What’s hot and what’s not – commissioning and delivering stop smoking services in England

Melanie McIlvar, Director NCSCTUKNSCC, Friday 13th June 2014

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

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

Commissioning

Commissioning of servicesNational 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

Commissioning of services• Survey sent to every local area (n=152) via a Survey

Monkey link• Open between 20th January – 26th February 2014• Final response rate = 49% (n=74)

Survey responses by region

Current commissioningEvery 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

Commissioning intentionsThe 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’

Outcome measures

Outcome measures

Priority groupsOutcomes 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

Payment schedulesOutcome Payment range

(£)Respondents

n (%)

Pre-quit assessment session completed 5 - 20 10 (14)

Quit date set 5 - 30 18 (24)

Post-quit sessions (3 weeks) 2.50 – 5 per session 3 (0.2)

Self-reported 4-week quitter 7.66 - 254 39 (53)

CO-validated 4-week quitter 5 - 254 40 (54)

Enhanced payments - 35 (47)

Medication provision1st line varenicline and combination NRT

Combination NRT as standard

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

Delivery of services – key findings from provider reviews

The “hot” and the “not”

NCSCT Service Provider ReviewPatient data assessmentInvolves accessing patient data to verify four-week quit rates and measure customer satisfaction via a short telephone interview.

Provider assessmentInvolves 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

NCSCT Service Provider Review

Delivery of services

Amber / red rating % (n)Session time 72.7 (8)Staff training 54.5% (6)Lost-to-follow up 54.5 (6)Quit rate 45.5 (5)CO rate 45.5 (5)Number of sessions 27.3 (3)

Delivery of services

Likely to be very satisfied with the

service

Likely to be very satisfied with the

service

Access to medications

Access to medications

Weekly sessionsWeekly sessions

Quit rateQuit rate

Support based on a protocol

Support based on a protocol

CO testingCO testing

Client satisfaction

“Lovely people…a great service”

“Lovely people…a great service”

“My advisor was incredibly helpful and supportive”

“My advisor was incredibly helpful and supportive”

“Very impressed with the service”“Very impressed with the service”

“It was an excellent

service ... all the advisors were very helpful”

“It was an excellent

service ... all the advisors were very helpful”

“Very happy, great support, really liked seeing the advisor

each week”

“Very happy, great support, really liked seeing the advisor

each week”

“Very disappointed as

was ready to quit but heard nothing

after being referred”

“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”

“The guy I saw, he left – and then the service didn’t get

back to me”

Data verification

• 943 clients spoken to

• 71.6% contacts verified

• Verification rate ranged from 94% - 29%

Reasons for non-verification

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

melanie.mcilvar@ncsct.co.ukwww.ncsct.co.uk