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Reductions to Stop Smoking and Tobacco Control (S04)


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Tobacco Control – Contribution to FRESH No contribution to FRESH the regional office for Tobacco Control. There would be no capacity to undertake local campaigns and limited capacity to support national or regional campaigns in Darlington.

Ending of Wider Tobacco Control £28,500, FRESH North East


S4 - Reductions to Stop Smoking and Tobacco Control

Your Say

9 comment(s)

This table lists comments from the public about this proposal


Core HP4 (Public Health Stop Smoking Service)
Cut S04 (Stop Smoking and Tobacco Control)

Cut this service

Cut S04 (Stop Smoking and Tobacco Control)

Stopping smoking is down to will power (I am an ex smoker so know), campaigns etc. don't really help so t6he council should save the money. If some one wants to stop smoking they will.

Core HP5 (Public Health Health Advice NHS Core Offer)
Cut W06 (Dolphin Centre)
Cut S04 (Stop Smoking and Tobacco Control)
Cut Hu01 (Childrens Centres, Early Help and intervention - Specialist Family Support)
Cut S11 (Engagement Team)
Cut C12 (Healthwatch)

Darlington Borough Council Medium Term Financial Plan 2016-2020

Thank you for the opportunity for NHS Darlington Clinical Commissioning Group (DCCG) to respond to the consultation on the Medium Term Financial Plan (MTFP) for Darlington Borough Council (DBC). As a key local strategic partner and having worked closely with the Council as part of the Health and Wellbeing Board, the CCG fully appreciates the scale of the financial challenges faced by the Council and the difficult prioritisation process that will need to be undertaken to finalise a sustainable financial position for the future.
We have reflected on your proposals and the impact assessment work completed to date in order to provide a considered response through the consultation process. We have particularly focused our comments described below, on those planned changes that we consider will be detrimental to the overall health and wellbeing of the population of Darlington now and in years to come. We note and appreciate the rationale for the two phase approach to the MTFP for 2016/17 to 2019/20. The scale of the financial challenge over this period is indeed unprecedented. The CCG has noted the projection that the Council will have lost £44.0m of Government Funding over the period 2010-2020 and acknowledges the need to first and foremost, focus effort and resource on discharging statutory duties and the need to systematically review those discretionary services that may be most valued by the public. That said we are keen to see and work with the council, to consider a transformational approach to demand management rather than simply shrinking services.
There are some key areas which the CCG would like to highlight where the planned actions may well impact directly on health services but most importantly on the overall health and well-being of the population. A number of the changes planned appear to be in direct conflict with “Fair Society, Healthy Lives” (Marmot, 2010) and specifically with the Darlington Health
Profile data which describes the needs of our local community and key areas of priority to improve health and wellbeing and reduce inequalities namely:-
 Giving every child the best start in life;
 Tackling alcohol related harm, and
 Promoting mental health and wellbeing
Children and Young People in Darlington
It is widely accepted that giving children a good start in life and prioritising children’s services is key to improving life outcomes. Planned reductions such as removing elements of the positive support pathway for young people and cessation of funding to the Aspire Service are a matter for concern. We know that early help and support ensures young people, and specifically those with learning difficulties, are able to live happy and productive lives often then reducing their dependency on more costly care provision. We therefore consider this planned reduction in services will impact on our statutory health services as well as the long term health and well-being of children and young people.
We have noted the proposal to change the operating model for Children’s Centres to a hub and spoke arrangement. This would appear to provide a useful and innovative way to preserve access to an important service although we have a degree of concern with respect to the potential impact of greater centralisation when we know that some of the most vulnerable families and children may fall away if services are not more local. This will require careful monitoring over coming months to ensure that the most needy continue to access the care and support they require.
Within the consultation documents other planned changes in the Children and Young People’s Portfolio such as changes to the Early Help and Looked After Children contact services and removal of discretionary early support service are considered critical to supporting vulnerable families. We are significantly concerned that such changes will inevitably hit the most vulnerable and will focus on crisis management rather than supporting early identification and prevention. This may result in increased pressure on other services including but not exclusively, healthcare where we know that these families typically use health services more than other groups in the population.
