We hope our latest edition of Health Matters – on the subject of tobacco standard packs and helping smokers quit will help you and other health professionals by compiling key facts, figures and evidence of effective interventions.
Where we can, we’re also committed to answering your questions and taking on your feedback. In this blog we’ve published the answers to a number of Health Matters tobacco standard packs questions we received from professionals across the UK at the launch teleconference (podcast available here).
We’d love to hear from you at email@example.com.
Question 1 (colour chosen for standard packs)
Did Australia select the same colour pack as being introduced in the UK? Did the poll that led to the selection of Pantone 448C reveal any differences in preference among, ages, genders, ethnicities etc of smokers?
The UK is using the same colour as used in Australia. We are not aware any of research on difference by age but there is research on UK youth response showing that plain white packs conveyed misleading messages of relative safety.
Question 2 (funding for stop smoking services)
If a national NHS Commissioning for Quality and Innovation (CQUIN) incentivises brief intervention and referral to stop smoking services, will the capacity to respond still be there? Cuts to the health grant, combined with the major fall in GP referrals to services, has led local authorities to make the in-year and subsequent savings from stop smoking services.
We agree that it is vital that smokers should be referred to effective services to help them quit (pharmacotherapy and behavioural support). How this is provided is a question for the local system.
Question 3 (funding to promote awareness of standard packs)
Is there any national funding from PHE to support the introduction of standardised packs (eg advertising, promotion etc)? Is there any extra money available for local authorities to enforce the legislation?
We will be incorporating the messages about standard packs in our Stoptober campaign. We have been preparing for the introduction of standard packs for the last 9 months in the knowledge that we were going to have to use our wits rather than extra funding.
We are going to start our business planning process shortly for next year in terms of our health marketing resources and investments. We'll be looking with our health marketing colleagues at ways in which we can strengthen some of our traditional campaigns, for example Stoptober, with messages around standard packs, so that some of these national resources can support the very interesting changes that are appearing at a local level.
Question 4 (funding to support enforcement of standard packs by Trading Standards)
Will there be any funding to support enforcement of standard packs by Trading Standards, for instance for local project work?
It would be great if your local authority can find funding for some local enforcement work, although this move should be self-enforcing.
The regulations came into force in May 2016 when tobacco companies were stopped from introducing any new branded packs into the UK. But they do have a whole year to achieve ‘wash-through’. So they will be legally entitled to sell branded packs until May 2017.
From an enforcement point of view it should be pretty straightforward. If you see anybody selling the old branded packs from 1 May 2017, they are breaking the law.
Question 5 (will the existing non-display of cigarettes in shops lessen the impact of standard packs?)
We already have branded cigarettes in hidden cabinets, so they are not on visual display as you walk into a shop. Could that negate the impact of standard packs? Or did Australia have a similar situation?
It shouldn’t negate the impact. Australia also brought in a point of sale display ban before they introduced standard packs. The thing about branded packs is that as they are carried around they act as billboard advertising for a brand.
Every time you get a cigarette pack you are advertising a brand which you were personally endorsing. Now every time the smoker takes out the cigarette pack they are going to communicate some fairly negative images and messages about the dangers of smoking.
That’s going to be the practical effect. Smokers are going to be carrying our messages from now on.
Question 6 (call to action)
My question is on the call to action. Considering that some authorities are disinvesting in stop smoking services and the majority are looking at redesigning stop smoking services to make them more online, what work is being done with NHS England and CCGs to ensure that referral to stop smoking services, where they exist, is still being encouraged?
It is an issue that we have been pushing out for quite a while. This is an opportunity to reach out to disadvantaged smokers and to bring about the biggest benefit to the NHS.
A lot of our work has been to support the idea that health professionals will be asking their patients if they smoke and if they do, to refer them to evidence-based support, using the Very Brief Advice model. We are hoping that we will have good news to share soon about a national CQUIN, so watch this space.
Question 7 (ROI tools)
Are there any return on investment (ROI) tools and what are the cost savings that can be made as a result of stop smoking services?
NICE has a very robust ROI tool which shows a range of evidence-based interventions that NICE recommends and the costs involved with each of them and the return on investment can be calculated.
For local authorities, the ASH ready reckoner tool is a very good tool, particularly for colleagues in local authorities when thinking about the cost to the health and social care system. Those are the two main tools.
Question 8 (e-cigarettes)
Should we be encouraging smokers, in this environment of standard packs, to switch to e-cigarettes?
The really important thing is that people stop smoking. Simply to use an e-cigarette and continue smoking is not going to do you much good.
But if you are using an e-cigarette with the goal of quitting, then they can be effective if purchased over the counter like nicotine replacement therapy.
But what is really exciting is looking at the data about what happens when you combine local stop smoking services with e-cigarettes, you get a success rate of about 65%, which is phenomenally good.
So we would argue again that if someone is thinking of quitting using e-cigarettes then the best thing they can do is to go to stop smoking service and get the behavioural support and pharmacological support that will make their e-cigarettes even more effective.
Question 9 (tobacco control plan)
Fiscal control and legislative action including the introduction of standard packaging, is playing a major role in driving down the proportion of adults that smoke in the UK. What recommendations and actions will PHE be pushing for in the new tobacco control plan due to be launched?
We can’t tell you anything in advance but Parliament TV might offer a few clues if you watch the debate in the House of Lords. Watch the ten minutes (starting at 20:21) with the health minister Lord Prior.
Things that may be included are national targets, smoking in pregnancy, health inequalities and mental health. We will certainly be working with our colleagues in the department of health that as soon as we have any idea about when the report is going to be released we will work with our local partners so that everyone is ready to receive the report and maximise the opportunities.
Question 10 (Smoking cessation services)
What smoking cessation services should local authorities be investing in?
We are quite spoilt with the breadth of NICE guidance that we have and we have a significant amount of robust evidence and recommendations on what a stop smoking service should look like.
It should provide behavioural support alongside stop smoking medicines and individuals delivering that behavioural support should be trained to a level certified by the National Centre for Smoking Cessation and Training to a practitioner standard.
Whether that’s a stand-alone service, whether it’s from a pharmacy or within a hospital, the fundamentals of that delivery should be behavioural support with stop smoking medicines matching NICE guidance.
Question 11 (black-market tobacco?)
Will standard packs increase the trade in black-market tobacco, as suggested by the tobacco industry?
We don’t remember a single tobacco control measure (point of sale display, vending machine ban, increasing the age of sale to eighteen, standard packaging) where the tobacco industry didn’t say that it would lead to an increase in illicit trade.
The Australian experience didn’t show an increase in black market trading. Australia is remote so inter-country trade might be low but there was no increase in the use of home-grown tobacco. When all legitimate tobacco packs are in instantly recognisable standard packaging with large picture warnings it will make it very easy to spot illicit tobacco. From May 2017, if you see a glossy pack you see a dodgy pack.
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