Framework for the Delivery of Stop
Smoking Services in Prisons
‘The basic principle underpinning health provision within
prisons is that services are based upon need and offered to an
equivalent standard to those in the wider Community’
(DH, 2003)
1
Contents
Introduction
1
Complexities of the Setting
4
Best Practice Checklist
6
Framework for the Delivery of Stop Smoking Services in Prison
7
Conclusions
14
References
15
Useful links
17
Contact Details
18
Acknowledgements
Stephen Woods
North West Tobacco Control Co-ordinator
Prisons and Criminal Justice Settings
Michelle Baybutt
Intervention Manager UCLan
Susan MacAskill
Senior Researcher Institute for Social Marketing
University of Stirling
Douglas Eadie
Senior Researcher Institute for Social Marketing
University of Stirling
Jennifer McKell
Research Assistant Institute for Social Marketing
University of Stirling
The project would also like to thank all those involved in developing
this document
The project is part of a portfolio funded by the Department of Health and led
by the UK Centre for Tobacco Control Studies (UKCTCS www.ukctcs.org): a UK
Public Health Research Centre of Excellence and a strategic partnership of
nine universities involved in tobacco research in the UK.
November 2011
2
INTRODUCTION
This document will outline the opportunities identified within North West prisons to enhance the
effective delivery of stop smoking services. It will outline the public health opportunities and
benefits of delivering targeted services within a prison setting. The document will draw on examples
of good practice from HMP services across the North West region and present how creative and
innovative approaches can support the delivery of stop smoking services. It will focus primarily on
opportunities to enhance service delivery within existing resources and will reflect on how creative
use of staff across the system can increase capacity and reduce waiting lists. It is widely recognised
that prison healthcare services can provide access to an ‘at risk’ group often deemed hard to reach
where innovative approaches can improve health and address health inequalities in areas of multiple
deprivation. In addition the document will draw on other examples of practice that challenge the
perceptions of offenders being a hard to reach group and present how the prison setting presents an
ideal opportunity to deliver stop smoking initiatives.
Background
This document is an output of the delivery of a Department of Health funded Public Health
Inequalities Demonstration project, one of 6 such programmes nationally. This project focuses on
the role of a Regional Tobacco Control Coordinator: Prisons and Criminal Justice Settings which was
established to look toward the organisational/systems perspectives across prisons, probation
services, and police custody in relation to tobacco control and stop smoking support and treatment
in the North West1. The project is part of a portfolio funded by the Department of Health and led by
the UK Centre for Tobacco Control Studies (UKCTCS www.ukctcs.org): a UK Public Health Research
Centre of Excellence and a strategic partnership of nine universities involved in tobacco research in
the UK. The overall findings and recommendations being used to focus on ‘what works’, recognising
complexities such as the constraints within systems for practitioners; challenges of working across
organisational boundaries; and the needs of differing audiences, such as commissioners and
providers.
Prisons as a Healthy Setting and Public Health Opportunity
The Healthy Settings approach was derived from the WHO strategy of ‘Health for All’ in 1980,
followed by the 1986 Ottawa Charter for Health Promotion (WHO, 1980 – WHO, 1986). Both these
documents were important steps towards establishing the holistic, multifaceted and
multidisciplinary approach embodied by Healthy Settings programmes, as well as towards the
integration of health promotion and sustainable development.
"Health is created and lived by people within the settings of their everyday life; where they
learn, work, play, and love."
(WHO, 1986)
1
UCLan http://www.healthysettings.org.uk/
1
WHO have defined ‘settings for health’ as “the place or social context in which people engage in
daily activities in which environmental, organisational and personal factors interact to affect health
and wellbeing” (Dooris, 2006).
In 2000 the responsibility for health policy development and standards passed from HM Prison
Service to the Department of Health, Primary Care Trusts becoming fully responsible for
commissioning prison healthcare in 2006. This helped change the perceptions of wider offender
healthcare presenting opportunities to widen the previous medical model focus and acknowledge
the opportunities for addressing the wider inequalities and public health agenda (Baybutt, et al
2006).
The Choosing Health White Paper (DH, 2004) identified the need for greater focus on preventative
services, fairer access to health information, resources and care, and greater emphasis on healthier
