Agenda item

Report and Presentation of the Corporate Director of Adult and Health Services and the Director of Public Health, Durham County Council.

The Board received a report and update presentation from the Corporate Director of Adult and Health Services and Director of Public Health, presented by Katie Bewick and Andrea Bracewell, Public Health Advanced Practitioners, the current position and next steps (for copy see file of minutes).

The Director of Public Health, A Healy introduced the Public Health Advanced Practitioners and Alisa Rutter OBE, Director of Fresh and Balance, the regional programme dedicated to reducing the harm from tobacco and alcohol in the North East of England.  She noted apologies from Councillor C Hunt and explained that there would be a video featuring Councillor C Hunt speaking at the All-Party Parliamentary Group (APPG) on smoking and health, held on 13 March, ‘No Smoking Day’.  She noted that the powerful videos produced telling Councillor C Hunt’s personal story with cancer, had been used regionally and now being used nationally.

K Bewick and A Bracewell asked the Board a series of questions relating to smoking and health, namely: was smoking the largest factor in health inequality in England, yes; did stopping smoking benefit both the pregnant woman and unborn child, yes with immediate benefits; was vaping as harmful as smoking, no, however, it was not without risk and should not be encouraged in children and non-smokers; whether nicotine was harmful, no, rather it was addictive, the other chemicals in cigarettes being harmful; and that quitting smoking would result in people becoming stressed, false in fact overall stress levels were found to decrease if someone stopped smoking.

The Board noted a video of Councillor C Hunt speaking as regards her experiences with cancer as a consequence of smoking at a meeting of the APPG on smoking and health, 13 March 2024.

The Director of Fresh and Balance noted there were a number of people at the APPG event, with Parliament shown the campaign videos featuring Councillor C Hunt.  She explained that Councillor C Hunt had spoken from the heart as regards her experiences.  She reminded the Board that smoking was the single greatest cause of health inequality and early death in England.  She noted the loss of her own farther and the importance of ensuring that the issue of smoking and the impact on health was not forgotten amongst other important public health messages.

J Pearce entered the meeting at 9.50am

The Director of Fresh and Balance noted that partner organisations in Durham had responded in the Autumn on consultation in connection with age of consent for smoking, including Further and Higher Education organisations.  She explained that the Government had published the Bill this morning at 9.30am, with the key aspects being that it was proposed that the age of sale be increased such that children born in 2009 would never be able to be legally sold tobacco products.  She noted the importance of this, adding that currently 350, 18-24 year-olds became addicted every day, and with 200 people dying every day in England as a result of smoking-related illness.  The Director of Fresh and Balance added that public response in the North East had shown that 72 percent supported the proposed age of sale restrictions.  She added that the restrictions would significantly impact the prevalence of cancer and represented a once in a lifetime opportunity.  She noted that Parliament would be voting on the matter, and it was important that young people were not criminalised.  The Director of Fresh and Balance explained that there would be press releases and social media posts to coincide with the announcement of the Bill, and it was very important that all MPs, Councillors helped to publicise and support the Bill. 

The Director of Fresh and Balance explained that while vaping had been a ‘gamechanger’ in terms of helping people to quit smoking, we did not want young people starting to smoke or vape, and it was hoped that changes would be made to packaging and flavours so as not to appeal to young people, with further consultation in this regard.  She thanked the Director of Public Health and all her Team for their hard work over the years, noting the work had been ‘a marathon not a sprint’, adding that it would be important to ensure that there was no distraction from the tobacco industry in terms of the positive impact the Bill would have on people’s health.  She noted the excellent work of the Durham Youth Council and thanked them all for their contributions, with their personal stories of losing grandparents to smoking related illnesses, such as Chronic Obstructive Pulmonary Disease (COPD).  The Director of Fresh and Balance noted that it was hoped that the Bill would be debated before the summer recess at the end of July 2024.  She added that if any members of the Board had stories to share, they could with Fresh or the Public Health Team.  She noted that the Chief Medical Officer had written to warn of the dangers of smoking and links with dementia, a risk that many were not aware of.

The Director of Fresh and Balance reiterated that the support of the Health and Wellbeing Board, as well as from Durham MPs in relation to the age of sale legislation was extremely helpful and if any Councillors wished to add their support to an open letter, in conjunction with Cancer Research UK, that would be very helpful.  She also gave her thanks for the work of Durham Trading Standards in their campaign looking at illegal tobacco, adding that partners could use the materials used in the campaign if they thought it may be helpful.

