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HOUNSLOW TOBACCO CONTROL PLAN 2019-2023

Buvana AilooLondon Borough of Hounslow

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Table of ContentsForeword ................................................................................................................................................2

Introduction............................................................................................................................................4

The current landscape on tobacco and smoking ...................................................................................7

Overview....................................................................................................................................7

Smoking prevalence in Hounslow .............................................................................................9

Smoking costs in Hounslow ....................................................................................................11

Hounslow smoking incidence 2018/2019................................................................................12

Our ambitions for 2019-2023 ...............................................................................................................14

Objectives ................................................................................................................................15

System leadership.......................................................................................................15

Whole systems partnership ........................................................................................15

Supporting delivery.....................................................................................................16

Marketing and engagement .......................................................................................19

Evidence base, data and monitoring ..........................................................................19

Summary and monitoring .....................................................................................................................21

Monitoring ...............................................................................................................................21

Appendix 1............................................................................................................................................22

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It is my pleasure to introduce the Tobacco Control Plan 2019-2023 for Hounslow as Chair of Hounslow’s Joint Health and Wellbeing Board. It is our ambition that Hounslow echoes the national aim in creating a smoke-free generation. Our Hounslow Joint Health and Wellbeing Strategy 2018-2022 identified reducing smoking in the borough as one of our top priorities. This plan is the vehicle through which we will work to undertake that work and achieve our goals. This plan was developed through the combined input of a broad range of stakeholders over the first half of 2019.

In Hounslow, great progress has been made in reducing the harms caused by tobacco and smoking through the coordinated efforts of a coalition of partners in the borough. Since our previous Hounslow Tobacco Control Plan1 was launched in 2013 the prevalence of smoking has reduced from 13.8% to 12.6%2. The Hounslow smoking prevalence of 12.6% is also lower compared to the regional prevalence of 16.5% and national prevalence of 14.6%3.

Since 2013, work to reduce smoking related harms have included universal provision of specialist stop smoking support for smokers who live and work in the borough; educating young people on the harms of smoking and tobacco use; mandatory routine screening of carbon monoxide for pregnant women, raising awareness of illicit tobacco and successful enforcement activities tackling illegal tobacco sales and our new guidance on planning and licensing committees for tobacco use including shisha.

Despite our efforts and lower prevalence rate in Hounslow, we still have a long journey ahead. Smoking is the single largest preventable cause of ill health, premature death and health inequalities in England and over 200 deaths every day across the country are attributed to smoking alone4.

We understand that smoking and tobacco use are more prevalent in certain groups in our society and affect our vulnerable population more severely. People with a lower socioeconomic background are three times more likely to smoke and have a lower life expectancy compared to someone from a higher socioeconomic background. Those who experience long term mental health condition smoke more compared to the general population. Smoking is major contributor to health inequalities. It accounts for approximately half of the difference in life expectancy between the lowest and highest income groups5.

Whilst in Hounslow we have a low rate of smoking by pregnant women, continued reductions in smoking in pregnancy are needed. known harms to the mother and unborn child include risk of miscarriage, premature birth, still birth and neonatal complications.

We want to focus on our young people to prevent the uptake of tobacco at all. This includes deterring young people from experimenting with smoking and also deterring the use of other

1 Hounslow Tobacco Control Plan 2013-20162 Local Tobacco Control Profile ‘Smoking Prevalence in adults (18+) - current smokers (APS) Hounslow'. 2017 Available at Public Health England Tobacco Control Profiles: https://fingertips.phe.org.uk/profile/tobacco-control (Viewed June 2019) 3 Local Tobacco Control Profile ‘Smoking Prevalence in adults (18+) - current smokers (APS) Hounslow'.2017 Available at Public Health England Tobacco Control Profiles: https://fingertips.phe.org.uk/profile/tobacco-control (Viewed June 2019)4 Public Health England ‘Towards a Smokefree Generation - A Tobacco Control Plan for England’ (2017) 5 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/431387/20150520_Tobacco_use_a_health_inequalities_briefing_for_London.pdf

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forms of tobacco. We will further support the progress of the work undertaken on illicit tobacco awareness and enforcement in the borough. Our efforts need to include reducing exposure to second hand smoke in closed environments such as homes and cars as well as creating more smokefree environments and spaces across our borough.

