10.10am

To receive a report and presentation from Cllr Mark Lygo, Cabinet Member for Public Health & Equality, Director of Public Health, Ansaf Azhar, and Derys Pragnell, Consultant in Public Health, in respect of the work already achieved as part of the Tobacco Control Strategy, and the reconfiguration of the Strategy, post-pandemic.

The Committee is asked to consider the report and agree any recommendations it wishes to make in response.

Cllr Mark Lygo, Cabinet Member for Public Health and Equalities, Ansaf Azhar, Director of Public Health, Derys Pragnell, Consultant in Public Health, and Katharine Eveleigh, Health Improvement Practitioner, attended to present a report to the Committee in respect of the work already achieved as part of the Tobacco Control Strategy, and the reconfiguration of the Strategy, post-pandemic.

Cllr Lygo, Cabinet Member for Public Health and Equalities explained the context of the report. Smoking was the leading cause of preventable death in the UK, and the single greatest modifiable risk factor in cancer, COPD, miscarriages, still-births and birth anomalies. To tackle this, in March 2020 the Council adopted a five-year Smoke Free Strategy with the ambition of reducing the prevalence of smoking to below 5% by 2025. Owing to the pandemic, progress towards this goal had been slower than originally envisaged.

Ansaf Azhar, Director of Public Health, noted that the health impacts of smoking were disproportionately experienced by those experiencing disadvantage in society. For instance, whilst Oxfordshire’s prevalence at the launch of the strategy was below the national average at between 10-11% those experiencing problems with serious mental health were at around 30%, likewise social housing tenants, and manual workers over 20%. The Council’s approach, therefore, needed to be targeted rather than universal. The Council had had the efficacy of different interventions independently assessed to identify the most effective ones for inclusion within the strategy. Evidence showed that a focus broader than simply smoking cessation services was required to underpin the ability of the majority of smokers to quit. This breadth was enabled by the strategy being a partnership document, signed by all the local councils, as well as local health partners, with specific actions for each partner. The effect of Covid was to put a complete stop to many of these actions for over two years. As a consequence, reaching the 5% target would be significantly more challenging. Nevertheless, not all actions had been stopped, and the importance of reducing smoking numbers meant it was important to keep on striving to meet the target on schedule. Looking from a national perspective, the Khan Review’s recommendations provided much greater impetus for smoking cessation than previously, and it was important to keep up the momentum in order to capture as much benefit from the Khan Review interventions as possible.

Derys Pragnell, Consultant in Public Health, presented the data as known at the time, which owing to Covid, was a little further out of date than would be expected. Smoking rates overall were declining, but with very significant spikes amongst a number of demographics, including those with serious mental health problems, routine manual workers and social housing tenants. Country of birth had a significant impact, with those born in Eastern Europe also displaying high rates. Following its habit of reviewing its strategy in light of new guidance, the Tobacco Control Alliance, made up of the County and District Councils, and health partners had recently begun co-producing interventions to help social housing tenants stop their smoking habits. Additional work was being undertaken with Trading Standards to reduce under-age sales of e-cigarettes. Key areas of focus for the coming year were expected to include enhancing the integration of smoking cessation services with the maternity pathway and early years, a review of provision for young people, developing smoke-free areas, improved enforcement and a Stoptober campaign about mental health and wellbeing.

The Committee explored ability of stigma to reduce smoking, but also its impact in preventing people from coming forward for treatment for smoking-related diseases. Ansaf Azhar confirmed that the focus on the Strategy was not to build additional stigma but to enable smokers to give up. Katharine Everleigh, Health Improvement Practitioner noted that the Council and system partners followed nationally-recognised good practice in the form of evidence-based questioning which was designed not to cause stigma.

