Scotland's Future is Smoke Free: A Smoking Prevention Action Plan

CHAPTER 7
DELIVERING, RESOURCING, AND MEASURING PROGRESS

"By focusing on outcomes we expect those delivering services to be freed to collaborate in achieving those outcomes" Shona Robison MSP, Minister for Public Health, NHS Annual Conference, June 2007

Delivering

7.1 Earlier chapters of this Plan have described the challenges faced, including trends in youth smoking, and how a number of different organisations and interests will contribute towards achieving our ambition for a non-smoking Scotland. The SPWG report highlights the important contribution of a range of different professionals and individuals who can bring influence to bear upon children and young people to encourage and promote a smoke-free lifestyle from parents and carers through to teachers and youth leaders, nurses, doctors and other health professionals. It also stressed the importance of involving young people themselves in the policy development process.

7.2 At a strategic level a wide range of organisations and interests will have a role to play in delivering the actions set out in this Action Plan. At national level:

• The Scottish Ministerial Working Group on Tobacco Control will oversee the Action Plan's implementation as part of its overall responsibilities for providing expert advice to the Scottish Government on tobacco control.
• The Scottish Government will play a major role in ensuring effective delivery and, specifically, we will be responsible for disseminating and promoting the Plan widely; ensuring appropriate systems are in place to measure its success; and making new resources available to facilitate that delivery. An additional £9m over the next 3 years (2008/09 to 2010/11) is being made available to support action in this Plan, bringing the total specific resources for tobacco control to £42m over the same period.
• The Convention of Scottish Local Authorities ( COSLA) will play an important role in fostering, co-ordinating and overseeing the local authorities' contribution to delivering action within the Plan.
• The Scottish Prison Service and other relevant criminal justice authorities, alongside other agencies, will play an important role in engaging harder to reach groups.
• NHS Health Scotland will also have a key role in delivery including through partnership working with other key interests, for example, in providing the evidence base for action, supporting the continuous improvement approach to effective interventions, and in developing and supporting the health promotion and education aspects of the Action Plan.
• Other key bodies include ASH Scotland, Partnership Action on Tobacco and Health, the Scottish Tobacco Control Alliance, the Scottish Cancer Coalition on Tobacco, Learning and Teaching Scotland, Young Scot and YouthLink Scotland, who all have a role in supporting the objectives set out here.
• Academic institutions and research units will have an important role to play in developing evidence to inform policy.

7.3 At local level, NHS Boards, Local Authorities, and their community planning partners in collaboration with local business and communities, including local tobacco control alliances, will be responsible for ensuring delivery. Key points to bear in mind:

• As reflected in section 1.3 of "Better Health, Better Care", Community Health Partnerships ( CHPs) have a crucial role to play in delivering better outcomes.
• The new national performance framework for local authorities and their partners which is enshrined in the Scottish Government and Local Authority concordat which underpins the funding provided to local government in Scotland over the period 2008-9 to 2010-11.
• The changes to the HEAT targets which reflect the thinking emerging from the review of health improvement performance management which aims to spell out the specific contribution of the NHS - along with partners in local authorities, and the voluntary and community sector - to achieving shared national outcomes and targets.
• The importance of interventions and approaches adopted being based on existing evidence of effectiveness.

Resourcing

7.4 Much of the action in this Plan will be delivered through use of resources already within the system although in some cases there may require to be a refocusing or reprioritisation of efforts, for example in social marketing and communications activity. However, it is recognised that in order to boost delivery of action within this plan some additional pump priming funding is necessary and, as indicated above, an additional £9m is being made available over the next 3 years (2008/09 to 2010/11) for this purpose.

Measuring progress

7.5 Targets are a key means of both driving progress and measuring performance. The current smoking reduction targets were originally set in the 1999 White Paper "Towards a Healthier Scotland"¹² and the adult targets were rebased and tightened in January 2006. The current targets are:

• To reduce smoking among adults (16 and over) from 26.5 in 2004 to 22% by 2010.
• To reduce smoking among children and young people (aged 12 to 15) from 14% to 12% between 1995 and 2005 and to 11% by 2010.

7.6 Targets are monitored through the Scottish Household Survey (16 and over) and the Scottish Schools Adolescent Lifestyles and Substance Use Survey (13 and 15 year olds). In 2006, 25% of adults (16 and over), 4% of 13 year olds and 15% of 15 year olds were regular smokers.

7.7 Local authorities' contribution will be measured through their Single Outcome Agreements which include scope for national indicators and targets, including those which to contribute towards reductions in smoking prevalence.

7.8 It is important for performance management activity not only to monitor progress against the targets but to evaluate and assess the impact of different measures. Research and evidence gathering will also have a place to play in determining policy.

Actions

Against this background, the Scottish Government proposes:

22. To use the Scottish Ministerial Working Group on Tobacco Control to oversee and advise upon the implementation of this Action Plan.

Delivery lead: Scottish Government. Timescale: Ongoing

23. To allocate additional funding to NHS Boards of £1.5m in each of the years 2008/9 to 2010/11 to enable them to co-ordinate action locally to underpin the measures outlined in this Action Plan and to ensure this is reflected in their tobacco control programmes.
Delivery lead: Scottish Government/ NHS Boards. Timescale: From 2008/09

24. To continue to support the activities of ASH Scotland, the Scottish Tobacco Control Alliance and Partnership Action on Tobacco and Health within an agreed outcome framework specifying their contribution to the actions identified in this Plan.
Delivery lead: Scottish Government Timescale: From 2008/09

25. To allocate funding within the spirit of the new relationship between the Scottish Government and local authorities, of £1.5m in each of the years 2008/09 to 2010/2011 to enable them, as set out at Actions 15, 18 and 20, to step up enforcement of tobacco sales law and to work in partnership with HM Revenue and Customs to tackle illicit sales of tobacco.
Delivery lead: Scottish Government/Local Authorities. Timescale: From 2008/09

26. To set new separate targets for boys and girls aged 13 and 15 and for 16 to 24 year olds to reflect the action within this plan as follows:

• To reduce the level of smoking amongst 13 year old girls from 5% in 2006 to 3% in 2014.
• To reduce the level of smoking amongst 13 year old boys from 3% in 2006 to 2% in 2014.
• To reduce the level of smoking amongst 15 year old girls from 18% in 2006 to 14% in 2014.
• To reduce the level of smoking amongst 15 year old boys from 12% in 2006 to 9% in 2014.
• to reduce the level of smoking amongst 16 to 24 year olds from 26.5% in 2006 to 22.9% in 2012.

Delivery lead: Scottish Government. Timescales: From 2008/09

27. To develop a research and evaluation framework to support the action in this plan setting clear timelines for action under the plan to be reviewed, as part of the wider tobacco control research and evaluation programme for "A Breath of Fresh Air for Scotland".
Delivery lead: NHS Health Scotland. Timescale: 2008/09