This Tobacco Control Plan will continue the progress of the previous strategy and build on and further develop successful initiatives implemented. We will continue to work in partnership with the wide of range of stakeholders who have contributed to this strategy and seek to involve others where this will bring benefits to our residents. We will take a whole systems approach to achieve our ambition of a smoke free generation and a reduction in health inequalities in Hounslow.

Councillor Katherine DunneCabinet Member for Communities and Workforce

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Introduction

Tobacco use remains the single leading cause of preventable deaths in the UK. Every tobacco use harms the body, causing damage to nearly every major organ in the body contributing to chronic diseases such as cancer, heart and lung disease6. Harms from tobacco use also contributes to the risk of developing other conditions such as developing dementia, osteoporosis (leading to increased risk of falling7),

infertility, age related macular degeneration and gastric ulcers8 9. It delays recovery and healing after medical procedures10 and increases hospital stay the chances of readmission11.

Tobacco is used in various forms, with smoking being the most common form of tobacco use but there are other niche tobacco products more popular in some cultures. All tobacco use carries significant risks to the body. Chewing smokeless tobacco, such as paan or gutkha is common among the communities from Indian subcontinent and increases the risk of mouth and oesophageal cancer. Smoked tobacco, such as shisha, is common is the Middle Eastern Cultures12. Shisha smoking has been gaining popularity in the UK, particularly among more young people and younger adults, with some evidence also showing a popularity amongst

6 ‘How Smoking affects your body’ https://www.nhs.uk/smokefree/why-quit/smoking-health-problems7 NICE https://www.nice.org.uk/Media/Default/About/what-we-do/Into-practice/measuring-uptake/NICE-Impact-falls-and-fragility-fractures.pdf8 NICEhttps://www.nice.org.uk/guidance/qs82/documents/smoking-reducing-tobacco-use-in-the-community-qs-briefing-paper2 9 ‘How Smoking affects your body’ https://www.nhs.uk/smokefree/why-quit/smoking-health-problems10The Clinical Case for Smoking Cessation for WOUND CARE https://www.ncsct.co.uk/usr/pub/interventions-in-secondary-care-june-10-wound-care-factsheet.pdf 11 https://www.longtermplan.nhs.uk/12 Paan, bidi and shisha https://www.nhs.uk/live-well/quit-smoking/paan-bidi-and-shisha-risks/

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females13. During one session of shisha session (around 20 to 80 minutes), a person can inhale the same amount of smoke as a cigarette smoker consuming 100 or more cigarettes14.

Tobacco use does not only cause harm directly to the users. Second hand smoking (SHS) is also linked to various health harms. The Government-appointed Scientific Committee on Tobacco and Health (SCOTH) 2004 report found passive smoking is a cause of lung cancer and ischaemic heart disease in adult non-smokers, and a cause of respiratory disease, cot death, middle ear infections and asthma attacks in children15.

The burden of tobacco use is not confined to personal health harms alone. There are significant financial costs to the NHS, social care and economy due to loss of productivity16. Other costs to society which are less apparent includes litter and waste service costs17,air quality18 and criminality and other associated costs including loss of tax revenue of the illicit tobacco trade19.

Illicit tobacco trade undermines the government efforts to reduce smoking by making illegal tobacco cheap and accessible. It also undermines businesses doing legal trading. Those who are more likely to buy cheap tobacco are from a lower socioeconomic background, perpetuating inequalities. Illicit tobacco trade is illegal and linked to serious organised crime.

