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** 10 February 2022
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** UK
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** Smoking 'single largest driver' of health inequalities (#1)
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** Experts respond to health and care integration white paper (#2)
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** Single accountable figure to lead new health and care 'place boards' (#3)
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** International
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** Smoking cessation drugs prescribed over the internet are as safe and effective as in-person treatment in Canada (#4)
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** Opinion: Tobacco lobby cynically undermines Middle East health policy (#5)
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** Parliamentary Activity
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** Parliamentary questions (#6)
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** UK
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A new breakdown published today by Action on Smoking and Health (ASH) shows that 110,000 households, 30% of all households containing smokers, live in poverty in the South West once spending on smoking is accounted for, close to the England average of 31%.

The findings also show that 25,235 people are economically inactive due to smoking in the South West and that smokers earn 6.8% less than non-smokers. Current smokers are also 2.5 times more likely to need social care support at home in England and need care on average 10 years earlier than non-smokers, accounting for 8% of all local authority spending on adult social care.

Deborah Arnott, Chief Executive of ASH, said: “Smoking is the single largest driver of health inequalities in England and it is shocking that it’s contributing to more than two million adults living in poverty, concentrated in the most disadvantaged regions in the country. Behind every statistic is a human being. A real person, threatened by the debilitating health effects of smoking, and significantly poorer because of an addiction that started in childhood. We look forward to the forthcoming Tobacco Control Plan to achieve the Government’s smokefree 2030 ambition, an ambition which is vital to delivering the Government’s manifesto commitments to increase healthy life expectancy, reduce inequalities and level up society.”

Source: Local Gov, 9 February 2022

See also:

Bath & North East Somerset Council - New data analysis shows more than 3,500 households in B&NES are living in poverty ([link removed])

Wiltshire Council - New data shows 10,016 of smoking households in Wiltshire are living in poverty ([link removed])
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** Following the publication of the Health and Care Integration white paper yesterday (9 February 2022), experts have responded that the paper does not address key funding and staff issues.

The white paper contained a number of proposals for structural reform, including more pooling of budgets between the health and social care services, the designation of a single person accountable for joint planning at local level, and the creation of “a more agile workforce” with care workers and nurses able to move easily between roles in the NHS and the care sector.

However, critics said that more funding was needed. Saffron Cordery, deputy chief executive of NHS Providers, said that pooling NHS and social care budgets was “no substitute for funding both systems appropriately”. Nigel Edwards, chief executive of the Nuffield Trust, warned that structural changes were not a magic bullet: “We also need to see workforce and funding issues addressed”.

Sally Warren, director of policy at The King’s Fund, said that staff shortages remained “the biggest issue, the biggest barrier to fast progress on the backlog and improving outcomes”. She added that “the government is just refusing to do a workforce plan, which is really odd”. Martin Green, chief executive of Care England, similarly said: “Workforce is our biggest challenge.”

Mike Padgham, chair of the Independent Care Group, noted that workforce issues would not be addressed without better pay: “Until the government does something about pay and terms and conditions, I can’t see how we’re going to recruit new people because they don’t earn enough.”

There were also concerns with the structural changes announced. Cordery said that the proposal for a single accountable person in each place “could further complicate lines of responsibility in already complex, developing system working structures” whilst Padgham said that the paper “stops too far short of the NHS and social care merger needed to provide the best service”.
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** Source: Financial Times, 10 February 2022

See also: Department of Health & Social Care - Joining up care for people, places, and populations ([link removed])
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** The new health and care integration white paper published yesterday (9 February 2022) outlines plans for each local place to install a single leader with accountability for NHS and social care services by spring 2023. The model endorsed by the paper features an integrated health and social care board at a ‘place’ level, more localised than Integrated Care Systems (ICSs), where budgets would be pooled or aligned, and a single accountable leader would operate.

The white paper says that all places with an ICS are expected to adopt the government’s ‘place-board’ governance model or an equivalent which achieves the same aims by spring 2023. The ‘place board’ would be assembled by an area’s integrated care board (ICB), one of the two governance bodies within the ICS, and its local authority, bringing together partner organisations to pool resources, make decisions, and plan jointly.

The local authority and ICB would delegate functions and budgets to the board. A single person will be chosen jointly by the local authority and ICB to lead the ‘place board’ and will be accountable for the delivery of the shared outcomes and plan for the area’s health and social care systems. The board would oversee the commissioning and funding of primary and community care services, mental health services, adult social care providers, hospitals, and other health care services.

Areas which choose not to follow a ‘place board’ arrangement but use an equivalent model instead will still be expected to appoint a single accountable figure. They should be an individual with a dual role across health and care and would still be agreed by the area’s local authority and ICB.

