, 44% self report a long term illness or disability compared with 32% of never smokers (ONS, 2013). Both smokers and those with a LTC are more likely to be hospitalised:

  • People with a LTC account for 50% of GP appointments, 64% of outpatient appointments and 70% of all inpatient bed days (ONS, 2009).
  • Around 2.6 million episodes of inpatient care are delivered to 1.1 million smokers every year and around 47% of people treated in hospital are current or ex-smokers (Szatkowski et al, 2014).
  • Health interventions are also less successful for smokers than non-smokers. Non-smokers have, on average, shorter hospital stays, lower drug doses and fewer complications.
  • Smokers are 38% more likely to die after surgery (Turan et al, 2011) and are more likely to experience wound infection (Sørenson, 2012).

Electronic cigarettes
Action on Smoking and Health (ASH) estimates that there are currently 3.2 million adults in Great Britain using electronic cigarettes (E cigarettes); equivalent to 6.2% of the adult population. Of these, approximately 1.7 million (51.6%) are ex-smokers and a further 1.4 million (44.2%) continue to smoke tobacco alongside their electronic cigarette use; there are approximately 100,000 (4.2%) never smokers. (Source: Department of Health quarterly return.) We are unable to confirm the numbers of Lincolnshire people using E cigarettes as this information is not yet collected.

Trend

Lincolnshire has a smoking prevalence rate statistically significantly higher than the national and East Midlands average prevalence. It has the fourth highest smoking prevalence in the East Midlands.

Smoking related hospital admissions are on the decline with the rate (1,556 per 100,000 population) currently statistically lower than the England average (1,685 per 100,000 population). (Source: Public Health England). We are unable to evidence a direct link between the decline in numbers admitted into hospital and the smoking related mortality rate, a more detailed study would need to be undertaken.

Pregnancy
Local pregnancy trend data is unavailable due to current issues with data quality. A Smoking in Pregnancy Task Group has been established to review current practice, identify gaps and develop robust data collection processes going forward.

Mental Health
Work with Mental Health clients has been recently implemented so it is too early to say what impact on trend this activity will generate. Nationally collection of this data is in its early stages.

Long Term Condition
Work with smokers with a LTC is in its infancy, brief advice training of ULHT front line staff has started and there is a desire to embed smoking cessation within the secondary care setting. The introduction of the NHS long term plan should help secure this for the future.

Young People
There is a large body of evidence showing that smoking behaviour in early adulthood affects health behaviours later in life. The Tobacco Control Plan (July 2017) highlights the importance of reducing the number of young people taking up smoking, as it is "an addiction largely taken up in childhood". One of the national ambitions set out in the document was to reduce rates of 15 year old regular smokers to 3% by 2022. In 2014/15 Lincolnshire's smoking prevalence at age 15 - regular smokers was reported as 5.6%, compared to England 5.5% and the East Midlands 5.3%. The rate of smoking prevalence continues on a downward trend and is comparative with England and the East Midlands. (Source: WAY Survey).

Key Inequalities

Health Matters: Smoking and Quitting in England (Public Health England, 2015) states that: "Smoking and the harm it causes aren’t evenly distributed. People in more deprived areas are more likely to smoke and are less likely to quit. Smoking is increasingly concentrated in more disadvantaged groups and is the main contributor to health inequalities in England. Men and women from the most deprived groups have more than double the death rate from lung cancer compared with those from the least deprived. Smoking is twice as common in people with longstanding mental health problems".

In 2009 the Department of Health published their best practice guidance 'Tackling Health Inequalities: Ten Years On' which stated that: "A third of Routine and Manual (R&M) smokers live in the most deprived 20% of areas. Over a third (37%) of this group smoke, compared with only 22% of those in managerial and professional occupations living in the same areas".

In addition there are specific groups in society with higher rates of smoking, not all defined by occupation but shown nationally to have higher smoking prevalence rates and higher nicotine dependence. Communities such as;

  • Gypsies and Travellers
  • Prisoners/ Ex-offenders
  • Lesbian, Gay, Bisexual & Transgender(LGBT)
  • Alcohol and Drug dependant.

Local data for specific communities is unavailable at present and some additional work is needed to identify local smoking prevalence amongst these groups and to establish if there are any specific issues that contribute to their higher smoking rates e.g. access to services.

In 2013 the Royal College of Physicians (RCP) published its report on Smoking and Mental Health. The report identified that 33% of all tobacco consumed in England is smoked by people with mental health disorders. The report identifies that "Although people with mental disorders are more likely to be smokers and more likely to be heavily addicted to cigarettes than those without, data from the Health Survey England (HSE) indicate that they are no less likely to want to quit smoking. When asked whether they would like to give up smoking altogether, 66% of all smokers in the HSE responded positively, as did 69% of smokers taking a psychoactive medication."