lifestyles, particularly amongst disadvantaged groups. The World Class Commissioning agenda and
the work of Sir Michael Marmot (Marmot, 2010) provided the context for the development of cost
effective, quality services that are delivered in partnership. The report by Sir Michael Marmot
stresses the importance of addressing inequality through joint work between the NHS, Local
Authorities and individual communities. The report estimates the cost of inequality as £5.5 billion to
the NHS and £31-33 billion to the economy. It is indicated that we currently spend an estimated
£2.7 billion a year on treating smoking related illness, but less than £150 million on encouraging
smoking cessation (DH, 2011). Prisons and probation present an ideal opportunity to access an
otherwise hard to reach and at risk group.
It is clear that prisons can be seen in this holistic way - they are indeed both a place and a social
context, albeit in a captive or controlled environment. The opportunities for health promotion are
evident in that the majority of the prison population are from deprived backgrounds and in many
instances engaged in a variety of risk taking behaviours. The headline findings and the best practice
outlined in the 2007 document Stop Smoking Support in HM Prisons: The impact of Nicotine
replacement therapy (MacAskill and Hayton, 2007) identifies that substantial quit rates can be
achieved in the prison setting acknowledging that in addition to this there is prisoner interest in
participation. This paper will build on these finding and the” Acquitted”: Best Practice Guidance
document (DH, 2003) using the North West mapping work to present a delivery framework and a
checklist for effective delivery of stop smoking services. Certainly the Prison Service Order PSO 3200
(HMPS, 2003) provides an additional lever and tool to consider prisons as healthy settings,
supporting health promotion interventions and approaches that acknowledge the holistic ethos set
out in the Ottawa Charter (WHO, 1986). It also provides the mechanism to consider how tobacco
control activities link to other initiatives and how they fit into the wider strategic level.
In addition to this there are high levels of smoking amongst prisoners (80%). It is reasonable to
consider that those in the probation system have an equally high rate, coupled with contributory
factors such as high levels of mental health conditions, substance use and educational limitations. It
is important that attention is given to the prisoner pathway on release, particularly those released
on licence, to help prevent successful quitters relapse. This is supported by evidence from a number
of studies across the wider Criminal Justice System. For example, a 2007 survey of offenders on the
probation caseloads in Nottinghamshire and Derbyshire revealed that 83% of probationers were
smokers compared to only 22% of the general population. (Brooker, et al 2009). In addition to this
2
63% of detainees in police custody in London reported dependence on cigarettes in a 2007 survey
(Payne-James, et al 2010).
‘Improving Health, Supporting Justice’ : The National Delivery Plan of the Health and Criminal Justice
Programme Board (DH, 2007) proposes a whole system approach and outlines that research has also
shown that offenders generally do not access the health services they need outside of prison (DH,
2007). The criminal justice system offers a range of settings and opportunities that, when properly
used, would allow health services to engage better the perceived ‘hard-to-reach’ sections of the
population. It provides a prime opportunity to address health inequalities, through engagement with
NHS health services and specific health promotion, treatment and prevention interventions.
The basic principle underpinning health provision within prisons is that services are based upon
need and offered to an equivalent standard to those in the wider Community
(DH, 2003;DH, 2002; DH, 1999)
This is supported in HMP service order PSO 3050 which states that the aim of the partnership
between HMP and health ‘is to provide prisoners with access to the same range and quality of
services as everyone else’ (HMP, 2006; DH, 1999).
3
COMPLEXITIES OF THE SETTING
‘Acquitted’: Best practice guidance for developing smoking cessation services in prisons (DH, 2003)
acknowledges the importance of understanding the role smoking has in the lives of prisoners, in
particular relief from both boredom and stress and this is supported from the mapping work to date.
This is perhaps further compounded by increased stress points and the lack of variety in diversionary
activities in prison;
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Offenders as a high risk group
Both educational and health literacy issues
Lifestyle experiences and risk taking behaviour
Isolation – lack of , or a need for, support from partners and family members
Boredom and including unemployment;– access to diversionary activities and incentives
Culture and masculinity issues relating to men’s health and access to health services
Tobacco and its role as currency in prisons including issues of illicit trade
