Conducting a Health Needs Assessment for smoking cessation services in Oxfordshire

When Oxfordshire County Council wanted to better understand the demand for and supply of local smoking cessation services, Solutions for Public Health was commissioned to undertake a Smoking and Tobacco Control Health Needs Assessment (HNA).

As public health specialists within Arden & GEM’s Health and Care Transformation consultancy, Solutions for Public Health assessed the need for and access to stop smoking services in Oxfordshire.

The resulting HNA highlighted service gaps and made recommendations to the Council, taking account of local needs and national best practice. These recommendations will inform future commissioning decisions around models of care and allocation of resources.

The challenge

Smoking rates in Oxfordshire have been falling roughly in line with the national picture, but this overall reduction conceals variation in some population sub-groups. For example, higher smoking rates were reported for people working in skilled manual and semi-skilled/unskilled manual roles, people with long-term health conditions and people admitted to opiate misuse treatment.

The HNA was commissioned to:

• Review national and local strategy, policy, guidance, evidence and best practice concerning interventions that:
  • prevent people starting smoking
  • support people to stop smoking
  • enhance tobacco enforcement and regulation
  • create smoke free environments
• Describe of the needs of the Oxfordshire population in relation to smoking
• Assess the demand for stop smoking services
• Consult with stakeholders to identify the barriers and enablers to delivering stop smoking services to different priority populations and their views on development and improvements required
• Describe any obvious gaps in current provision
• Make a series of recommendations for consideration about provision of stop smoking services across different priority populations.

Our approach

The Smoking and Tobacco Control HNA needed to incorporate information from a wide range of sources in order to understand the health needs of the Oxfordshire population in relation to tobacco smoking and how these were currently being met.

Reviewing policies and practice
Global and national policies, guidance and best practice relevant to tobacco smoking from bodies such as the World Health Organization, Department of Health and Social Care, National Institute for Health and Care Excellence and Royal Colleges – along with recent research literature – were accessed through hand searching, collated and summarised. Local policies and strategies were accessed and reviewed.

Providing a demographic overview
Quantitative data using national and local sources was used to provide a demographic overview of the characteristics of the Oxfordshire population and epidemiological perspective of smoking prevalence and harm. Key risk factors/indices of smoking inequality such as age, gender, deprivation, ethnicity, socioeconomic classification, employment and housing status were presented by district and comparisons made between Oxfordshire, the South East region and other similar local authorities.

Gathering stakeholder perspectives
Qualitative information was gathered from conversations with stakeholders structured around specific questions and through an online survey. Stakeholders included professionals delivering stop smoking services within the NHS, in the community and within specific settings such as drug and alcohol services. Questions focused on how services operate, how they link with other services across sectors and geography, including the perceived strengths and weaknesses of services, inequalities in who accesses services, perceived gaps, trends, effects of the pandemic, and suggestions for improvement.

The production of the HNA was carried out in conjunction with key members of the County Council’s public health team and overseen by the multi-agency HNA project group.

Outcomes

The clear and comprehensive Smoking and Tobacco Control HNA produced by Solutions for Public Health has given Oxfordshire County Council the evidence and insights needed to commission effective future stop smoking services.

In Oxfordshire, one in ten adults are estimated to smoke, equating to 61,000 people. Between 2017 and 2019, there were approximately 1,700 deaths attributed to smoking in Oxfordshire. This means that around 570 people are dying due to smoking in Oxfordshire every year.

Stop smoking services in Oxfordshire continue to support people to quit. This further reduces the numbers of people who smoke in the county where rates are generally relatively low.

The HNA identified that as Oxfordshire smokers tended to belong to specific groups such as those with mental ill health, those misusing drugs and those working in unskilled or manual jobs, there was a need to tailor stop smoking services to these particular groups in a way that improved access and ease of quitting. These groups were less likely to access the usual generic stop smoking services on offer.

There is also a need to target children and young people to prevent them from taking up smoking and vaping. It is estimated that 28,500 Oxfordshire children live in smoking households and each year around 880 children start smoking. This was something that Oxfordshire had just started to address in schools prior to the HNA although targeted support aimed at smoking households was not yet in place.

The HNA identified areas where there are barriers to implementing the existing tobacco control strategy including not fully utilising the full range of stop smoking products, getting agencies to work more closely together, and limited understanding of stop smoking services and signposting among health and social care professionals.

The HNA made 27 recommendations to address the issues identified by the project activities. These recommendations will support the development of a specification for a new stop smoking service in Oxfordshire when it is recommissioned in the near future.

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