E-cigarettes were a complex issue for the Committee, specifically the tension between their usefulness as a tool for smoking cessation amongst tobacco smokers, and the ‘gateway’ effect of younger people taking up vaping without having previously smoked. Ansaf Azhar recognised the importance of e cigarettes in helping existing smokers quit, and their dangers as a gateway to nicotine consumption. The Committee was informed that a national review had concluded that whilst not absolutely safe, e-cigarettes were 95% safer than tobacco cigarettes. It was important, therefore, that their use as a tool to help tobacco smokers quit was not undermined, but it was also recognised that the work was necessary to prevent young people taking up vaping, particularly with the mistaken view that doing so was risk-free. This was being undertaken in conjunction with schools via anti-addiction training and work by School Health Nurses, as well as existing programmes from the Fire Service and Trading Standards but the need for more work, particularly focusing on the harm of addition rather than direct health harms, was necessary.  It was requested and agreed that feedback on this additional work with children and young people would be provided to the HOSC.

The challenge of developing coordinated policy across all schools within a fragmented educational context which allowed academies to set their own policies was explored. Cllr Lygo drew attention to the fact smoking was not allowed by law in any school but that the Council was working with schools to try and develop smoke-free school gates.  If HOSC members had particular concerns about specific schools the topic should be raised with the relevant Head Teachers. In the longer-run, however, the Tobacco Control Alliance would review recently-changed advice from NICE on the most effective approaches to working with schools and parents before embarking on specific actions to address these issues.

In view of the cost of living crisis and the growth in demand for illegal tobacco it would engender, the adequacy of the £6000 of fines issued by the Council for selling illegal tobacco was queried. It was recognised by Ansaf Azhar that with enforcement forming one of the four pillars to the strategic approach, more needed to be done and would be looked into on the back of Scrutiny’s challenge. Equally however, it was noted that other alliance members, such as the districts, also were involved in issuing fines through their licensing inspections.

The Committee also queried the degree to which the Council was building on the opportunities afforded by the cost of living crisis to develop relationships with stakeholders, such as advice centres and food banks, and through them with members of key disadvantaged communities.  Though work was being undertaken with social housing providers, the suggestion of food banks was recognised as valuable and would be looked into as part of an assessment as to which services were being accessed and how every contact could be made to count.

More information was sought in relation to the actual nature of the work being undertaken with social housing providers. Given that it had only recently begun, to date it included training of housing officers around smoking cessation conversations, and a review of the information available to tenants. However, a key element of work which was yet to be undertaken was co-production with tenants. The outcome of this would heavily inform the work undertaken in the future.

The Committee explored whether the community-basis of much of the work to stop smoking would translate to funding from the BOB ICS coming to Council services. It was noted that the Chair of the BOB ICS was Javid Khan, the author of the Khan review, an individual keen to see the entire BOB ICS area become smoke-free. The Inequality Forum of the BOB ICS was prioritising smoking cessation but it was felt that interventions when people were entering into the healthcare service for elective surgeries, mental health or maternity would likely be more effective than community-based services.

The Committee questioned how much, in light of Covid, individuals who were vulnerable owing to smoking-related health conditions were getting the support they needed. This, it was explained, would be a key part of the BOB’s ICP strategy, but more immediately increased numbers of health checks were being made available.

Finally, the realism of the modelled reductions in smoking were challenged. It was accepted that the models had been developed prior to Covid, meaning possibly some disruption. However, the models would be kept under review, and as a counter-balance to the negative impacts of Covid, a lot effort was being invested nationally and locally into smoking cessation, efforts which would reasonably be expected to show clear reductions in smoking.

The Committee AGREED to:

1)    Give its support to the proposed amended actions to the Smoke Free Strategy Action Plan

2)    Recommend to the Health and Wellbeing Board that work to consider how the smoke-free agenda could be progressed further in light of the cost of living crisis be undertaken, as well as work with younger people around the addictive potential of e-cigarettes.

3)    To emphasise to the Health and Wellbeing Board the importance of meaningful co-production in service and strategy planning, as well as the avoidance of stigmatisation as a tool for smoking cessation.