The MTFP describes a range of cuts to the provision of services for preventing and reducing obesity in adults and children, including no direct intervention programmes and the removal of the Healthy Darlington Hub, the Move More Team and the Schools Sports Partnership Programme. This is disappointing given the poor Child Health Profiles for Darlington including higher than average deprivation, poor life expectancy, which is 11.8 years lower for men and 9.4 years lower for women in the most deprived areas of Darlington than in the least deprived areas of the town (2015),and that about 20.6% (4,100) children live in poverty.
Our health profiles tell us that improvements in child health are needed given that for example, 11.2% of children aged 4-5 years and 18.4% aged 10-11 years are classified as obese and Darlington is worse than the England average for adult obesity (29.3% vs 23% England average). The Healthy Hub has been highly valued by our GP community and we understand that almost 2/3 of referrals to the Hub are from Primary Care. Proposed changes to the service will have a direct impact on GP colleagues and their ability to signpost the most needy in the population to services that appropriately focus on support, empowerment, self-care and primary prevention thus avoiding over medicalisation and dependence. The Healthy Hub has provided a key point of contact for advice and support programmes in the
community to encourage the right wellbeing choices and not being reliant on a health service solution. Again applying the Marmot principles we need to work as a system to ensure we are focussed on improving outcomes for children and vulnerable groups which will impact on longer term health. Planned changes by the Council to the obesity prevention and support services appear to conflict with this local priority and will impact on services available to the population, young and older, to “eat well and move more” and constrain their ability to achieve a healthier lifestyle.
Vulnerable Groups in the population
We are concerned that several of the planned changes appear to affect those most at risk and the vulnerable in our society, in particular those with a learning difficulty, the homeless and those who are often known to several organisations as high impact users with complex and chaotic lifestyles.
The MTFP describes removal of posts in the Drug, Alcohol and Tobacco Team and removal of the contribution to BALANCE and FRESH. These actions will impact on the capacity to deliver national campaigns and allow a local focus. We believe that BALANCE and FRESH deliver significant local benefits and by working at scale should provide good value. Services such as these have critical importance in raising awareness, prevention and improving health outcomes for the population which in turn is important to maintaining a healthy workforce and economic prosperity. The local health profiles for Darlington highlight both alcohol and smoking as key priorities. We know the rate of alcohol related hospital stays among the under 18s is worse than the England average; the rate of alcohol related harm in adults is worse than the England average; the rate of self-harm hospital stays is worse than the England average; the rate of smoking at time of delivery is worse than the England average and whilst the rates of smoking in Darlington have begun to decline over recent years, they remain unacceptably high and the rates of smoking related deaths is worse than the England average. There may therefore be scope in reshaping services to ensure that those services that are funded have a high probability of delivery of the expected impact.
Public mental health services, such as the removal of the Arts on Prescription service and the community based mental health improvement training, provide additional support for people living with mental health issues. We know improved mental health and wellbeing is associated with a range of better outcomes, including improved physical health, increased life expectancy and employment rates and reduced risk-taking behaviours such as smoking and drug and alcohol misuse.
For all these areas there are direct impacts on individuals, but they also place avoidable economic pressures on NHS and social care resources. We believe that a reduced focus on these priority areas could produce detrimental medium and longer term impacts on the health and wellbeing of the population and widen the inequalities gap we are trying so hard to collectively reduce.That said we do acknowledge the challenging reductions in the public health grant and the difficulty in identifying those interventions that are evidenced based and will deliver the greatest health and wellbeing impact. We will be keen to work with you over the coming months to understand better how these effects could potentially be mitigated.