Mental health and well-being – depression, anxiety ; confidence self-worth ; emotional
wellbeing; stress and appropriate coping mechanisms
Bullying – the social context, relationships and cultures of violence
Identity and the need to ‘fit in’
Control over the frequency, ability and affordability of smoking; impact on offenders of staff
smoking – in prison and probation
Barriers / Facilitators
As has been previously outlined, smoking prevalence in prison has been estimated to be around
80%, with similar figures suggested for the probation setting. However smoking habits do change in
prison and this can be both positive and negative. The feedback from the mapping exercise indicates
that smokers in prison smoke a reduced amount largely due to the reduced supply and in some
instances, in a reduction in the frequency of smoking. This is supported by findings from the project
rapid literature review (Mac Leod, et al 2010) which cites evidence from a number of sources. The
review also identifies a US study from a female prison that indicates an increase in smoking
behaviour among inmates showing that 14% of prisoners started smoking for the first time when
entering the prison 50% having increased their consumption (Cropsey, et al 2008 cited in Mac Leod,
2010).
From the project mapping exercise it is possible to identify a number of keys issues in the delivery of
stop smoking services. The variety of delivery models is in some ways to be applauded, as there have
been creative solutions to providing access to stop smoking services. However there are also a
number of barriers to delivery. The key area of concern is that of capacity, an issue despite how or
who delivers the service. All the prisons have waiting lists which range from 2/3 weeks to potentially
12 weeks, although drop in style services have in some instances resolved this. The number of DNA’s
(did not attend) in some establishments is a problem due in many instances to regime issues and
difficulties escorting prisoners to sessions or appointments.
4
There are positives and negatives to the mode of delivery. In establishments where the community
teams deliver the sessions, the benefits are dedicated time by staff whose core role is delivery of
stop smoking services. The negative to this is that staff are less familiar with the complexities of the
prison system and the internal nuances, offering greater opportunities for prisoners to abuse the
system and use of NRT. Where prison health care staff or gym staff deliver the sessions, the positive
is that they understand the internal systems and day to day issues and are perhaps more aware of
potential abuse etc. The downside is that the time is not always dedicated or prioritised to the
delivery of stop smoking sessions so they are more prone to being cancelled. In some prisons,
particularly local remand and female establishments, the turn round of the population presents a
challenge to delivery of a structured stop smoking programme and as a result it is understandable to
see lower numbers accessing services.
The abuse of NRT is an issue although most prisons have mechanisms in place to monitor the
distribution and use of patches in most instances this is on a patch for patch return basis. This
coupled with regular/random CO monitoring helps alleviate some of the issues. However in larger
prisons, the distribution and monitoring through pharmacy is more complicated and weekly supplies
are more frequent. Some prisons use compacts ( a contract) with prisoners commencing stop
smoking programmes. These explain the prisoner’s commitment to the programme, outlining the
use of CO validation, monitoring the use of patches and in some instances, informing prisoners of
potential random cell checks. These measures are useful in terms of controlling abuse of NRT,
reducing the opportunity to use it as currency. Both tobacco and NRT are used as currency and there
is the potential for bullying to take place as a result. This is an important factor in understanding the
role of tobacco in the prison environment.
The use of random CO monitoring is utilised in some establishments to varying success but it
certainly provides an additional level of control. It should be feasible in prison to achieve the target
of 85% CO validated 4 week quits and there is definitely potential to have 100% CO validation. The
only barrier would be prisoners lost to follow up due to release or transfer.
Access to NRT is limited to patches in many establishments although some do actively provide access
to Micro tablets, nasal sprays, inhalators and in a small number Champix. However access to
Champix is not good and is often only considered in instances where a prisoner has already started
on a programme on the outside or has been transferred part way through a course of treatment.
Some prisons do not provide access due to the indicated additional suicide and mental health risks.
Patches are generally accepted as the preferred treatment option as they are proven to be effective,
easily administered and cost effective and this is reflected across the prison system. There is clearly a
