Agenda item

– Report following review – Liann Brookes-Smith

Berni Lee introduced this item providing a presentation in addition to the circulated report. The presentation covered the following areas:

• Smoking and birth outcomes
• Estimated costs
• Context for the smoking in pregnancy (SiP) review
• Recent trends in performance, highlighting the challenges in the north Warwickshire area
• Objectives and overview of the SiP review
• Review findings, showing the higher numbers in the north of the county
• Characteristics of smokers vs non-smokers
• Access to smoking cessation services – showing that only 20% ceased smoking
• A slide disaggregated this by district/borough area
• Smoking at the time of delivery, also disaggregated by area and the number that ceased smoking during the course of their pregnancy
• Engagement and responses from staff surveys including key messages
• Compliance with NICE guidance
• What needs to change? This was based on the review findings
• What does the evidence say?
• Key recommendations
• Warwickshire smoking estimates

The Coventry and Warwickshire SiP review was commissioned by the local maternity and neonatal system (LMNS) board in order to provide a detailed picture of the women who smoked during pregnancy, the support they had received and to identify any further measures that could be taken to enable them to stop smoking.

The report set out sources of insight, differences in the midwifery workforce at the three acute hospital trusts, changes to commissioning arrangements and key issues and findings under the headings of:

• Scale of the problem
• Failure to meet targets
  
  
• Epidemiology
• Access to specialist support
• Compliance with guidance
• Staff engagement
• Evidence

Key areas to be addressed and a number of key review recommendations were provided. There were financial implications associated with the need to identify a resource to support dedicated strategic lead(s) for the Smoking in Pregnancy and Tobacco Control/Smoke-free 2030 initiative across Coventry and Warwickshire

A discussion took place on the following areas:

• A request for the presentation slides to be circulated.
• Dame Stella Manzie noted the progress made and resources in place at SWFT. The use of transformation funds to contribute towards posts at GEH and UHCW was welcomed. Whilst she couldn’t give a commitment to funding at this meeting, it would be taken back to UHCW and she agreed that a strategic smoke free lead across the system made a lot of sense. The Chair agreed that one post on a partnership basis was required.
• Councillor Humphreys agreed that a lead was needed who could give time and advice.
• Sharon Beamish saw this as a priority area and would refer it back to the Warwickshire North CCG.
• Councillor Sally Bragg voiced concerns about vaping and e-cigarettes. The report only referenced smoking and she was concerned about the impact of vaping on both children and expectant mothers.
• Berni Lee responded to the points raised. On funding, she referred to the transformational monies which may be allocated to the three trusts. At the LMS board, she had questioned whether some could be earmarked to fund the coordinated approach.  She acknowledged Councillor Bragg’s points about e-cigarettes. They did contain nicotine, but not carbon monoxide, which was the significant cause of harm. As such they could be viewed as a temporary step towards total cessation.
• Councillor Falp stated not only the health benefits for expectant mothers and their families, but also the financial benefits.

Resolved

That the Health and Wellbeing Board:

1. Supports the adoption of a Tobacco Control/Smokefree 2030 programme of work including smoking cessation in pregnancy and supports the use of resources to address this priority.

2. Supports the adoption of a place-based, system-wide approach that addresses the inequalities and social norms that result in higher smoking in pregnancy rates in some areas of Warwickshire (e.g. Nuneaton), as compared to others.

3. Supports the co-production of a new model for specialist smoking in pregnancy services, embedded within maternity services, that provide rapid access to specialist advice and NRT.

Identifies potential funding sources for a strategic LMS Smokefree Pregnancy Lead / Programme Manager to plan and drive the implementation of a system-wide approach to tackling SiP across Coventry and Warwickshire.