K Bewick reiterated the thanks to the Board for their support for ‘stopping the start’, noting that to reach the target of five percent prevalence of smoking by 2030, then there needed to be around 49,600 fewer smokers.  She added that there would be an increased push in terms of communications to help speak to those harder to reach individuals.  She explained as regards the target of five percent smoking at the time of birth, adding that to reach zero, there would need to 710 fewer mothers smoking at the time of birth.  K Bewick noted that the percentage had already fallen to 14.2 percent from around 22 percent, however, it was still above the national average.  She explained that while prevalence was decreasing, health inequalities were increasing.  She noted the work with the NHS Trusts in our area to look at the cost implications in respect of neo-natal care, to help show the cost effectiveness of interventions to reduce smoking levels.

K Bewick explained as regards some national funding, around £800,000 over five years, to help those wishing to quit smoking.  She asked the Board for support and suggestions and in respect of smoking at the time of delivery.  A Bracewell noted that smoking was a modifiable risk factor and was routinely looked at as part of pre-birth care.  She noted that this was included with other risks and therefore it was how to integrate into that care, and not to just signpost to other services, or note as a lifestyle issue.

The Director of Integrated Community Services, M Laing noted that within the report and the video shown, it was clear that people were more receptive to the idea of stopping smoking in and around major life events, such as the birth of a child, or a significant birthday.  He noted that there had been a lot mentioned in respect of work and campaigns to reach women smokers, and asked how we could also target men at similar points in their lives.  He suggested that Registrars could provide information, at the point births were registered, to include information within any packs they gave out and that women and their partners could be targeted, alongside anyone in the household where a newborn would be living.

A Bracewell noted the suggestion and reiterated that it recognised that smoking was a modifiable risk, and it was important to prevent smoking both pre and post pregnancy, to prevent risk to both unborn babies and young children in their homes.  She added there was work ongoing with the Sexual Health Team, to include information on smoking harm in with the information they provided.

The Corporate Director of Children and Young People, J Pearce noted the important of recognising the impact of smoking in a social care setting, and to be able to reach that cohort, as well as staff we employed or procured the services of.  K Bewick explained it was one of the priorities identified, being able to reach two priority groups within one setting. 

The Corporate Director of Children and Young People noted that the Council operated a ‘Better Health at Work’ scheme, and therefore there would be an element of targeting of our staff and their families in that way.  K Bewick noted that from January 2024, one of the questions asked was ‘do you work for Durham County Council’ and therefore we would be able to track the impact year on year going forward in respect our staff.

P Sutton noted that smoking prevalence in North Tyneside of less than 10 percent and asked whether the difference was solely due to demographics, or whether there was some best practice that could be shared.  A Bracewell noted that one aspect was the demographic difference, however, there was a lot of very good regional work carried out in relation to tobacco, and noted additional posts within anti-natal clinics in North Tyneside which were hoped to be replicated elsewhere in the region.

The Director of Fresh and Balance noted the work and campaigns carried out in Durham were exemplary and she felt that deprivation was a key factor in the county.  She noted an example where financial incentives had made an impact in terms of encouraging pregnant women to quit smoking.  She reiterated that she felt that age of sale legislation would make the largest impact and would represent a generational shift.  She added that it was important to note that the responsibility did not fall solely to those mothers, but also for their whole family.

Councillor T Henderson noted he was the Portfolio Holder for Children and Young People and asked as regards smoking rates in our young people, the work we carried out within our schools, and the impact of vaping, especially in terms of those young people who would never have smoked.  A Bracewell noted that the Team worked very closely with our schools and were consulted in terms of schools’ relationships, sex and health education (RHSE) agenda.  She noted that 2022 data showed both low numbers in terms of smoking and vaping, with 2023 data likely to repeat this trend.  K Bewick noted that while smoking numbers had come down, while vaping numbers were low, vaping prevalence was increasing.  She explained that there would be a survey carried out this year and that schools were been given a lot of information to not only target the school children, but also their wider families.  Councillor T Henderson asked if stopping smoking and vaping on school sites would help, in terms of both staff and pupils.  K Bewick noted that lots of schools already had policies in place, however, smoking and vaping were still visible.  She added it was therefore how schools could be supported in their policies.  The Director of Integrated Community Services noted that should the Tobacco and Vapes Bill come into effect, it would mean that many young people would never be able to legally buy cigarettes, and therefore could there be a shift to target those young people aged 17-22 who would still be able to buy cigarettes. 

He asked about peer-mentoring and whether the additional central Government funding referred to could be utilised in this regard.  K Bewick noted the approach of ‘making every contact count’ and the work to embed key health messages, such as at Durham University, with information being provided within sports and academic clubs and groups.