A national Tobacco Control Plan for England was published in 2017 supported by a tobacco control delivery plan 2017-202220. The plan recognises the public health gains achieved from the previous plan, reducing prevalence of smoking from 20.2% to 15.5%. This was achieved through world-leading public health measures including legislation which curbed advertising and smoke free places, ban on proxy purchasing and smoking in cars, standardised packaging, supporting smokers to quit by offering evidence-based smoking cessation services. The plan recognises that there is more to do as we can prevent the 200 deaths per day caused by smoking, with the most vulnerable- people with mental illness and people from lower socio-economic status having the highest burden. 8% of children under 15 years still smoke risking a life time of ill health and 10% of pregnant women smoke that increases the risk of miscarriage, premature birth, still births and neonatal complications. The national plan aspires to a ‘smoke free generation and stamping out inequalities’

Locally the new Hounslow Tobacco Control Plan 2019-2023 will support implementation of local initiatives against the national ‘Towards a Smokefree Generation’ -Tobacco Control Plan (2017). Hounslow’s aim is to work towards a

13 Action on Smoking and Health Waterpipes (shisha) 2015 14 https://www.nhs.uk/live-well/quit-smoking/paan-bidi-and-shisha-risks/ 15 Second hand smoke ASH http://ash.org.uk/information-and-resources/secondhand-smoke/secondhand-smoke/16 Public Health England Health matters: stopping smoking - what works? 2018 https://www.gov.uk/government/publications/health-matters-stopping-smoking-what-works/health-matters-stopping-smoking-what-works17 https://www.keepbritaintidy.org/local-authorities/reduce-litter/smoking-related-litter18 Public Health England Health matters: air pollution 2018 https://www.gov.uk/government/publications/health-matters-air-pollution/health-matters-air-pollution19Action on Smoking and Health Illicit trade in tobacco 201720 DH (2017) Towards a smoke-free generation: tobacco control plan for England

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smokefree borough where the prevalence of smoking is reduced to an ambitious 5%. Tobacco control is one of the priorities within the new Hounslow Joint Health and Wellbeing Strategy 2018-2022 which aims to improve health and reduce health inequalities in the borough.

The new Hounslow Tobacco Control Plan (HTCP) 2019-2023 will aim to build on the progress made through the previous Hounslow Tobacco Control Plan 2013-2016 as well as create a platform for innovative evidence based initiatives in reducing the harms caused by tobacco and smoking; reducing the prevalence of smoking and reducing health inequalities resulting from smoking.

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Figure 1: Trend in smoking prevalence in Hounslow 2011 - 2017

The current landscape on tobacco and smoking

Overview

The Hounslow tobacco plan 2013-201621 and action plan similarly achieved gains with smoking prevalence in adults falling from 18.5% in 2012 to 12.6% in 201722. There was a decrease in smoking at time of delivery from 5% (2011/12) to 3.1% (2016/2017). However, inequalities in smoking has persisted over the time with higher smoking rates in adults in routine and manual occupation (23.5%) and in people with mental ill health (36.9%). The burden from ill- health resulting from smoking was estimated to be over £4.5 million to social care in Hounslow with half spent by local authority and half by self-funding care (2017)23. Smokers are twice as likely to need social care support compared to non-smokers. The cost related to hospital admissions due to smoking was around £4 million in 2016/2017.

21 London Borough of Hounslow Tobacco Control Plan 2013-2016 22 PHE Local Tobacco Fingertips accessed 10 October 201823 ASH (2017 update) The cost of smoking to the social care system in England

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Smoking prevalence in Hounslow

Whilst the prevalence is lower in Hounslow, smoking disproportionately affects the most disadvantaged in the community and largely contributes to the health inequalities in the borough. The 2018 – 2022 Hounslow Joint Health and Wellbeing Strategy highlights smoking rates are seven times higher in deprived part of the borough and someone living in the most affluent part of the borough can have at least nine more years of good health to enjoy compared to someone living in a more deprived area of the borough24 affecting both individuals and families.

Those who are in routine and manual occupation have a higher smoking prevalence of 23.5%, furthermore, those with a long term mental health condition in Hounslow have a higher prevalence rate of 27.6% and 36.9% of those with serious mental illness smoke25, which is three times higher compared to the general population.