We acknowledge the considered approach taken to streamline the Sexual Health Services however, we have already had a degree of concern raised from Primary Care with respect to the new arrangements for sexual health and need to ensure that our organisations are working together to commission services that are accessible and appropriate to provide for the immediate needs of individuals and to prevent longer term ill health.
We note a planned removal of the contribution to the Home Improvement Agency which would inevitably reduce the provision of services with a possible impact seen again on those most vulnerable and those from a low income homes with respect to ensuring a safe and accessible home environment and thereby reducing the need for higher cost alternative care provision.
Darlington’s Voluntary and Community Sector (VCS)
Darlington has long been regarded as having a vibrant and active VCS and a pivotal role in delivery of care outside of mainstream services; indeed to date DBC and the CCG have jointly sought to strengthen the capacity and capability of the sector in order to ensure we have services aligned to key joint priorities and plans such as the Better Care Fund projects which are critical to delivery of our Darlington 2020 Vision and priority focus on self-management, optimising independence and care outside of hospital. We know VCS organisations provide extremely cost effective alternatives in certain areas of provision as well as meeting key gaps in provision in the end to end care pathway. The planned impact of removing the engagement team support to the VCS, cutting of the Strategic Grant to organisations (including Age UK Darlington, Citizens Advice Bureau, Darlington Action on Disability and First Stop), together with stopping the discretionary rate relief will no doubt place significant pressure on VCS organisations and impact on their viability long term. Sadly we know that it will take many years to re-build this capacity and expertise once it has gone.
We are surprised and disappointed in the planned and marked reduction in the Healthwatch Darlington (HWD) funding arrangements from 2017/18. We and other organisations very much value the work of HWD, particularly with specific seldom heard groups in our population such as children and young people and BME communities. Such funding pressures on HWD alongside other funding impacts on the VCS give major cause for concern in the context of achieving the ambitions of the 2020 Vision, Better Care Fund and indeed the Healthy New Towns initiatives.
We are keen therefore to explore the potential for a more strategic approach to developing and sustaining the VCS and review how we collectively channel our resources with others to commission these important supporting services. Indeed we acknowledge your support for this approach and are pleased with our early discussions on this subject.
Public Health Core Offer
The MTFP highlights a range of reductions to the Public Health Grant many of which we have already commented on above. Whilst we have had a number of helpful discussions with the Director of Public Health and other DBC colleagues in respect of the impacts and mitigations, we remain concerned that such significant and far reaching changes are planned within the context of the Five Year Forward View (July, 2014) which requires a very clear system wide focus on prevention. We note that you intend to serve notice on the contract for Tees Valley Shared Services which raises significant concerns from the CCG in terms of delivery of the required Public Health core offer within a local and more limited team. We have welcomed the discussions already started with the Director of Public Health on how this core offer can be met and the challenges that may present, however we would like to understand better how DBC will fulfil its required duties in providing the required advice and support in terms of access to data, analytical capacity and the full range of expertise we currently enjoy, given our shared responsibilities for closing the health and wellbeing gap articulated in the Five Year Forward View and to be delivered through the Sustainability and Transformation Plan.
In summary, we have articulated our concerns in relation to those areas that we believe will specifically impact on the health and wellbeing of Darlington residents, recognising the difficulties in identifying alternative proposals that could deliver the required reduction in spending. We genuinely recognise the difficult prioritisation process DBC faces and very much wish to place on record our commitment to work collaborative with the Council to strategically consider how we mitigate the impact of planned changes to ensure the most advantageous health and wellbeing outcomes for local people.
We look forward to discussing with you in due course the outputs of the consultation.
Yours sincerely,
Ali Wilson
Chief Officer
Darlington Clinical Commissioning Group
Andrea Jones
Miriam Davidson
Suzanne Joyner
Cllr Bill Dixon
Cllr Wendy Newall
Cllr Andy Scott

