CHIEF EXECUTIVES WORKING GROUP

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					                                    AGMA EXECUTIVE


                                   27 FEBRUARY 2009

    PROPOSED IMPLEMENTATION OF THE HEALTH COMMISSION TOBACCO
                           MANIFESTO

EXECUTIVE SUMMARY

Following the AGMA Executive’s consideration of the GM Health Commission’s Tobacco
Manifesto last year and ‘in principle’ agreement to the content, a further report setting out
plans to implement the manifesto is now being presented for discussion and approval.

The approach suggests a combination of regional, but mainly sub-regional and local co-
ordination of the activities in the manifesto. Local action groups made up of relevant
existing NHS and Council officers at a borough level will lead the work in a way which is
consistent with current local smoking strategies and plans. Where it is more appropriate
and cost-effective to do so, a number of the actions will be explored across GM and this
learning can be shared with the local groups via a forum to be chaired by Director of
Tobacco Free Greater Manchester, who will also monitor collective progress.



SUB REGIONAL CONTEXT, AND VALUE ADDED

Despite the significant progress made to reduce smoking regionally and nationally, it
remains the single most influential risk in developing cancer and coronary heart disease
and is therefore the main driver of reduced life expectancy, especially in socio-
economically deprived communities across Greater Manchester. A collective community
leadership response to this agenda will yield results greater than each borough could
achieve in isolation.

Whilst ‘smoking’ is traditionally seen to be a health and therefore NHS issue, there are a
range of opportunities where Local Authorities (and other agencies such as GMP, GM
Fire and Rescue Service) can use their influence to support and facilitate this agenda. It
is hoped that with the active support of the AGMA Executive, the scope of this influence
can be more clearly recognised and realised, and stronger local and GM alliances
developed around the tobacco agenda as a direct result.


CONTACT DETAILS

This report has been produced on behalf of the Health Commission to support the joint
delivery of the tobacco manifesto within AGMA, across the NHS and with wider partners
in Greater Manchester.




                                                                                            1
                    The approach to implementing the manifesto

1.   Background information and overview

     It was no coincidence that ‘smoking’ was one of the first issues to be considered by
     the GM Health Commission. The risks associated with smoking and exposure to
     second-hand smoke represent the single greatest preventable threat to our
     individual and collective health in the UK. Heart and circulatory disease, cancers
     but especially lung cancer, respiratory disease and other problems like asthma and
     chest & ear infections in children are all evidentially linked to smoking. This is the
     case despite prevalence rates in adults gradually reducing - but the effect is
     uneven, with prevalence in more deprived neighbourhoods sometimes being more
     than double that of the typical borough rate. Smoking is therefore one of the main
     factors contributing to health inequalities in Greater Manchester.

     Despite the hard-won success of the past few decades which has seen smoking
     generally decline and become less recognised as a social norm, in the communities
     where it is most prevalent there are still significant challenges, not least because of
     the rates of early death from smoking-related illnesses. It is in these communities
     where a partnership approach to smoking is most valuable - where routine NHS
     smoking cessation services are sometimes both less popular and less successful
     and new and different approaches to the issue may have a far greater yield than the
     traditional ‘stop-smoking’ methods used to date.

     Following the initial discussion of the smoking manifesto by the AGMA Executive
     last year, progress has been made against a number of the objectives. The
     implementation plan attached sets out progress and information-gathering to date
     and makes suggestions to deliver the aspirations in the manifesto.

     The ethos of the Health Commission, as is no doubt the case with the other
     strategic Commissions, is to demonstrate partnership in action and how co-
     ordinated work at a GM level can collaboratively address the issues that affect
     quality of life for Greater Manchester residents and deliver improvement more
     effectively than each constituent organisation might be able to do alone. This
     thinking is reflected in the implementation of the smoking manifesto which aims to
     harness work that is taking place nationally, regionally, sub-regionally and at the
     local borough level and co-ordinate all these important elements so that there is a
     shared understanding about what we are trying to achieve in relation to smoking
     and a broadly consistent approach to delivery.

     Whilst the GM Health Commission’s primary goal is to see the manifesto
     implemented locally in a timely way, it is important that this takes place in line with
     evolving regional ambitions and can be incorporated into the existing local smoking
     strategy and delivery in each borough. The approach discussed here seeks to
     achieve that, making full use of the existing knowledge, skills and experience of this
     agenda in each GM borough, sharing learning and collectively monitoring progress
     across GM and ensuring consistency with the regional agenda and lobby.

