1. What’s hot and what’s not – commissioning and delivering stop smoking services in England Melanie McIlvar, Director NCSCT UKNSCC, Friday 13 th June 2014

2. Presentation overview Commissioning of services – key findings from national commissioner survey Delivery of services – key findings from provider reviews What service users have told us

3. Acknowledgements Public Health England Tobacco control commissioners who responded to the survey Stop smoking service providers involved in the reviews Jo Locker, PHE Andy McEwen, NCSCT Jennifer Potts, NCSCT

4. Commissioning

5. Commissioning of services National survey of tobacco control commissioners undertaken in early 2014 to: Establish the nature of commissioning arrangements in place for stop smoking services at present Investigate the range of different commissioning models in place Identify the nature of targets set (2013/14), intentions for 2014/15 targets and targets for priority groups Gain insight into payments awarded to providers

6. Commissioning of services Survey sent to every local area (n=152) via a Survey Monkey link Open between 20 th January – 26 th February 2014 Final response rate = 49% (n=74)

7. Survey responses by region

8. Current commissioning Every responding area reported commissioning services for 2013/14 30% (n=22) through block contracts 31% (n=23) multiple providers individually commissioned with specific targets 14% (n=10) large number of community providers directly commissioned with no specific target

9. Commissioning intentions The vast majority (85%, n=56) intended to go through a service commissioning process for 2014/15 Same provider and model = 51% (n=35) Same model but retendering providers = 7% (n=5) Different commissioning arrangements = 24% (n=16) Reasons for not re-commissioning in 2014/15: Existing contract until 2015/16 Integration with ‘lifestyle services’

10. Outcome measures

12. Priority groups Outcomes for priority groups reported by: 81% (n=59) 2013/14 82% (n=54) 2014/15 (intended) Black, Asian and Minority Ethnic Routine and manual workers Unemployed Those living in deprived areas Young people People with mental heath difficulties Prisoners Pregnant women People with long-term conditions

13. Payment schedules OutcomePayment range (£) Respondents n (%) Pre-quit assessment session completed5 - 2010 (14) Quit date set5 - 3018 (24) Post-quit sessions (3 weeks)2.50 – 5 per session3 (0.2) Self-reported 4-week quitter7.66 - 25439 (53) CO-validated 4-week quitter5 - 25440 (54) Enhanced payments-35 (47)

14. Medication provision 1 st line varenicline and combination NRT Combination NRT as standard

15. Potential developments Limiting access 11% (n=8) Harm reduction activities 35% (n=25) Interventions for users of unlicensed nicotine containing products 24% (n=17) already commissioned services to provide behavioural support 70% (n=50) do not currently commission support 6% (n=4) didn’t know

16. Delivery of services – key findings from provider reviews The “hot” and the “not”

17. NCSCT Service Provider Review Patient data assessment Involves accessing patient data to verify four-week quit rates and measure customer satisfaction via a short telephone interview. Provider assessment Involves a self-completion questionnaire to be filled out by the provider and signed off at manager level. Report (review outcome) Issued to the provider / commissioner

18. NCSCT Service Provider Review

20. Delivery of services Amber / red rating% (n) Session time72.7 (8) Staff training54.5% (6) Lost-to-follow up54.5 (6) Quit rate45.5 (5) CO rate45.5 (5) Number of sessions27.3 (3)

21. Delivery of services Likely to be very satisfied with the service Access to medications Weekly sessions Quit rate Support based on a protocol CO testing

22. Client satisfaction “Lovely people…a great service” “My advisor was incredibly helpful and supportive” “Very impressed with the service” “It was an excellent service... all the advisors were very helpful” “Very happy, great support, really liked seeing the advisor each week” “Very disappointed as was ready to quit but heard nothing after being referred” “The guy I saw, he left – and then the service didn’t get back to me”

23. Data verification 943 clients spoken to 71.6% contacts verified Verification rate ranged from 94% - 29%

24. Reasons for non-verification

25. Summary Remains variable and change continues! Stop smoking services, four-week quit outcomes and priority groups are still a focus Services continue to be well regarded by their users Inconsistency in service delivery Good opportunity to revise what the local minimum standards for service delivery are (commissioners) Providers need to consider how they can meet minimum standards Data accuracy requires on-going assessment Importance of independent review

26. melanie.mcilvar@ncsct.co.uk www.ncsct.co.uk