24 London Borough of Hounslow ‘Hounslow Joint Health and Wellbeing Strategy 2018-2022’ (2018)25 Public Health Profiles ‘Smoking prevalence in adults (18+) with serious mental illness (SMI)’ 2015 Available at Public Health England Public Health Profiles: https://fingertips.phe.org.uk/search/mental%20and%20smoking#page (Viewed June 2019)

Figure 2: Smoking prevalence 2017/2018 comparison of Hounslow, London and England Source: PHE Local Tobacco Control Profiles

Each year nearly 77,900 deaths are attributed to

smoking in. The smoking prevalence in Hounslow has steadily

decreased and is currently 12.6%, lowest since 2011 and is lower

compared to London and England prevalence.

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Smoking also affects the most vulnerable unfairly – the unborn baby, when the mother smokes during her pregnancy (or others in the household exposes the pregnant woman to second hand smoke). There are multiple risk factors associated with the adverse effects of smoking caused during pregnancy to the unborn baby include stillbirth, low birth weight, premature birth which has increased risk of long term health problems for the baby26.

26 Effects of smoking during pregnancy https://www.nhs.uk/conditions/pregnancy-and-baby/smoking-pregnant/

Figure 3: Smoking prevalence in adults in routine and manual occupation - comparison of Hounslow, London and England Source: PHE Local Tobacco Control Profiles

Figure 4: Smoking prevalence in with long term mental health conditions - comparison of Hounslow, London and England Source: PHE Local Tobacco Control Profiles

Whilst smoking prevalence in routine and manual

occupation is lower compared to London and England, smoking affects

nearly twice as many people in this group compared to

the normal population

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The 2017/2018 smoking status of women who smoke at the time of delivery in Hounslow is 5.8%27 which is lower compared to England but higher compared to London as seen in figure 5.

Whilst the prevalence is low, research suggests that women who smoke during pregnancy are younger and from a lower socioeconomic background. These women are four times more likely to smoke throughout pregnancy28.

In 2014/2015, the prevalence of young people aged 15 in Hounslow who smoked was 6.2%29, lower level compared with England as a whole but higher than London as a whole. Children and young people who start smoking at a young age become addicted to smoking before the legal age of buying cigarettes30. Children who start smoking at a younger age find it hardest to quit and have the highest risk of harm from smoking including being more susceptible to coughs and increased phlegm, wheeziness and shortness of breath in the short term and chronic obstructive lung disease and cancer later in life31.

27 Tobacco control profiles28 Passive smoking in children (2010) Royal College of Physicians https://cdn.shopify.com/s/files/1/0924/4392/files/passive-smoking-and-children.pdf?1559943601378614855329 Local tobacco control profiles smoking prevalence in young people30 ASH Young people and smoking 201831 ASH Young people and smoking 2018

Figure 5: Smoking status at the time of delivery 2017/2018 comparison of Hounslow, London and England Source: PHE Local Tobacco Control Profiles

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Smoking costs for Hounslow

Figure 6: Smoking cost to Hounslow, Source: Action on Smoking and Health 2018

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Hounslow smoking incidence 2018/2019

Figure 7: Smoking incidence in Hounslow 2018/2019, Source: Hounslow Public Health Intelligence Team using GP clinical data Systmone

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Figure 7 illustrates the smoking incidence in Hounslow for 2018/2019. The map highlights areas with higher level of smoking incidence such as in areas of Hanworth Park, Feltham West, Bedfont, Feltham North, Cranford and Ivybridge which directly correlates to the most deprived wards in Hounslow.

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Our ambitions for 2019-2023: Through the Hounslow Tobacco Control Plan 2013-2016, evidence based initiatives were implemented to tackle harms from tobacco use and Hounslow has seen significant improvements to the prevalence rate across all the indicators. However the problem persists and continue, further targeted efforts are needed in the coming years to reach Hounslow’s most disadvantaged population to reduce the smoking related health inequalities found in the borough.

In order to achieve Hounslow’s aspiration in creating a smokefree generation, the impetus and drive set out from the previous strategy needs to continue. Tackling tobacco use in Hounslow is not a single stream of work, this needs a wider collective force of stakeholders in the borough to come together and develop priorities and deliverables which is outcomes focused. Our plan is outlined below. The content of the plan was informed by the National Tobacco Control Plan 2017-2022 and the view of local stakeholders who contributed to the plan development in a Stakeholder Engagement event held in May 2019 (see Appendix 1 for the report of the event).