A Petty noted the Bill going through Parliament was very good and asked whether Officers wished for a call to action from the Board, sharing the presentation and information more widely.  The Director of Fresh and Balance noted the Board’s support on the proposed age of sale legislation would be helpful, as would partners from the Board sharing the information within their organisations, as well as on social media.  A Petty noted as regards illegal vapes, including the use of some synthetic drugs via vaping, and referred to the work of the local and regional Police and Trading Standards in tackling the issue.  The Director of Fresh and Balance noted that people should only buy regulated vapes. 

Deputy Chief Fire Officer, K Carruthers explained that the cost of fire call outs from smoking associated incidents was estimated to be around £2.2million and noted the safety issues with illegal tobacco and vapes.  He added that the Fire and Rescue Service carried out over 18,000 home fire safety visits each year and worked with Public Health colleagues and other partners in terms of information sharing.  He added that the Fire and Rescue Service supported the Bill and would promote via their social media channels.

The Corporate Director of Children and Young People noted the fantastic progress that had been made on the issue of smoking, adding his daughter would be one of those young people that would, should the Bill be passed, not longer be able to purchase cigarettes.  He added, however, that there needed to be clear messaging on vaping, and while it was encouraging that this was helping many people quit smoking it was clear that vapes were being mass-marketed towards children and young people.  He noted feedback from schools and noted more work to be done in terms of the risks of vaping itself, noting a potential entry into smoking, albeit the evidence base was not yet there in terms of risk/harms.  He added he felt that a significant number of people who were vaping had never smoked, and while much less harmful that smoking, messaging should not conflate vaping with being ‘good’.  He reiterated that vape advertising was very prominent and with flavours that would be attractive to young people.

The Director of Fresh and Balance agreed that a lot of the marketing around vapes was not suitable, and the packaging were in many cases ‘sweet-like’, and this was also an element of the Bill.  She added that it was also associated with other ‘risk-taking’ behaviours, with Balance pushing nationally to recognise that alcohol is a Class 1 carcinogen. 

She added that another element was mental health issues faced by many young people, with more research needed in tackling those types of issues.  The Director of Public Health noted that the additional Government funding may be able to be used to look more in depth at schools in those sorts of issues.  She too hoped that the Bill would pass and help provide that generational shift as described.

The Corporate Director of Children and Young People noted that for many young people vaping was novel and therefore it would be important to understand vaping from their perspective in order to prevent non-smokers from becoming vapers.  The Corporate Director of Adult and Health Services, J Robinson noted that disposable vapes were also becoming an environmental issue, and therefore there was an opportunity to link in with the Environment and Climate Change in this regard.  The Director of Fresh and Balance noted that the Department for Environment, Food and Rural Affairs (DEFRA) had announced the intention to ban single use vapes in England, with the Scottish and Welsh Governments looking to introduce similar proposals in the near future.  She added the consultation on the proposed ban for England closed the following Monday, and therefore would encourage people to respond.  She added Fresh had responded to the consultation, and noted she felt that there needed to be a robust response to the consultation in order to get a ban in place.  She added that, in addition, there needed to be the correct sanctions in place from an Environmental Health perspective.  She noted that many Mental Health Trusts had referred to disposable vapes as ‘lifesavers’ and therefore it was important to be clear on what was being supported in terms of a ban.

A Petty noted she would opt out of recommendation (e), in terms of the Office of the Police and Crime Commissioner not being required to seek approval from the Director of Public Health in respect of communications.

Resolved:

(a)      That the contents of the report and support a renewed emphasis on tobacco control work to address the smoking prevalence across the County be noted.

(b)      That the Board continues to support the work of the Tobacco Control Alliance to deliver on its actions, which include the recommendations from the government’s plans regarding ‘Stopping the Start’.

(c)      That the Board champion Tobacco Control to become everyone’s business.

(d)      That the Board champion stop smoking advice and support to become a core part of all council directorates including, but not limited to, social care and housing.

(e)      That the Board support with the vaping agenda, ensuring that there is consistent communication and language used about vaping.  Using the ADPH communications guidance, ensuring that all communications are approved in advance by the Director of Public Health to ensure that vapes are available as a tool to support adult smokers in County Durham to quit, including through the local Stop Smoking Service. 

(f)        That the Board commit to conduct local research to ensure that we add to the evidence-base and continue to provide the best support to local smokers who are wanting to make a quit attempt.

(g)      That the Board commit to support the key recommendations from the quality improvement workshop regarding Treating Tobacco Dependency in Pregnancy to reduce preventable harms to mother and unborn baby.