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** Source: LGC, 9 February 2022

See also: HSJ - ICSs must devolve ‘significant’ budget to ‘place’, says government ([link removed])
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** International
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** A new study published in Drug and Alcohol Dependence has found that smoking cessation drugs that are prescribed exclusively over the internet in a clinical trial were as safe and effective as when prescribed in a clinician’s office. The Canadian study found that 30.3% of the study participants given varenicline over the internet, and 19.6% of the participants given bupropion, had quit smoking by the end of the trial, a similar effectiveness rate to that found in in-person clinical trials.

The study also found that the quit rate was substantially lower for an unassisted attempt without aids or interventions, at between 3 and 5%, showing the value of clinical support to quit, whether delivered digitally or in person. The study’s authors state that expanding the use of internet-based smoking cessation treatment programs is particularly important because marginalised populations, where smoking rates are disproportionately high, and smokers in rural areas may have more difficulty in accessing in-person smoking cessation treatments. They said that the study was also timely with COVID-19 having reduced access to face-to-face clinical services.

The research was conducted by The Centre for Addiction and Mental Health (CAMH) in Canada and took place before the COVID-19 pandemic. CAMH said that the number of patients attending its Nicotine Dependence Clinic had halved during the pandemic, and that following the study CAMH would explore ways to make internet-based treatment programs more readily available.
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** Source: EurekAlert!, 9 February 2022

See also: Drug and Alcohol Dependence - Evaluating the effectiveness of bupropion and varenicline for smoking cessation using an internet-based delivery system: A pragmatic randomized controlled trial (MATCH study) ([link removed])
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** Journalist Jonathon Gornall argues in the Asia Times that Middle Eastern and North African governments are not adequately resisting tobacco industry lobbying and attempted collaboration.

Gornall argues that countries in the Middle East and North Africa (MENA) bloc are accepting a “devil’s deal” whereby those nations encourage and sometimes even reward the growth of the tobacco industry in exchange for lucrative tax revenue. A report published this week (beginning 7 February) by the Global Center for Good Governance in Tobacco Control, in collaboration with the WHO’s Eastern Mediterranean Regional Office, exposed industry interference with tobacco-control policies in eight countries: Egypt, Iran, Iraq, Jordan, Lebanon, Oman, Pakistan, and Sudan.

All eight countries are party to the WHO’s Framework Convention on Tobacco Control (FCTC), which commits them to implement tobacco-control measures and “protect their health policies from interference from commercial and other vested interest.” However, the report found that in Sudan and Iraq, the industry “participate[s] in developing the standards for tobacco products” with representatives on various official committees. In Jordan, a new factory built by international tobacco company JTI was in 2018 given an Environmental Stewardship Award by the Jordanian Environment Ministry. In Egypt, international tobacco giant Philip Morris runs training courses for customs officials to combat smuggling that might undercut its market and the company was presented with a certificate of appreciation by the Finance Ministry for paying its taxes on time.

Gornall says that the industry has exploited COVID-19 “to gain public endorsement and access senior government officials.” He adds that conflicts of interest are common with several nations, including Egypt and Lebanon, state-owning tobacco firms. Gornall concludes that “governments are, quite literally, profiting from the deaths of the citizens they are supposed to be protecting”.

Source: Asia Times, 10 February 2021
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** Parliamentary Activity
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** PQs 1&2:
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** Asked by Martyn Day, Linlithgow and East Falkirk

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** To ask the Secretary of State for Health and Social Care, pursuant to the Answer of 15 December 2021 to Question 84415 on Oral Tobacco: Health Hazards, if he will publish his Department's assessment on the risks of adverse health outcomes caused by snus.

To ask the Secretary of State for Health and Social Care, pursuant to the Answer of 15 December 2021 to Question 84415 on Oral Tobacco: Health Hazards, what the mortality rate is per 100,000 users as a result of the use of (a) cigarettes and (b) Swedish snus.

Answered by Maggie Throup, Public Health Minister

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** There is no available data related to the mortality rate as a result of the use of cigarettes or for Swedish snus. The Department has made no formal assessment of adverse health outcomes caused by snus. However, there is evidence of increased all-cause mortality among snus users although this is lower than for tobacco smokers. Snus use also has cardiovascular risks.
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We are exploring a range of proposals to reduce the harms caused by smoking as part of the forthcoming tobacco control plan. This will not include proposals to introduce additional tobacco products into the market, such as oral tobacco.
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Source: Hansard, 9 February 2022
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ASH Daily News is a digest of published news on smoking-related topics. ASH is not responsible for the content of external websites. ASH does not necessarily endorse the material contained in this bulletin.

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