'The Stolen Years' (Action on Smoking and Health (ASH), 2016) concludes that "Although mental health conditions vary widely, there is long-standing evidence that smoking prevalence is substantially higher among most mental health conditions, and increases with the severity of the condition. Smoking rates are around 60% in those with probable psychosis and up to 70% for people in psychiatric units. People with mental health conditions die on average 10-20 years earlier than the general population and smoking is the single largest factor accounting for this difference." Despite their apparent willingness to stop only a very small proportion of people with mental health conditions access the help of a stop smoking service. Smoking cessation approaches with this group can prevent a large proportion of the physical illness and premature death they experience and are also associated with reduced depression, anxiety and levels of medication (Source APMS).

Despite a refocus of the stop smoking service to target this group of smokers only a very small number are currently accessing the service, particularly those living with long term Mental Health issues managed out in the community. We need to identify more opportunities to make it easier for people with mental health conditions to access the support of cessation services.

A Smoking in Pregnancy Challenge Group was established in 2012 in response to a challenge from the then Public Health Minister to produce recommendations on how the smoking in pregnancy ambition to reduce smoking in pregnancy rate to 6% or less by the end of 2022, measured at time of delivery could be realised. In 2018, the group published a report called 'Review of the Challenge' which calls on the government to take action to tackle smoking in pregnancy. It states, "When a woman smokes during pregnancy or when she is exposed to secondhand smoke, oxygen to the baby is restricted making the babies heart work faster and exposing the baby to harmful toxins. As a result, exposure to smoke in pregnancy is responsible for an increased rate of stillbirths, miscarriages and birth defects. There is a major health inequality in this as women from more deprived backgrounds are more likely to be exposed to smoke during pregnancy".

Current Activity & Services

Since 2016 Quit 51 have provided a specialist stop smoking service for Lincolnshire.

In addition to the general service the stop smoking service has specific target groups to engage in smoking cessation and these are based on evidence of those who would benefit the most from stopping smoking;

  • Pregnant women supported throughout their pregnancy
  • Mental health clients, targeting those with long term mental health conditions such as Schizophrenia or Bipolar Disorder
  • Acute clients which includes smokers who are due to go into hospital for surgery or who suffer from long term conditions such as heart disease or COPD.

The service offers behavioural advice and support, together with access to proven nicotine replacement therapies. Advisors are trained professionals with experience in the field of smoking cessation.

The service is currently going through a re-tendering exercise and it is proposed to have a new Integrated Lifestyle Service (ILS) that will include a stop smoking service, in place by July 2019.

Lincolnshire's Tobacco Control Activity
The focus of Lincolnshire's Tobacco Control activity is now led by the Safer Communities team in Lincolnshire County Council. The Tobacco Control lead in Public Health continues to work closely with external organisations to support them in the delivery of their enforcement and legislative responsibilities.

Smoking in Pregnancy
Following a smoking in pregnancy peer review assessment undertaken in 2016 a Smoking in Pregnancy (SIP) task group has met regularly to review service provision and identify gaps; together with the stop smoking service, initiatives are being implemented to help reduce the number of women who continue to smoke during pregnancy. This includes the routine carbon monoxide (CO) monitoring of every pregnant women and 'opt out' referral to the stop smoking service.

In June 2018 the United Lincolnshire Hospital Trust (ULHT) introduced a comprehensive data management tool that captures and reports the smoking status for every pregnant woman. This tool is updated at every ante natal appointment and provides an accurate patient record which will be used to report smoking at time of delivery data. This will make the future reporting of smoking in pregnancy more accurate.

Following a survey undertaken in 2018 by Lincolnshire Maternity Services (LMS) with pregnant women; resulting in requests for more services to be delivered in localities, thus reducing travel issues for service users. Quit 51 now provide stop smoking support in five children centre venues. This move has been supported both by service users and midwives who find referring pregnant smokers an easier and quicker process.

Young Person’s Activity
Research has shown that the best way to influence young people's decision not to smoke is through reducing the adult smoking prevalence and education. In Lincolnshire we offer an adult stop smoking service, although children as young as 12 year of age can be supported provided they meet the principles of the Gillick competence we also offer a series of educational programmes, delivered in a range of settings.

Evidence of the efficacy of stop smoking services and young people stopping smoking is limited and for a number of years tobacco control has focussed efforts on the uptake of smoking by young people through education programmes across all key stage groups. To date this has been evaluated internally with the outcomes appearing favourable and as good if not better than programmes promoted nationally.

