Implementation of the NHS-funded tobacco dependence services in England: a qualitative study to understand the contexts of implementation
Brennan-Tovey K., Aquino MRJ., Flanagan S., Kaner E., Wearn A., Bigirumurame T., Fong M., Todd A., Aveyard P., Jolly K., Damery S., Attwood A., Robson D., West J., Bridges S., Armitage CJ., Russell S., Strong S., Ramsay SE.
BACKGROUND: The National Health Service (NHS) Long Term Plan is a national policy that offers a package of treatment and support, called the NHS-funded tobacco dependence service, to help people stop smoking. It will be offered to people who smoke and are admitted to hospital by 2023-24. We present preliminary findings from our study, aiming to describe the contexts that the NHS-funded tobacco dependence services is being implemented in, including current service provisions. METHODS: We did a qualitative study in five regions across England to understand the current provision and context implementing the NHS-funded tobacco dependence services, including current barriers to a quality service, and challenges of implementing the new service. We used key informant technique and document analysis. We interviewed those involved in the planning, commissioning, or delivery of NHS-funded tobacco dependence services. Documents analysed included implementation plans. Interviews and documents were analysed thematically. Ethical approval was obtained from Newcastle University. FINDINGS: At time of writing (May 25, 2022), 11 interviews had been done, conducted by KBT and SF, and 12 documents analysed (Integrated Care System implementation plans, hospital trust polices, and protocols). Preliminary findings show that pre-existing services were patchy across regions, trusts, and patient pathways, whereas referrals to Local Authority Stop Smoking Services and community pharmacies differed between regions. Current practices to identify smokers within NHS settings were inadequate, with many smokers being discharged with no nicotine replacement therapy. Barriers to implementing the NHS Long Term Plan included funding issues, engagement of trusts, and a hesitancy to change. Participants identified anticipated changes being a reduction in health inequalities, reducing stigma, and a change in staff perception of smoking. INTERPRETATION: Our findings show how funding, trust interest and systems, current services, infrastructure, and attitudes and culture of staff pose challenges and barriers to the successful implementation of the NHS Long Term Plan, locally and nationally. These findings will provide a detailed insight into the plans implementation challenges to policy and practice partners, as well as hopefully guide them on how to overcome these challenges. FUNDING: NIHR's National Priority Areas Research Programme 2020-23 via the Prevention Including Behavioural Risk Factors Applied Research Collaboration (ARC) Consortium.