need to provide some consistency to the wider products available across the system as some prisons
have cleared items through security whilst others have not; again these are issues that need to be
considered in the training of staff.
The following checklist provides an excellent framework to support the delivery of prison specific
stop smoking services. This along with the service delivery framework, will provide a comprehensive
tool kit to assess current stop smoking services, outlining a set of minimum standards and identifying
best practice to support enhanced delivery.
5
BEST PRACTICE CHECKLIST: KEY LEARNING TO MAXIMISE SUCCESS WITH QUITTERS IN PRISON
SETTING
 Effective partnership development between the PCT and the prison is an underpinning essential -both in health care
and the wider prison organisational structures - building relationships through on-going planning and feedback
mechanisms for cessation and wider tobacco control issues.
 A range of cessation delivery models, both group and one-to-one support, should be available offering flexible
support to meet individual needs. Services can be offered through a range of prison staff, i.e. not just health care staff
but others such as physical education instructors or Prison Officers. Stop smoking external specialists may run group
sessions and staff quit support, but involvement of internal prison staff remains vital.
 Protected staff time and role development for those delivering the service needs to be secured, not just for core
interaction with quitters, but for administration and record keeping activities which may be more demanding than in
community settings. This is important for both prison staff and stop smoking specialists and will also enable advance
planning of programme sessions. Sufficient staff should be recruited and supported to provide a sustainable service.
An enthusiastic ‘champion’ who promotes the service, co-ordinates activities and liaises across organisations is
extremely valuable and should be supported, making cessation part of core work.
 Clear record keeping will enable promotion of the service – telling people what is happening and ‘selling’ the
successes. This is important for providing rewarding feedback to those delivering the service and making a case for
future developments.
 Assessing and exploiting the expressed desire to quit among prisoners, as well as interest from staff, will contribute
to building the service. Needs assessments and keeping track of waiting lists will help.
 Ring-fenced or clearly identified NRT budgets for prisoners and on-going funding commitment continue to be
needed. Efficient and economical ordering procedures and effective supply mechanisms should be developed across
localities, in conjunction with prison pharmacies and pharmaceutical companies.
 Straightforward NRT prescribing and dispensing should be developed within the context of safety issues. Experience
shows that weekly dispensing of NRT with return of used patches achieves a balance between empowering prisoners
and minimising misuse of NRT as currency. Consistent guidance is needed, for example in use of alternative forms such
as lozenges.
 Staff training and on-going support by stop smoking specialist services will contribute to high standards and increase
confidence among those delivering the service. Network meetings are valuable.
 Additional support approaches should be explored and developed, such as peer support, previous quitters joining a
session, and access to exercise and healthier food options. Wider involvement of prison staff will contribute to a
supportive environment, for example, through Brief Intervention training. Recruitment of prisoners from one wing at a
time facilitates mutual support, or at least involving a few quitters at a time from each wing to minimise isolation.
Appropriate visual aids and support literature are needed.
 Care Pathways should be developed with mechanisms to cope with prisoners being transferred from one prison to
another or released during a course of treatment (PSO 3050).
 Wider tobacco control interventions, which are being addressed nationally by the Prison Service, should be on the
agenda in each prison, considering for example smoke-free cells for non-smokers and quitters and making all ‘public
areas’ outside of cells smoke free. This will support cessation attempts and contribute to de-normalising smoking. Staff
cessation support should be considered, within the prison or through links to community settings.
 Awareness and anticipation of relevant legislation and guidance in relation to prisoner health promotion and
workplace issues will enable and support planning and preparation and increase effectiveness – be ahead of the game.
This includes the 2006 Health Act and the forthcoming PSO, current PSO 3200 and the requirement for Local Delivery
Plans.
(MacAskill and Hayton, 2007)
6
FRAMEWORK FOR THE DELIVERY OF STOP SMOKING SERVICES IN PRISON
Assessment area
Anticipated service
delivery
Health Needs Assessment
(HNA)completed and up to date