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Objectives

The Hounslow Tobacco Control Plan 2019-2023 will focus on the following objectives: .

1. System leadership2. Whole systems partnership3. Supporting delivery 4. Marketing and engagement5. Evidence base, data and monitoring

1. System leadershipActions:

Health and Wellbeing Board to endorse this plan and all member organisations to support the goals and ambitions of the plan and support smokefree and tobacco policy implementation across all sectors and organisation

Tobacco Control Alliance members to provide information and work with councillors in highlighting the problem. Request that councillors promote local support for quitting smoking, raise awareness on the dangers of tobacco use and illicit tobacco

London Borough of Hounslow taking a lead in modelling smokefree policy to all staff, residents and visitors who use council premises

Whole systems partnership

Local authorities are best placed to create a whole systems approach in tackling tobacco use. The impact of council services is invaluable in raising awareness and promoting quitting smoking through frontline contact with residents, communication, planning and commissioning services.

As well as working intrinsically within the council, it is imperative collaboration and joint working is harnessed across various stakeholders in the borough. Hounslow prides itself for

the successful partnership working and owes the reduced rate of prevalence in the borough to successful collaboration across various sectors and organisations in the borough. To implement further change, commitment from partners is a key priority, to enable shared resources.

The NHS Long Term Plan has prioritised preventative action and highlighted the contribution the NHS can make to tackling tobacco dependence, especially for hospital inpatients,

Example

Establish working relationships across all council departments to promote Tobacco Control Plan 2019-2023

Example

Hounslow Tobacco Control Alliance is with a wide range of members from the community healthcare providers, maternity and acute, clinical commissioning group, public health,

planning and legislation ensure the governance of the implementation of Hounslow Tobacco Control Plan 2019-2023

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pregnant women and long-term users of mental health services. Sustainability Transformation Plans and Integrated Care systems need embed tobacco control in their workstreams.

Actions: All health service providers and other frontline services (such as Housing and Social

Care) to support service users to access stop smoking services or signpost users to stop smoking services

All major health organisations, council and other partner organisations to support stop smoking campaigns through their communication channels as and when campaigns run (including Stoptober and other such campaigns)

Stakeholders working with council and health provider services support smokefree workplace (i.e. third sector partners, leisure providers, construction providers and local businesses)

Elected members to sign up to the Local Government Declaration on Tobacco Control

NHS Organisations sign up to the NHS Smokefree Pledge

Any others organisations (e.g. schools, colleges and higher education settings) reaching at least 1000 children and young people per year through direct events to prevent uptake of smoking

Supporting delivery

The crucial element of implementing the Hounslow Tobacco Control Pan 2019 -2023 is by creating a seamless pathway of integrated smoking cessation delivery system. The pathway will be permeable to the changing structures of organisation and population and offering and end point of NICE guidance support to stopping smoking.

The Hounslow Tobacco Control Pan 2019 -2023 will establish particular efforts in focusing support to the most disadvantaged communities through innovative methods and building workforce capacity and utilising the Making Every Contact Count approach for smoking cessation.

The delivery will use a preventative approach including outreach to work with schools, workplaces, hospitals, housing estates, community, cultural and religious settings in tackling tobacco use including smoking, shisha and illicit tobacco.

Actions: Continue the Public Health Grant funded evidence based smoking cessation support

provided in the borough by Hounslow and Richmond Community Healthcare NHS Trust’s One You Hounslow health and wellbeing service by

o Supporting at least 1200 numbers of 4 week quitters annually including specific targets for routine and manual (240), those experiencing mental health conditions (45) and pregnant women (30)

o Educating up to 1000 children and young people on the dangers of smoking and tobacco use

o Offering Making Every Contact Count (MECC) approach through very brief advice training (Level 1) and stop smoking advisor training (Level 2) to frontline staff