     The approach to implementation is two-fold. Some of the actions will initially be
     explored at a GM level via the Director of Tobacco Free Greater Manchester and
     colleagues at the Association of GM PCTs with relevant partners. In some cases,
     this preparatory work will help to inform and ‘set-up’ local delivery. Those actions
     which are more appropriately delivered locally will be delegated to a local action
                                                                                               2
group which all GM local authority Chief Executives and PCT Chief Executives
(copied to Directors of Public Health) will be asked to support the development of in
a letter to be sent out in March / April (on behalf of the Health Commission). The
letter will explain the envisaged joint responsibilities of the PCT and the local
authority, advise how they can lend their support to the implementation of the
manifesto locally and provide further guidance on delivering some of the
commitments, especially where the scope of influence of some services in this
agenda may not have been actively explored before.

The plan on the following pages addresses each of the manifesto commitments in
turn and sets out the intended method of delivering on each, with additional
commentary where relevant.




                                                                                        3
Proposed implementation of GM Health Commission smoking manifesto

      Original Health Commission smoking manifesto                     Proposed approach / responsibility for action               Further comments
      commitment
 a.   The GM Health Commission will write to all GM Acute              New group of public health leads from acute trusts in GM,   This GM Health promoting
      Hospital Trust Chief Executives requesting that Hospital         administered by Association of GM PCTs and Chaired by       hospitals network is newly formed
      sites are completely smoke free, and that the rules are          Chris Burke (Chief Executive of Stockport Foundation        and will be supported by Assoc. of
      enforced.                                                        Trust), to consider and implement.                          GM PCTs to deliver on this.

 b.   The GM Health Commission will write to all GM PCT Chief          Requested in letter as described above
      Executives requesting that all health care premises and
      sites for which they are responsible are completely smoke        Delegate immediately to the local action groups
      free, with enforcement of the rules, as are sites belonging to
      independent sector providers from whom PCTs commission
      services.

 c.   The GM Health Commission will ask the AGMA Executive             Requested in letter as described above
      to recommend that all Local Authority buildings and sites
      are completely smoke free, with enforcement of the rules         Delegate immediately to the local action groups
      and this is also required of sites belong to independent
      sector providers from whom local authorities commission
      services.

 d.   The GM health Commission will ask the AGMA Executive to          Director of Tobacco Free Greater Manchester to explore at
      recommend that all local authorities explore the scope for       GM level, initially via Manchester City Council
      categorizing as an 18 any new film which uses tobacco
      product placement. To maximize pressure on producers of          Learning to be disseminated to local action groups
      films AGMA should seek support for this policy from other
      local authorities.

 e.   The GM Health Commission will ask the AGMA Executive             Director of Tobacco Free Greater Manchester to explore at   AGMA Policy & Research Unit
      to recommend that a condition against the inclusion of           GM level via theatres and stadia & through the AGMA         have already made contact with the
      actual smoking should be attached to all AGMA and local          Grants Unit                                                 Arts Council England and the
      authority grants to artistic, cultural or sporting activities.                                                               response was limited to supporting
                                                                       Learning to be disseminated to local action groups          a condition around the actual
                                                                                                                                   burning of tobacco products on
                                                                                                                                   stage, not the depiction of smoking
                                                                                                                                   or smoking other products to mimic
                                                                                                                                   tobacco.



                                                                                                                                                                         4
     Original Health Commission smoking manifesto                      Proposed approach / responsibility for action                    Further comments
     commitment
f.   The GM Health Commission will ask the AGMA Executive              Initial letter to contain advice / briefing on how this can be   It is anticipated that legislation will
     to recommend all local authorities to consider using              implemented based on knowledge of planning system and            soon pick up this issue statutorily
     planning legislation to prevent the sale of cigarettes close to   existing examples of voluntary sign-up by developers
     check-outs in new retail outlets.
                                                                       Delegate immediately to the local action groups for
                                                                       discussion with local planning authority

g.   The GM Health Commission will seek assurance from the             This is already being co-ordinated by a colleague at the
     GM PCTs on the improved effectiveness of stop smoking             Association of GM PCTs for delivery in each borough
     services following recent social marketing activity.

h.   The GM Health Commission will strongly endorse any                GM wide campaign being delivered from January via
     promotional activity across GM aimed at challenging social        Association of GM PCTs. This will be considered.
     norms on smoking particularly in relation to smoking at
     home/around children.