Smoking Policy Present


Best Practice
HNA completed
and action plan
in place.
HNA reviewed
and updated on
an annual basis.

Smoking policy
in place in line
with the current
PSI.
All staff
informed of the
policy.

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Core Services delivered
(see additional sections)

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Applications
and assessment
process in place
to outline
motivation and
readiness to
quit.
Access to
weekly support
sessions and
provision of
pharmacothera
py (with regard
to
pharmacothera
py minimum
treatment
options being
access to NRT
patches).

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HNA completed and action
plan produced reviewed and
updated on an annual basis.
HNA used to develop a wider
strategy for prison health care
incorporating health
promotion and addressing
inequalities.
Policy reviewed bi-annually
and compliance monitored
quarterly.
Smoking cells designated in
writing in line with the current
PSI.
Non-smoking prisoners housed
in smokefree cells.
Prisoners have access to
smokefree landings if
requested.
Staff smoking closely
monitored to ensure
compliance with policy.
Applications and assessment
process in place to outline
motivation and readiness to
quit.
12 week structured
programme in place with
access to both 1:1 and group
support as appropriate.
Dedicated staff time allocated
to stop smoking service
delivery and all delivery staff
trained in line with North West
Prisons and Criminal Justice
Settings - Stop Smoking
Training Knowledge and Skills
Competency Framework
(UCLan, 2011) and to NCSCT
accredited levels - other nonhealth care staff trained in
brief intervention and all staff
7
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

Minimum
duration of
support 6
weeks. (12
week
programme
recommended)
4 week Quits
CO validated.
Referral to
healthcare for
prisoners with
additional
health issues.
Access to
appropriate
literature.
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Pharmacotherapy support

Routine access
to support and
NRT in the form

trained in Very Brief
Intervention (VBA).
Health trainers and prisoners
involved in supporting the
delivery. Services supported by
a variety of staff across the
wider prison. Protocols in place
to monitor and deal with those
who do not attend (DNA’s)
including where necessary
waiting list initiatives.
Systems in place to ensure
timely prisoner movement and
mechanisms in place to provide
speedy follow up when
regime/security issues prevent
attendance.
In line with regional and local
NRT protocols access to
patches for the majority of
prisoners with additional NRT
options including combination
therapies as appropriate.
Access to Varenicline
(Champix) for selected
individuals supported by
healthcare (it is anticipated
numbers accessing will be very
low).
Protocols and controls in place
for provision and prescribing of
NRT and Champix (see below).
All 4 week Quits CO validated
(minimum 85%) with regular
weekly CO checks in place.
Prisoners sign a compact on
commencement of treatment
outlining their commitment to
the programme.
Incentives and diversionary
activities in place.
Links to partners and visitor
centres. Programme specific
literature available
(consideration given to literacy
and language needs).
In line with regional and local
NRT protocols - Routine access
to NRT in the form of patches
8


of patches as a
minimum for all
prisoners
signing up to a
stop smoking
programme.
Regular use of
CO monitoring.
Access to
additional
healthcare
support for
prisoners with
additional
health needs.

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Funding


Funding
available for
NRT to
prisoners
ordering
arrangements
and delivery
mechanisms in
place.
Monitoring of
budget.
for all prisoners signing up to a
stop smoking programme.
Clear patches prescribed to aid
security. Controls in place to
monitor prescribing of NRT
supplies distributed on a
minimum weekly patch for
patch return basis including
routine/random CO
validation/monitoring.
All prisoners achieving 4 quit
status to be CO Validated.
Prisoners agree a compact on
sign up to stop smoking service
programmes (including
notification of potential
random cell searches).
Access to other forms of NRT
and combination therapies as
appropriate in consultation
with healthcare lead.
Varenicline (Champix) available
to those meeting criteria.
Referral protocols in place for
prisoners with additional
health needs.
Priority targeting and access to
support for prisoners with long
term conditions for example
those with COPD.

PCT formularies and protocols
reflect access to NRT delivered
in the community and
delivered in line with regional
and local protocols.

