The purpose of this report is to inform Health and Wellbeing Board on the recent publication of the ‘The Khan review: Making smoking obsolete’ (Appendix 1) and the findings from the recent smoking needs assessment (Appendix 2) and for the board to endorse the recommendations set-out within the report.

The chair introduced the report and Luke Bennett (Senior Commissioning Officer) presented, providing a summary of the Khan review: Appendix 1 The Khan Review Summary , which broadly recommended:

·         Increased investment for interventions

·         Increasing the age of sale

·         Offering vaping as a substitute for smoking

·         Improving prevention in the NHS

A local context was then provided, including a brief overview of work being undertaken in the area.

The senior officer went through recommendations for the board, which included:

1.       That the Health and wellbeing Board welcomes the publication of Javed Khan’s Independent Review into smoking

2.       Health and wellbeing board supports the recommendations from the Khan review and the resulting actions to help make smoking obsolete in England and Herefordshire.

3.       Health and wellbeing board member organisations are asked to actively promote and engage in activity to work towards making smoking obsolete in Herefordshire.

The chair thanked the senior officer for his presentation. Concerns were raised about the available manpower to implement some of the recommendations in the Khan review.

The chair asked the managing director of Wye Valley NHS Trust about the Wye Valley Trust’s response to smoking in pregnancy figures in Herefordshire, which were above the national average.

The managing director of Wye Valley NHS Trust explained that recent data showed the number of pregnant smokers was going in the right direction and that hopefully this would be a trend. Carbon monoxide monitoring of pregnant women was also helping the situation.

The managing director of Wye Valley NHS Trust said that this was a broad area and that what they were already doing was working, but there was a need to prioritize and focus on areas of concern.

Hilary Hall (Corporate Director Community Wellbeing) endorsed what the managing director of Wye Valley NHS Trust had said and suggested that trying to do everything could result in things generally being done less well. By focusing on one or two priorities, such as smoking in pregnancy it would be possible to achieve something significant and make a demonstrable gain.

Cllr Toynbee also agreed with the need for focus on key areas of concern. Additionally, Cllr Toynbee raised concerns about the promotion of vaping contained with the Khan review. She acknowledged the argument that vaping was an alternative to smoking or an aid to giving up, but she had serious concerns about the explosion in popularity of vaping in school children and the damaging chemicals they were being exposed to as a result.

The director of public health agreed with the need for focus on areas of concerns, but also urged mindfulness in relation to areas where Herefordshire was faring well on a national basis, as this could potentially mask important inequalities in the population and that a business as usual approach was also needed to ensure those areas where Herefordshire was in the average range were still monitored closely, as they could often have significant impact on death rates and illness.

The director of public health noted Cllr Toynbee’s comments about vaping and pointed out that in public health vaping is often seen from a harm reduction perspective rather than as being a gateway into smoking and it was important that messages about vaping were framed properly.

The senior officer also emphasised the importance of not neglecting fundamental issues relating to smoking such as the fact that 66% of smokers start before the age of 18. Getting to the root and stopping people before they start would have broad and wide benefits.

The director for ICS development noted that the local maternity and neonatal system (LMNS) would have stopping smoking during pregnancy as one of their priority work areas, so it was already a business as usual priority that was operating within the system.

A discussion took place about recommendation ‘d’ it was felt that there were existing mechanisms in place including; ongoing NHS tobacco dependency work, steering groups and the forthcoming Integrated Care Strategy that would help in promoting and engaging in activity to work towards making smoking obsolete in Herefordshire, but it was not felt necessary to amend the recommendation.

The report recommendations were proposed, seconded and approved unanimously.

APPROVED

That:

a) Health and Wellbeing Board welcomes the publication of Javed Khan’s Independent Review into smoking and supports the development of an action plan to help make smoking obsolete in Herefordshire;

b) Health and Wellbeing Board acknowledge the findings from the recent smoking needs assessment and commit to supporting Herefordshire to become Smoke Free;

c) Health and Wellbeing Board actively support the need for a whole system approach to smoking at primary, secondary and tertiary prevention levels, and

d) Health and Wellbeing Board member organisations are asked to actively promote and engage in activity to work towards making smoking obsolete in Herefordshire, including supporting the establishment of a working group to produce an action plan reporting into the board annually.