i.   The GM Health Commission endorses promotional activity            As h. above                                                      Social marketing work in some
     to challenge smoking as a social norm and explore new,                                                                             boroughs is already exploring the
     high impact messages                                                                                                               use of different types of imagery
                                                                                                                                        and marketing devices to tap into
                                                                                                                                        smoking ‘mindsets’ & motivations in
                                                                                                                                        some neighbourhoods

j.   The GM Health Commission strongly supports the principle          Requested in letter as described above                           There is an existing joint
     of smoke free homes and request the GM PCT’s and GM                                                                                programme of work between GM
     Fire & Rescue Service to produce a written joint action plan      Delegate immediately to the local action groups for local        Fire and Rescue and Assoc. GM
     for implementation                                                delivery as a joint agreement already exists                     PCTS which includes this. Local
                                                                                                                                        work on smoke free homes likely to
                                                                                                                                        be at different stages.

k.   The GM Health Commission will strongly endorse the                Suggest that ongoing concerns / interest in the legislation      The manifesto was submitted in its
     proposed North West ASH submission to the national                continues to be fed into the Northwest lobby                     totality to the consultation on behalf
     consultation on future legislation due in Summer 2008,                                                                             of the Health Commission
     including the following propositions:
          i.      No smoking in cars with children present.
          ii.     No smoking by drivers.
          iii.    No smoking at outside tables for eating and
                  drinking unless self-service.
          iv.     No smoking in the outside seats at sporting
                  arenas.
          v.      No smoking on stage.
                                                                                                                                                                                  5
     Original Health Commission smoking manifesto                 Proposed approach / responsibility for action                      Further comments
     commitment
         vi.      Abolish VAT on nicotine replacement therapy.
         vii.     Nationally set targets for seizing tobacco.
         viii.    All films with smoking to be rated as 18.
         ix.      No smoking on TV
         x.       Tobacco only to be sold from licensed
                  premises.
         xi.
l.   The GM Health Commission will request that every             Requested in letter as described above                             Specific reference to the local stop
     statutory organization in GM reviews and updates their own                                                                      smoking services and the GM quit
     smoke free policies by Autumn 2009.                          Delegate immediately to the local action groups to work            line could be included
                                                                  with local bodies to achieve this

m.   The GM Health Commission will endorse publicizing the        Due to the links to low-level organised crime, the initial         Health Commission press releases
     contamination within counterfeit cigarettes.                 approach is for Director of Tobacco Free Greater                   on this topic have already been
                                                                  Manchester to liaise with GMP to explore how this can be           distributed.
                                                                  strengthened

n.   The GM Health Commission will ask GMAC to ensure the         As M                                                               This is reflected in the GMAC
     fight against counterfeit and smuggled tobacco is                                                                               strategic assessment and although
     highlighted in the GMAC Strategic Assessment, and                                                                               not prioritized this year has been
     informs every GM CDRP.                                                                                                          noted. Recent presentation at the
                                                                                                                                     Health Commission conference on
                                                                                                                                     this topic.

o.   The GM Health Commission will request a detailed action      As M
     plan from the Community Safety Commission when
     established on the issue of smuggled and counterfeit
     tobacco.

p.   The GM Health Commission will wish to see a repeat of the    To be implemented in 2010                                          GM DPH’s collectively fund this
     GM wide prevalence survey, to be undertaken in 2010.                                                                            every 2 years

q.   The GM Health Commission will press for all partners to      Initial letter to explain the aspirational nature of this target
     sign up to a target average adult smoking prevalence of      with basic advice (aimed at Council) on how to work
     10% by 2015, and a target of no more than a 25% gap          towards this regional target
     between the highest and lowest prevalence between wards
     in any borough. It is recognized that this will require
     investment in community activities to change social norms.   Delegate immediately to the local action groups




                                                                                                                                                                            6
     Original Health Commission smoking manifesto                     Proposed approach / responsibility for action             Further comments
     commitment
r.   The GM Health Commission will ask the AGMA Executive             Requested in letter as described above                    Children’s Social Care colleagues
     to recommend that all local authorities carry out a review of                                                              advise that the British Association
     policy regarding ‘looked after children’ to ensure children in   Delegate immediately to the local action groups for       for Adoption and Fostering (BAAF)
     their care are protected from second hand smoke in their         discussion with children’s social care family placement   has produced practice note 51 on
     home placement environment (if they have not done so             team managers in each borough                             this issue which is understood to be
     already)                                                                                                                   in wide use for adoptions. It is
                                                                                                                                possibly used less directly for foster
                                                                                                                                care placements due to the
                                                                                                                                circumstances of fostering, but
                                                                                                                                some Councils are likely to have
                                                                                                                                policies in place.




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