Work with Partners - NHS
Links with ULHT have been re-established referring clients to stop smoking services as part of the Commissioning for Quality and Innovation national goals (CQUIN) 9 Risky Behaviours programme. In addition the trust is in the process of reviewing it's no smoking policy; advocating tobacco control through their intention to move toward smokefree sites, and reiterated in the Government's plan which states 'NHS Trusts will encourage smokers using, visiting and working in the NHS to quit, with the goal of creating a smokefree NHS by 2020 through the 5 Year Forward View Mandate'.

Links with LPfT has continued beyond the implementation of their smokefree sites policy in June 2016, however more work needs to be undertaken to encourage smokers living with a long-term mental health condition out in the community, to take up the support of the stop smoking services.

Unmet Needs & Gaps

Smokers with Long Term Conditions or Requiring Surgery
Relationships with secondary care broke down following the change in service provider, however these are improving and pathways into the service continue to be developed. Links between GP's and Quit 51 need to be re-established to support those smokers who would benefit the most from stopping smoking. Referral numbers remain quite low from primary care and this area could benefit from better engagement by local GP practices with their smoking clients to encourage better take up of services.

Minority Groups
There is a need to review the evidence in relation to minority groups i.e. prisoners/ex- offenders, LGBT, gypsy and travelling communities; and where evidence suggests that smoking prevalence remains high, identify ways to target these communities with stop smoking support.

Training and Role of Making Every Contact Count (MECC)
The countywide reduction in many of the established prevention programmes may lead to a gap in knowledge by local teams of where or how to make referrals. The MECC programme provides training to front line staff on how they can use every engagement with a client to deliver a health intervention. There is a need to step up training that will upskill a broader range of people/groups to help fill those gaps.

Local Views & Insights

There remains a high level of public support for tackling the issues associated with smoking, such as the environmental impact of litter and perceived higher numbers of smokers on the streets, the impact of electronic cigarettes (e-cigs) on our children and young people, and the influence of marketing through packaging and product placement in TV and Film. Lincolnshire's tobacco control activity continues to take forward actions that help to minimise the effects and raise public awareness by supporting the six recognised strands these include: enforcement of smokefree legislation, illicit and counterfeit activity, young person's educational work and Stoptober campaigns.

Following engagement with pregnant women a collaborative approach between Lincolnshire's Local Maternity Systems group (LMS), Lincolnshire East Clinical Commissioning Group (CCG), ULHT and Quit 51 has been taken; offering a range of services in community settings. Specifically five children's centre sites have been identified as maternity hubs, with midwives working closely with stop smoking advisers to refer pregnant smokers directly into the service and offer support locally.

Risks of not doing something

There are a significantly higher number of deaths in areas such as Boston, East Lindsey and Lincoln for diseases attributable from smoking e.g. lung cancer and COPD; in addition death attributable to heart disease is a major factor for Lincolnshire. If we ceased provision of stop smoking support and tobacco control activities, the numbers of people presenting with diseases attributable to smoking and smoking prevalence could increase, putting a further burden on our health care system.

Studies show that smokers attempting to stop without additional support have a success rate of about 25% at four weeks (for carbon monoxide (CO) validated quits) and 35% at four weeks for self-reported quits (Source: NCSCT). When offered behavioural support through a stop smoking service together with access to medications such as nicotine replacement therapy (NRT) or Champix, a prescription medicine which blocks the action of nicotine in your brain, helping to reduce cravings and withdrawal symptoms; the success rate measured at four weeks can improve to over 50%.

Based on 2016 data, when adult smoking prevalence was at 17.7%, the estimated smoking population of Lincolnshire was estimated at 106,155. The estimated cost to society in Lincolnshire was £175.2 million. (Source: ASH Ready Reckoner 2018) This total cost includes:

  • £102.8 million of potential wealth lost from the local economy as a result of lost productivity due to smoking
  • £5.2 million of costs associated with smoking related fires.