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o Ensuring outreach programmes are provided across the borough to engage and reach communities widely

o Ensuring services are provide in various locations that most benefit residents eg local groups in target areas, GPs, pharmacies, youth services etc

o Enhancing the referral pathways across healthcare organisations, community services, voluntary organisations, workplaces, local business, faith groups and other stakeholder organisations

the work with local acute and maternity service at from West Middlesex University Hospital provided part of the Chelsea and Westminster Hospital NHS Foundation Trust to continue and further strengthen through the NHS Long Term Plan by :

o signing up to a smokefree NHSo Offering mandatory carbon monoxide tests to all newly expectant motherso Offering advice and onward referral to specialist stop smoking midwife or the

One You Hounslowo Offer second hand smoking advice to partners and family of expectant

mothers and provide information on local stop smoking support o Encouraging expectant mother to sign up to the smokefree homes and cars

pledgeo supporting patients admitted to hospitals with stop smoking support including

seamless referrals to local One You Hounslow serviceo promote level 1 training to all staff o increased number of level 2 trained stop smoking advisors (and specialist

smoking in pregnancy advisors)

Continue to engage and work in partnership with various council organisations e.g. housing, parks and leisure and open spaces, adult education, social care, regeneration to signpost to local support, promote smokefree environment and smokefree homes and cars through their services

Example

Work across maternity, health visiting and school nursing teams to ensure every contact with a smoking adult in a home where children live is offered information on local support to quit, encouraged to sign up to smokefree homes and communicate the dangers of passive smoking

Example

Use of innovative technology to support smokers to quit such as skype consultation

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London Borough of Hounslow

EducationWaste and recycling

Transport

Planning and enforcement

HousingParks and

leisure

Health and social care

Employment

Communications

Regeneration

Ensuring all tobacco used in the borough is lawfully permitted. This work will be robustly monitored through the council’s

o planning, licensing and enforcement department who provide information and advice to local business such as smoking in public spaces, setting up local shisha bars/lounges, sale of tobacco to over 18 to ensure local business adhere to the law

o enforcement when business fail to comply after information and advice is provided with notice of improvement

o trading standards department who are responsible for ensuring illicit tobacco is not traded locally through wide range of initiatives such as raising awareness of illicit tobacco through training and education taking part in the annual Pan London Campaign ‘Stamp it out’ to working in partnership with local business to ensure that they are not

trading illicit tobacco joint operation with police and HMRC in ceasing illicit tobacco in the

borough

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Marketing and engagementHounslow Tobacco Control Plan 2019-2023 will support the national and regional tobacco control campaigns to ensure the key messages of the campaigns reach wide across the borough. The boroughs MARCOMMS group will lead on promoting Public Health England (PHE) campaigns and ensuring partners are engaged in this process as well as using innovative communication methods including digital such a display screens across various settings, social media, email and newsletters. Behaviour change techniques will be embedded across various marketing and communication channels to target opportunistic life transitions such as moving home, pregnancy, attending higher education, changing employment and receiving a health check.

Actions: 1-2 campaigns to be run per year using the most effective communication channels

to reach the smokers in the borough led by MARCOMMS group All stakeholder organisations request to support and augment campaigns All frontline organisations including voluntary sector to ensure that staff have the

knowledge and information about the stop services available and how to refer or signpost people to them

Use a range of communication channels to reach people supported by local data and community experts on the best way to communicate using, printed materials, easy read materials, display screens, digital platforms such as websites and social media, text messages, email, regular newsletters and face to face events,

Evidence base, data and monitoringThe local tobacco control initiatives will be based on the PHE’s Local Tobacco Control Profiles to ensure the programmes are targeted at the most needed. Use local intelligence such as GP data, MOSAIC profiling tool and other local data available to ensure effectiveness of the programmes.

