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What ’ s hot and what ’ s not – commissioning and delivering stop smoking services in England. Melanie McIlvar, Director NCSCT UKNSCC, Friday 13 th June 2014. Presentation overview. Commissioning of services – key findings from national commissioner survey - PowerPoint PPT Presentation
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What’s hot and what’s not – commissioning and delivering stop smoking services in England
Melanie McIlvar, Director NCSCTUKNSCC, Friday 13th June 2014
Presentation overview• Commissioning of services – key findings from
national commissioner survey• Delivery of services – key findings from provider
reviews• What service users have told us
Acknowledgements
• Public Health England• Tobacco control commissioners who responded
to the survey• Stop smoking service providers involved in the
reviews• Jo Locker, PHE• Andy McEwen, NCSCT• Jennifer Potts, NCSCT
Commissioning
Commissioning of servicesNational survey of tobacco control commissioners undertaken in early 2014 to:•Establish the nature of commissioning arrangements in place for stop smoking services at present•Investigate the range of different commissioning models in place •Identify the nature of targets set (2013/14), intentions for 2014/15 targets and targets for priority groups•Gain insight into payments awarded to providers
Commissioning of services• Survey sent to every local area (n=152) via a Survey
Monkey link• Open between 20th January – 26th February 2014• Final response rate = 49% (n=74)
Survey responses by region
Current commissioningEvery responding area reported commissioning services for 2013/14•30% (n=22) through block contracts•31% (n=23) multiple providers individually commissioned with specific targets•14% (n=10) large number of community providers directly commissioned with no specific target
Commissioning intentionsThe vast majority (85%, n=56) intended to go through a service commissioning process for 2014/15•Same provider and model = 51% (n=35)•Same model but retendering providers = 7% (n=5)•Different commissioning arrangements = 24% (n=16)
Reasons for not re-commissioning in 2014/15:•Existing contract until 2015/16•Integration with ‘lifestyle services’
Outcome measures
Outcome measures
Priority groupsOutcomes for priority groups reported by:•81% (n=59) 2013/14•82% (n=54) 2014/15 (intended)
• Black, Asian and Minority Ethnic
• Routine and manual workers• Unemployed• Those living in deprived areas• Young people
• People with mental heath difficulties
• Prisoners• Pregnant women• People with long-term
conditions
Payment schedulesOutcome Payment range
(£)Respondents
n (%)
Pre-quit assessment session completed 5 - 20 10 (14)
Quit date set 5 - 30 18 (24)
Post-quit sessions (3 weeks) 2.50 – 5 per session 3 (0.2)
Self-reported 4-week quitter 7.66 - 254 39 (53)
CO-validated 4-week quitter 5 - 254 40 (54)
Enhanced payments - 35 (47)
Medication provision1st line varenicline and combination NRT
Combination NRT as standard
Potential developments• Limiting access 11% (n=8)• Harm reduction activities 35% (n=25)
Interventions for users of unlicensed nicotine containing products
• 24% (n=17) already commissioned services to provide behavioural support
• 70% (n=50) do not currently commission support• 6% (n=4) didn’t know
Delivery of services – key findings from provider reviews
The “hot” and the “not”
NCSCT Service Provider ReviewPatient data assessmentInvolves accessing patient data to verify four-week quit rates and measure customer satisfaction via a short telephone interview.
Provider assessmentInvolves a self-completion questionnaire to be filled out by the provider and signed off at manager level.
Report (review outcome)Issued to the provider / commissioner
NCSCT Service Provider Review
Delivery of services
Amber / red rating % (n)Session time 72.7 (8)Staff training 54.5% (6)Lost-to-follow up 54.5 (6)Quit rate 45.5 (5)CO rate 45.5 (5)Number of sessions 27.3 (3)
Delivery of services
Likely to be very satisfied with the
service
Likely to be very satisfied with the
service
Access to medications
Access to medications
Weekly sessionsWeekly sessions
Quit rateQuit rate
Support based on a protocol
Support based on a protocol
CO testingCO testing
Client satisfaction
“Lovely people…a great service”
“Lovely people…a great service”
“My advisor was incredibly helpful and supportive”
“My advisor was incredibly helpful and supportive”
“Very impressed with the service”“Very impressed with the service”
“It was an excellent
service ... all the advisors were very helpful”
“It was an excellent
service ... all the advisors were very helpful”
“Very happy, great support, really liked seeing the advisor
each week”
“Very happy, great support, really liked seeing the advisor
each week”
“Very disappointed as
was ready to quit but heard nothing
after being referred”
“Very disappointed as
was ready to quit but heard nothing
after being referred”
“The guy I saw, he left – and then the service didn’t get
back to me”
“The guy I saw, he left – and then the service didn’t get
back to me”
Data verification
• 943 clients spoken to
• 71.6% contacts verified
• Verification rate ranged from 94% - 29%
Reasons for non-verification
Summary• Remains variable and change continues!• Stop smoking services, four-week quit outcomes and priority
groups are still a focus• Services continue to be well regarded by their users• Inconsistency in service delivery• Good opportunity to revise what the local minimum standards
for service delivery are (commissioners)• Providers need to consider how they can meet minimum
standards• Data accuracy requires on-going assessment• Importance of independent review