Cut S04 (Stop Smoking and Tobacco Control)

Reference- Fresh and Balance funding We are writing in response to the recently published Borough Council budget proposals and specifically in relation to the potential cancellation of all funding to Fresh and Balance in 2017-18. We understand that there will be a meeting in relation to the budget proposals tomorrow. We absolutely sympathise with the Council, which we know is facing incredibly hard decisions with regards to public health and many other areas of business, due to wider local government funding cuts. We also of course appreciate all of the support you have given to Fresh and Balance over the years. However, it is important to stress that Darlington and the North East as a whole, suffers an appalling burden as a result of alcohol and smoking, with massive costs to local authorities, the NHS, the police, workplaces, families and communities. Alcohol and tobacco are also the leading causes of preventable illness and mortality in Darlington, representing the most immediate public health challenges facing not just adults, but also future generations, in the town. From a Darlington perspective: • Alcohol costs £41.09m per annum, in costs to the NHS, crime & licensing, social services and the workplace • Alcohol is a factor in an estimated 10,969 recorded and unrecorded crimes in Darlington every year • There were 2430 alcohol-related hospital admissions in 2013-14 • 198 people prematurely die from smoking every year • Tobacco use generates 18,000 GP appointments and 3,900 hospital admissions and outpatient visits per annum • The tobacco burden equates to a £3.6m cost to the NHS and an extra £1.3m to the council spent on social care costs – not to mention the cost to local people. In addition, alcohol and tobacco also drive health inequalities: people from more deprived groups suffer far greater harm from than people in higher socio-economic groups and this is particularly clear in communities across Darlington and the wider North East. Taking this huge burden into account, it is clear that continued investment in Balance and Fresh offers the most efficient and cost effective option for tackling tobacco and alcohol related harms in Darlington. Evidence shows that the most impactful way of tackling smoking and alcohol harm is to take action at a population level: since the two programmes were introduced (Fresh 2005 and Balance 2009) key impacts have been made on tobacco and alcohol: • Smoking has declined by more than a third from 2005 to 2014, with the biggest decline of any region in England from 1 in 3 adults regularly smoking in 2005, it is now down to 1 in 5 (19.9%). This is 165,000 fewer smokers. The North East approach of working together has been commended by the World Health Organisation, England’s former Chief Medical Officer Sir Liam Donaldson, the NHS Leadership Academy, and in two government strategies. The North East “locally together” approach has been recently praised by Public Health England as the model for the rest of the country. • Smoking related mortality in the NE is declining faster than the national average. • The North East is the only region in the country to experience a decrease in the rate of alcohol-related hospital admissions and it has significantly narrowed the gap with the rest of England. • Leadership, expertise and advocacy on both tobacco and alcohol creating a social movement and some of the highest levels of public support nationally. In addition, Darlington would continue to generate significant efficiencies through commissioning regional programmes. For example, hugely impressive economies of scale are achieved across the North East, particularly around PR, where the annual returns on investment have regularly exceeded 30:1 achieving unpaid media coverage of over £3million per year; and through award winning mass media campaigns, where buying power is substantially cheaper at a regional rather than local level. Taken as a proportion of Balance and Fresh’s budgets, Darlington has as one example benefitted from two world class alcohol and tobacco media campaigns per year – in four separate bursts of activity - reaching significant numbers of the target population, for approximately nine pence per capita of the local population. That simply would not be possible through isolated investment at the local level. As noted earlier, we appreciate the difficult choices facing the council, in the light of unprecedented funding cuts. However, we genuinely believe that working together as a region makes us stronger and more cost effective for the people of Darlington. In the absence of investment in evidence-based programmes, which have been shown to deliver excellent results for the local authority, the concern is that we will see rates of smoking and risky drinking creep up again, with more lives lost, more illness, more pressure on local services and greater costs in the long-term. Finally, if Darlington Council does withdraw all funding from Fresh and Balance the whole future of the model is potentially at stake as for a decade now it has covered the whole region. We would ask you to consider whether continuing to fund the two programmes, even at a substantially reduced level, would be possible in order to maintain the significant progress made in addressing the two most important public health issues for the people of Darlington.

