Agenda item

(A report by Philip Garner, Health Improvement Programme Manager, which invites the Committee to consider a proposed decision on the re-procurement of Local Stop Smoking Service (LSSS))

Consideration was given to a report on the Local Stop Smoking Services (LSSS) Re-procurement which was due to be considered by the Executive Councillor on 17 January 2018.

Members were advised that there were two main aspects to consider, smoking cessation and tobacco control, and there were both short term and long term benefits to the re-procurement of this contract.  It was reported that this service had already been re-procured once, and there had been some efficiencies gained at that time.  It was highlighted that it was not proposed to look for any further efficiencies.  It was planned to offer the service to around 5,500 residents in Lincolnshire, and around 19-20% of Lincolnshire's population were smokers.

The service would aim to target those who required additional support to stop smoking, as evidence had shown that people were more likely to be successful if they had support rather than if they tried to do it themselves.

Members were advised that the current providers had been struggling to hit targets.  It was also reported that some big variations to the contract had been made during the life of the contract due to NHS changes, and so there could be some procurement risk to extending rather than re-commissioning.  It was also noted that the current contract was payment by results only, which had led to delays in payments and also the provider had not been able to invest in services and so were currently running the contract at a loss.  It was planned that the new contract would be a very similar to the current model with a prime provider and single point of contact.

Members were provided with the opportunity to ask questions to the officers present in relation to the information contained within the report and some of the points raised included the following:

·         It was queried how the service would engage with people whose first language was not English and going forward, how would these groups be engaged with.  Members were advised that information was offered in other languages but some nationalities did not have the same sense of harm that the British did about smoking.  It was noted that there was still more education to do.  However, the authority would be able to procure this service every couple of years to ensure that there was a more targeted approach.

·         Clarification was sought regarding the figures stated in paragraphs 1.1 and 1.5 which set out the costs of smoking to the county.  Members were advised that these costs were extrapolated from national data.

·         It was confirmed that there was a net benefit to the national economy from smoking.

·         In terms of the contract going forward, there was a move away from the pure payment by results model as the provider was making a loss and was unable to invest in services.  It was queried therefore, whether there was a risk from going in the other direction with no incentive to be efficient or produce results.  Members were advised that it was planned to have a combination, with a basic payment and then additional funds for performance.

·         In terms of illicit and illegal tobacco, it was queried whether there was work being carried out with the Police and other services to tackle this market.  It was noted that work had been very effective in identifying retailers who were supplying illegal tobacco products.  However, there was still more to do in tackling the organised crime behind it.

·         It was also highlighted that there was a safety issue with the use of illegal cigarettes as they were not manufactured to the same standard as western made ones.

·         There was a need for balance in terms of pricing, so prices were not so high that they drove people to seek out illicit tobacco.

·         It was queried how people were targeted by this service and members were advised that people mainly self-referred, and many were signposted by health care or social work professionals.  A lot of research had been carried out about a person's readiness to change, and there was a finite window for how long that motivation lasted.  It was also noted that these services would be highlighted to smokers by GP's, or when they were admitted to hospital, or female smokers when they registered as pregnant.

·         Members were advised that there were options which could be put in place if more people than expected decided to stop smoking.  It was noted that expected numbers were generally based on past usage unless there had been a large change e.g. the increased popularity of e-cigarettes.

·         It was expected that demand for the service would increase as people did not always quit successfully the first time.  It was also noted that smoking prevalence was declining slightly.

·         It was commented that quitting smoking was a matter of willpower.  With smoking habits declining in young people it was suggested that that there was a need to emphasise to young people that smoking was an expensive and dangerous habit. It was also suggested that prices should be increased as a deterrent.  One member doubted whether this amount of money should be spent on this service, as people could find ways to quit by themselves if they had the willpower to do so.  However, members were reminded that there were always people who needed more help than others and those that could create harm for example smoking during pregnancy.

·         It was queried whether group support, similar to weight loss groups, had been tried, as people were more likely to be successful if they had other people to support them rather than doing it on their own.  Members were informed that the current provider was capable of offering group support, and there was some evidence of success with this method.

·         It was commented that it could be prohibitive to raise prices too much as it could drive people to the black market.

·         It was queried whether any work had been done around whether smoking rates dropped during 'flu season'.  Members were advised that health professionals would take advantage of every opportunity to encourage people to stop smoking and remind people that when theyre ill they would recover better if they stopped smoking.

·         In terms of use of e-cigarettes, it was highlighted that some people may have stopped smoking but they may have increased their intake of nicotine.  It was acknowledged that there was not enough research into the long term effects of using e-cigarettes to determine whether they really were a better option than smoking.

·         It was important that the right contract was put in place and it was requested that officers come back to the Committee once the contract was in place and had been established.

RESOLVED

1.    That the Committee supports the recommendations to the Executive Councillor as set out in the report.

2.    That comments setting out support for the recommendations be passed to the Executive Councillor for consideration.