Funding available for NRT to
prisoners ordering
arrangements and delivery
mechanisms in place.
Monitoring of budget to
identify pressures. Additional
allocations to support targeting
of prisoners with long term
conditions.
PCT payments to prisons
achieving successful quits as an
incentive to service
developments. Consideration


9
given to schemes to support
staff in prison to access
services.
Structured programme

Prisoners have
access to
weekly support
sessions either
on a 1:1 or
group basis
including
monitoring of
NRT and CO
validation.

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Access to information sources – literacy
/culturally sensitive

Prisoners have
access to basic
materials and or
verbal support
as appropriate
there is
provision to
accommodate
any language
barriers for
example
Language Line.

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Prisoners have access to a 12
week structured programme of
support delivered on a 1:1 or
group basis or a combination.
Sessions include support,
monitoring of NRT use and
routine CO monitoring.
There is access to diversionary
activities and there is a variety
of incentives available to
prisoners.
Programmes have clear links to
opportunities for physical
activity and discussion around
diet and nutrition.
Prisoners have access to a
range of support materials as
part of a structured
programme including
information on diet and
nutrition to support quit
attempts.
Use of a prisoner workbook
structured over the length of
the programme.
Information is available for
partners and family members.
Induction sessions include
information on accessing stop
smoking services.
Promotional material outlining
services are available in
Healthcare, communal areas
and landings.
Consideration given to literacy
levels and language needs in
workbooks and promotional
materials.
10
Wider Health Promotion
Strategy/action plan in place

Prisons operate
a Heath
Improvement
group in line
with the PSO
3200. These are
governor led
and have
dedicated
action plans.

Information included in
welcome packs for all those
requesting a smoking pack.

Prison Health Improvement
Groups (PHIG’s) have
structured action plans which
make explicit links across other
programmes.
Public health teams are key
partners in these groups to
support links with other
initiatives.
There is good engagement of
commissioners as appropriate
and robust links to the Prison
Partnership Boards.
Prisoners are routinely
represented on these groups.
Work towards removing
tobacco welcome packs
replacing these with a healthy
alternative.

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Prisoners involved in delivery of
services

Prisoners
routinely
engaged in
service
developments
and PHIG’s.

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
Use Health trainers
Staff trained in delivery/support


Prison supports
the use of
health trainers
drawn from
staff and
prisoners.

Delivery teams
trained to

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Prisoners routinely engaged in
service developments and
Prison Health Improvement
Group PHIG’s.
Prisoners trained up to offer
brief Intervention and or
support – listeners trained up
and allocated to wings.
Use of health trainers (HT’s)
trained in additional brief
intervention these should
include prisoners.
Prisoners and staff trained as
HT’s to act as champions for
health.
HT’s trained in stop smoking
brief intervention and
potentially as stop smoking
advisors.
Nominated prison lead for stop
smoking services. Healthcare
11

NCSCT level to
deliver services.
Other
disciplines
trained to offer
additional
support as
reflected in
service delivery
model.

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
teams trained to provide
advisor role and deliver
services.
Multidisciplinary teams trained
to provide greater capacity to
service delivery. (consideration
given to alternative structures
including discipline staff, gym
teams, and prisoners alongside
healthcare).
Community Stop Smoking
Teams (CSST’s) deliver training
in line with National and
Regional framework, CSST‘s
key role in maintaining skills,
knowledge and competency.
All staff trained in basic health
awareness with designated
staff trained brief intervention
to improve knowledge base
and provide greater capacity.

Access to incentives or diversionary
activities

Prisoners have
access to a
range of
diversionary
activities.


Prisoners have access to a
range of diversionary activities
especially at daily pressure
points when prisoners are in
lock down and particularly in
the evenings and at weekends.
Additional Incentives are in
place to support prisoners –
- Extra gym sessions
- Access to environmental
projects.
- Pumping Pad – cell based
physical activity routines
- Yoga and Relaxation
- Music /Meditation tapes
and exercises
- Replacements – study,
reading , games, mints,
fruit and water
- Structured programmes for
the day
- Sleep hygiene programmes
- Puzzles/diary/writing and
drawing
- Access to additional dental
cleaning and polishing
- Beauty/body care
treatments

Consideration should be given
to the provision of smokefree
12
landings as incentives
Partners and visitors – links/information

Promotional
Stop Smoking
Service
materials
displayed in
visitors centres.