Cut S04 (Stop Smoking and Tobacco Control)
Cut S02 (DAAT and substance misuse)
Cut S13 (Social Fund Budget)

There are three proposals as part of the MTFP as follows: • Terminate the funding provided to First Stop Darlington by the Drug, Alcohol and Tobacco (DAAT) Team for the Substance Use Homelessness Service. This is a discretionary service, currently contracted to March 2018 (subject to annual review) and the proposal is to end it a year early, on the 31st of March 2017. • Disband the Drug, Alcohol and Tobacco (DAAT) Strategic Commissioning Team. Services for drugs, alcohol and tobacco control are part of the Council’s Public Health responsibilities but are defined as discretionary services. The proposal is for the whole team to be made redundant in 2016-17 and its functions to be split up and either terminated, absorbed into Public Health, or transferred to other Council departments. • Terminate the funding provided by the Council to the FRESH North East Tobacco Control Office and Balance North East Alcohol Office. These are defined as discretionary services and are currently jointly contracted, with the other 11 North East Councils, to March 2017. The proposal is for Darlington to end its contributions on the 31st of March 2017. Darlington LG Branch of Unison is concerned at the impact these proposals will have, not just for the immediate service users and the staff that deliver the services but for other, probably overburdened, services and staff that will have to deal with the fall-out. Whilst funding for First Stop and Fresh/Balance has funding secured for another year, DAAT is due to be disbanded much earlier. This will be a significant loss to the community because of the essential work DAAT does, particularly around prevention of harm to young people and its partnership working with other agencies. After speaking to [...], I believe [...] can put together a workable plan to deliver these services into the future, albeit in a different way, but they will need time to do this. I would suggest keeping DAAT going for a further year to allow [...] to put together a plan B.

Cut S04 (Stop Smoking and Tobacco Control)

I’m writing to express ASH’s support for Darlington Council’s continued funding of a regional tobacco control programme. We are unable to respond to the detailed questionnaire but wanted to take this opportunity to set out clearly why ASH believes the regional tobacco programme in the North East offers exceptional value for money for the Council. Action on Smoking and Health (ASH) is the country’s leading charity dedicated to ending the harm from smoking. Find out more about ASH here: We understand that this is a time of unprecedented pressure on local government finances and localities have been forced to take difficult to decisions about where to prioritise investment. However, given the contribution that reducing smoking makes to tackling health inequalities and delivering on key public health indicators, such as the reduction of premature deaths, investment in the regional tobacco control programme should be a priority. ASH has developed a tool which helps local authorities understand the impact of smoking on their community, which shows that smoking in Darlington costs £30.1 million a year (see attached document setting this out). The programme in the North East has been an exemplar for the rest of the country demonstrating what can be achieved both in terms of outcomes and value for money where local authorities join resources up across a region. In the North East, Fresh achieves a great deal for localities for the investment made, for example: • Media campaigns such as the highly successful recent 16 Cancers campaign which no single local authority could deliver alone. • Securing a high level of PR for smoking issues throughout the year (nearly £2.5 million PR value in 15/16) which again local authorities would struggle to achieve, particularly in the context of diminishing corporate resources to undertake such work • Opportunity for best practice to be shared and developed across the region through the coordination of various regional forums and networks • Delivery of ground breaking new approaches to reducing smoking such as the recent roll out of the highly successful babyClear programme to reduce the number of women who smoke in pregnancy • Undertaking region-wide work that could not be replicated successfully at a local level such as tackling illicit tobacco • Tracking various metrics which it would be difficult for each locality to invest the resource in alone such as public opinion and assessing size of illicit market • Acting as an important hub of expertise for tobacco control professional across the region able to provide strategic advice and practical support to the 12 alliances, the commissioners This activity has resulted in some major achievements for the North East: • Smoking has declined by more than a third from 2005 to 2014, with the biggest decline of any region in England from 1 in 3 adults regularly smoking in 2005, it is now down to 1 in 5 (19.9%). This is 165,000 fewer smokers. • Smoking related mortality in the North East is declining faster than the national average. • The North East has highest public support for tobacco control measures • North East maternal smoking rates have fallen by 4.0% (from 20.7% to 16.7%) compared to a 2.6% decline nationally The investment in a regional tobacco control programme has been exceptional value for money and provided a blue print for other areas of public health and firmly placed the NE on the international map for innovative, effective, collaborative working. ASH strongly urges the council to maintain its investment in this programme. There are few other areas of public health, or indeed tobacco control, where such a small level of investment could deliver so much for the people of Darlington.