To monitor the progress of the Tobacco Control Plan 2019-2023, PHE’S CLeaR assessment tool will be utilised to evaluate the effectiveness of local tobacco control initiatives and benchmark the progress against local and other boroughs over time. The tool will provide an opportunity to choose an area to ‘deep-dive’, such as initiatives locally to support stopping smoking during and after pregnancy, in acute and maternity settings, in mental health settings and illicit tobacco. CLeaR stands for three linked domains: Challenge the existing service provision and if they are fit for purpose and are grounded

on strong up to date evidence base

Example

To provide information on all local tobacco control initiatives to new social housing tenants via their handbook

Example

Use GP data and MOSAIC data to establish best form of communication with patients registered as smokers and invite them to local One You Hounslow specialist stop smoking

support

Example

Contribute to the Pan London Illicit Tobacco Group and deliver the ‘Stamp it Out’ campaign to raise awareness of illicit tobacco in the borough

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Leadership for supporting action on tobacco control Results to illustrate outcomes against national and local priorities.

Actions:

Utilise MOSAIC and other targeting data to reach those who would benefit most Continually review local services to ensure that most up to date and evidence

based approaches used Make use of behavioural insight approaches to increase effectiveness Undertake at least one CLEAR assessment of the Hounslow services in the plan

period (i.e. between 2019 and 2023)

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Summary and monitoring:

The Hounslow Tobacco Control Plan 2019-2023 set out the aspirations of creating a smokefree generation. Tobacco use have significant implications to health of individuals and burdens families and the society. To reduce inequalities, tackling tobacco use is imperative.

This Hounslow Tobacco Control Plan 2019-2023 builds on the successful work of reducing smoking prevalence in the borough and focuses on both quick wins and long term systems change.

The implementation of this policy will be governed through the Tobacco Control Alliance and an action plan will be develop accordingly to achieve short, medium and long term outcomes.

Monitoring:An annual report of this plan will be presented to the Hounslow Health and Wellbeing Board. The report will cover all action areas and also data on the following on indicators:

Smoking prevalence in Hounslow and the vulnerable groupso Routine and manualo Pregnant women who smokeo People who experience mental health

Number of 4 week quitters includingo Routine and manualo Pregnant women who smokeo People who experience mental health

Number of children and young people educated on the dangers of smoking Number of smokefree homes and cars pledge Number of people trained on level 1 and level 2 smoking cessation Number of campaigns supported i.e. STOPTOBER, Stamp it out, No Smoking Day

The report will also include other outcomes such as:

New initiatives on tobacco control through joint partnership working Implementation of new approaches embedded within practice to improve the

smoking prevalence in Hounslow and the illicit tobacco traded in the borough

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Appendix 1

Appendix 1: Stakeholder Engagement event workshop May 2019:

Stakeholder engagementA local stakeholder engagement workshop took place in May 2019 to consult partners and stakeholders on the priorities and direction for the new Tobacco Control Plan 2019-2023.

Stakeholders form a wide range of organisations were invited. Those who attended include, local councillor, ex smoker/service user, One You Hounslow, Hounslow Improving Access to Psychological Therapies (IAPT) service, Cardiology and COPD consultants from West Middlesex University Hospital, Hounslow CCG, youth social worker, Brentford Football Club Community Sports Trust, HMRC, Hounslow COPD group, London Borough of Hounslow’s housing, planning and legislation and health and social care teams.

The workshop was organised to gain insights on three major topics:

Prevention Workshop 1: Towards a smokefree Hounslow – how could we improve the borough’s efforts on: a) reducing smoking prevalenceb) use and trading of illicit tobaccoc) use of dangerous niche tobacco/smoked or smokeless tobacco (shisha, chewing tobacco, beedi, paan, Ghutka)

Engaging the most vulnerable Workshop 2: How do we successfully engage with:a) Pregnant women, their partners, family and friendsb) Routine and manual workersc) Black and minority Ethnic Groupsd) Young peoplee) People experiencing mental health problemsf) People with learning and/or physical disabilitiesg) Patients in hospitals

Stakeholder commitment (a whole systems approach) Workshop 3: What level of commitment could stakeholders commit toa) Smokefree policy, workplaces, homes and environmentb) Supporting local and national smokefree campaigns c) Referrals to servicesd) Increasing awareness of illicit tobacco (i.e. trading, reporting) The insights from the were collated and arranged in thematic objectives as illustrated in the table below.

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