The cost burdens of smoking fall upon both the NHS and Adult Social care. Current and ex- smokers who require care in later life (aged 50 and over) as a result of smoking-related illnesses cost an additional £26.3 million each year across Lincolnshire. This represents £14.4 million in local authority spending on social care and £11.9 million in costs to individuals who self-fund their care. (Source: ASH Ready Reckoner 2018)

The total annual cost to the NHS for smoking across Lincolnshire is about £40.9 million. £29.7 million is a direct result of treating smoking related ill health and £11.2 million due to hospital admissions for smoking related conditions. (Source: ASH Ready Reckoner 2018)

Smokers in Lincolnshire spend approximately £221.4 million on tobacco related products each year. That equates to £2,050 per smoker. Of the total expenditure, £110.5 million is collected by the Treasury as tobacco duty. Despite this extra revenue, tobacco still costs the Lincolnshire economy roughly one and half times more as much as the duty raised. (Source: ASH Ready Reckoner 2018)

Tobacco smuggling costs over £2 billion in lost revenue each year. It undermines legitimate business and is dominated by internationally organised criminal groups often involved in other crimes such as drug smuggling and people trafficking (Source: HM Revenue and Customs and Border Force). Smokefree Lincolnshire's Alliance supports Trading Standards and their partners in the Police and HMRC to target resources effectively, based on an intelligence led approach. This has resulted in a number of prosecutions across the county that have led to fines, withdrawal of alcohol licences and in some instances, prison sentences for unscrupulous vendors.

What is coming on the horizon?

LCC's, Public Health Division are currently redesigning and expanding their smoking cessation offer to an Integrated Lifestyle Service (ILS). This service will include (from the 1st July 2019) the following components; stop smoking, physical activity, weight management and alcohol extended brief interventions.

This approach will enable individuals to tackle several unhealthy behaviours under one umbrella service, rather than having to access multiple providers.

The NHS long term plan set out new commitments for action over the next 10 years that the NHS itself will take to improve prevention, adopting models such as 'The Ottawa Model' for Smoking Cessation.

The five year Sustainability and Transformation Plan (STP) for local health service funding requires health providers to deliver services that meet the needs of local populations as well as supporting the Five Year Forward View vision, which includes a ‘radical upgrade’ in prevention. This provides the opportunity to enhance the current investment of resources in tobacco control and stop smoking programmes that will result in financial savings to the NHS through contributing to primary and secondary prevention outcomes. The STP prevention plan has prioritised the need for a number of lifestyle services that will include a focus on smokers with long term conditions; however, this commissioning will depend on whether the plan is adopted.

The Government implemented a smokefree policy across the prisons estate in England. Lincoln prison implemented smokefree from January 2018. The number of prisoners accessing the support of in-house stop smoking services following the implementation is unknown and further investigation is needed.

E Cigarettes
On the 20th May 2016 electronic cigarettes became regulated by the revised The Tobacco and Related Products Regulations 2016. The Medicines and Healthcare products Regulatory Agency ( MHRA) is responsible for assessing the safety, quality and efficacy of medicines, and authorising their sale or supply in the UK. Companies wishing to bring to market a device containing nicotine as a medicine must apply to the MHRA for a licence.

Public Health England (PHE) has published an independent evidence update on electronic cigarettes which concluded that the devices are significantly less harmful than smoking. The review also found no evidence that electronic cigarettes act as a route into smoking for children or non-smokers.

The Government Response to the Science and Technology Committee’s Seventh Report of the Session 2017-19 on E-cigarettes, published in December 2018 states "That quitting smoking and nicotine use completely is the best way to improve health. E-cigarettes are not risk free. However, the evidence is increasingly clear that e-cigarettes are significantly less harmful to health than smoking tobacco, and can help smokers to quit, particularly when combined with stop smoking services. The Government does take concerns about e-cigarettes seriously. That is why in the Tobacco Control Plan for England it committed to monitor the impact of regulation and policy on e-cigarettes and novel tobacco products (including evidence on safety, uptake, the health impact and effectiveness of these products as smoking cessation aids) to inform future policy. Public Health England (PHE) will continue to update its evidence base on e-cigarettes and other novel nicotine delivery systems."

What should we be doing next?

Local Data
Local data is vital to create that local picture which will help us understand needs and to commission the right services in the right areas. Despite a wealth of local data being collected by partners there appears to be little sharing across organisations. We need to develop closer links across partners e.g. ULHT, Lincolnshire Partnership Foundation Trust, local authorities, CCGs and LCC directorates, to better use the local data collected so that it may be mapped effectively and give a more informative picture to commissioners and providers. Once we understand what data is collected and what it is telling us, we will have a better understanding of what information is still missing.

It's Everyone's Business
Many organisations are already tackling tobacco control in some form. With the reduction in budgets, staffing, resources and time, it is critical that organisations work in partnership to tackle this agenda.

NHS Long term Plan
Ensure that the NHS and Local Authority collaborate on the implementation of the long term plan avoiding any duplication and enhancing services. Working together to tackle smokers with long term conditions, mental health issues and those smoking during pregnancy.

Lincolnshire's Tobacco Control Strategy 2015 - 2018
There is currently no plan to review the current strategy for Lincolnshire.

 

If you need to contact us about this topic, please email JSNA@lincolnshire.gov.uk

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