Cut S04 (Stop Smoking and Tobacco Control)

We are responding to the consultation exercise related to the proposed 100% cut to Fresh and Balance from 2017/18. We did not think it was appropriate to complete the questionnaire but did want to provide further thoughts in relation to the proposal. We also emailed to the official consultation feedback on 10th February 2016 when initial views were called for. This email is pasted below for ease of reference. We wish to express our continued serious concern at the implication- locally, regionally, and nationally- of this 100% cut. We are of course very conscious of the significant pressure the authority is under and do sympathise with the team and the predicament that you are under in terms of making 'savings' and the difficult decisions that need to be made. But we would ask that you reconsider this 100% cut and consider some financial contribution to the programmes for 17/18 even if this is a nominal amount. Any contribution would be welcomed and would importantly keep the authority tied into the locally together North East approach around these two very important public health issues. This approach has been going for a decade now and the North East has shown real leadership with the approach being viewed as the exemplar for elsewhere. There is a real risk that by withdrawing totally from contributing to the Programme it could cause instability indeed risk the whole viability of the programme. We believe that the contribution that you currently make to Fresh and Balance is exceptional value for money and that Darlington has benefited significantly from this investment into the regional pooled budget. We have always delivered 100% of our KPIs in the Service Level Agreement and provided much more beyond the SLA. In the last year alone, the Borough through its combined £56,000 contribution to Fresh and Balance has received: • Two world class integrated mass media campaigns ("16 cancers" for tobacco with TV, radio, digital, social media, PR and "Spot of Lunch" for alcohol with TV, digital and PR. Both of these have reached significant numbers of Darlington residents with evidence based messages supporting behaviour change. • Nearly £6 million of earned media coverage across the region around tobacco and alcohol issues throughout the year • Promotion and support to Stoptober and Dry January campaigns • Expert advice around a range of topics including: smoking cessation commissioning, tobacco regulation, alcohol licensing etc • Expert advice and support to Tees Esk Wear Valley Trust on smoking culminating in the Trust going 100% smokefree in March • In depth report on alcohol's impact on the emergency services • An alcohol licensing conference and an event on alcohol in secondary care • Training to trading standards on the EU Tobacco Products Directive • Three different quarterly tobacco forums and two quarterly alcohol forums for Darlington to attend and gain up to date information on range of issues, share practise • Ongoing work around smoking in pregnancy through the babyClear initiative with the independent evaluation showing, amongst others, this has nearly doubled quit rates and led to a 6% increase in birth weights of babies born to mothers who have quit during pregnancy • Ongoing advocacy on issues of direct relevance to the borough including: tobacco tax in the budget, impact of tobacco poverty on local communities and campaign for a levy on the tobacco industry, alcohol duty and minimum unit price, drink driving and health labelling • Provision of local data to Darlington on smoking cessation, smoking in pregnancy, alcohol related hospital admissions, cost of alcohol harm, cost of alcohol admissions by GP surgery • Annual public opinion survey on tobacco issues, showing NE support remains the highest in the country with expectation from the public for more action • Annual public opinion survey on alcohol harm showing local data on drinking levels, awareness of alcohol harms and support for evidence based policies • Electronic cigarettes research and evidence event attended by a number of professionals from Darlington and Fresh briefing on e-cigs provided • Assistance for responses to government consultations including tobacco licensing and the CMO guidance In summary, we hope that you can reconsider this proposal and instead consider some level of a contribution from 2017/18 towards Fresh and Balance. We have enjoyed working with you over the years and thank you for all of the support to date- financial but also through the leadership to the Alcohol Partnership, during the previous 'review' period pre transition, and of course through the local delivery of work on tobacco and alcohol.

Cut S04 (Stop Smoking and Tobacco Control)

Letter from Fresh and Balance regarding funding


Cut S04 (Stop Smoking and Tobacco Control)

Response to the Fresh and Balance proposals