#QuitForCOVID: The Newcastle experience

In 2007, the introduction of the smoking ban in public places saw smoking rates dramatically fall. Despite this, 15% of the adult population continue to smoke, of which a high percentage represent those from socially deprived areas. It is evident that those who receive ongoing support and/or pharmacotherapy increase their chance of quitting rather than doing it alone, often resulting in multiple quit attempts and a feeling of failure.

As a Consultant Anaesthetist, I have always been driven to encourage patients to stop smoking before any surgical operation, yet the advice or interventions didn’t seem ideal. Targeting smokers to “stop before your op” has always been a priority within our pre-assessment clinics. With the additional support of Public Health Newcastle and a recognised pathway, we were able to train our nurses and AHPs in evidence-based brief behavioural interventions to help encourage patients to stop and refer them into stop smoking services within their local communities. Overnight, we were so successful we became the biggest referrers into this service.

COVID-19 hit us all hard. The vast majority of elective surgery stopped, and pre-assessment became everything we had worked for it ‘not to be’. Reduction in face to face visits, timely assessments, an inability to provide optimisation in the form of PREHAB / Chronic Obstructive Pulmonary Disease clinic, cardiopulmonary exercise testing ... We were deemed the ‘clean’ hospital and although some cancer work continued, pre-assessment lost its purpose. Personal protective equipment became the overwhelming theme of all our conversations and emails signed off with “stay safe”.

The focus soon became staff safety and ensuring their wellbeing. How were we going to keep us all going throughout the outbreak and the inevitable changes that would occur? Could we minimise the risks for staff and how would we do this? Reports from China highlighted that the numbers of healthcare workers being infected with COVID were dying and there was an established link between smoking and worse outcomes. It made us question whether we could use our pre-habilitation smoking cessation pathway for staff instead of patients?

Following a quick email to a contact in public health and Healthworks, a community-based charity aiming to improve health and wellbeing across the North East, a staff intervention pathway was created within three days. Staff could simply email Healthworks directly and one of their health trainers would contact them within 24 hours. Free vouchers were supplied by Public Health for nicotine replacement therapy (NRT) and/or would be sent out with continuing emotional support over the telephone.

Publicity for the intervention was difficult initially. Fresh NE, a stop smoking charity, designed the flyers to be distributed across the trust and our CEO included it twice in her weekly blog. 

So far, 35 staff members have used the service. Eight have managed to quit, but the majority haven’t as yet been followed up with and we are eagerly awaiting the full results. All those spoken to have relayed their gratitude emphasising that the service had been ideal and an easy to follow process. We are now looking to include the pharmacy located in the hospital to provide the products allowing staff to pick up the NRT products at their place of work. Though the pandemic has had a dramatic impact upon us all, it was the push they needed to quit for good, not only due to the risks to themselves but the added strain on their colleagues within the NHS.

James Prentis