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Data collection and submission

Data collected
and submitted
in line with the
national
guidance.
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Robust links in place to ensure
partners and family members
are aware of prison stop
smoking services outlining
what they can do to support
prisoners.
Referral information is
available in the visitor centres.
Visitor centre staff trained in
brief intervention.
Certificates utilised for
successful quitters that they
can share with partners and
family members.
Health days in prison take
account of the opportunities
with family/visitors.
Information on accessing
community services available
for visitors/family.
SystmOne in place to collect
and collate stop smoking
service data and links with local
SSS data collection.
Data monitored on a monthly
basis to performance manage
delivery.
Dedicated time allocated to the
collection, collation and
submission of data.
Data reported to the Prison
Health Improvement Group
(PHIG) as part of the PSO 3200.
Target of 85% CO validation
(100% for all completing in the
same establishment).
Systems in place to deal with
those released or transferred
that are potentially lost to
follow-up. Routine collection of
prisoner occupation categories
in line with national guidance.
Community stop smoking
teams support the collection
and monitoring of data.
13
Pathways/protocols on transfer and
release

Recorded
information on
smoking status
and those on
Stop Smoking
programmes
available on
release or
transfer.

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
Support links - mental health and
wellbeing – emotional support

Support
available for
prisoners with
additional
needs.

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

Administration of schemes – waiting
lists/NRT/patches

Recording and
data collection
systems in
place.


Protocols in place to ensure
recorded information on
smoking status and progress of
those on stop smoking
programmes available on
release or transfer.
Prisoners released receive a
minimum of 2 weeks NRT to
support them in the transition
and prevent relapse.
All prisoners being released
receive information on local
stop smoking services and
referral links in place for those
needing continued support.
Those released on licence have
access to stop smoking
information as part of their
Probation induction.
Full assessment on smoking
status completed on transfer.
Stop Smoking Service
Information made available to
all remand and short sentence
prisoners.
Support available for prisoners
with additional needs –
integrated into initial
assessment process.
Referral links in place for those
suitable for Champix.
Mental health staff involved in
the development of services
and staff trained in Brief
Intervention (BI). Additional
support literature available.
Mental health and wellbeing
including emotional support
included in the 12 week
programme. Staff across the
prison system trained in
awareness.
Recording and data collection
systems in place.
Dedicated time available for
the administration of schemes
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
PCT/CCG support and contacts
Commissioners and Public Health


Designated
Commissioning
and Public
Health Leads for
Prisons and
Offender
Health.
Health leads
represented on
Prison
Partnership
boards.




Staff Support available

All staff have
access to local
Stop Smoking
Service
information.



including protocols for dealing
with those who do not attend
(DNA’s) and monitoring use of
NRT.
Support available from the
Community Stop Smoking
Teams (CSST’s).
Designated Commissioning and
Public Health Leads for prisons
and offender health.
Public Health Needs
Assessments (PHNA) regularly
reviewed and partnership
mechanisms in place between
offender health and tobacco
control leads – prisons
included as part of a wider
public health offender health
strategy.
Commissioners and Public
Health Leads working across
PCT’s /CCG’s to design and
commission services
collaboratively.
Prisons and offender health
feature in all PCT/CCG and
HWB’s plans as appropriate.
Designated public health
representation at Prison Health
Improvement Group (PHIG).
Staff have access to service
information in the workplace
stop smoking sessions available
to and or voucher scheme
operational.
Key staff trained in brief
intervention to act as a support
and referral route for staff
wishing to stop smoking.
Ensure compliance with
smoking policy and PSI
09/2007 (HMPS, 2007) to
support and protect staff from
exposure to the harm from
second hand smoke (Staff only
being allowed to smoke in
15

Additional observations
designated areas at dedicated
times).
Prisons working towards
Smokefree environments for
staff.

Development of a regional prison health strategy that
includes both prisoners and staff. This could be
supported by the PSO 3200 prison health promotion
groups with support from the North West Health
Promoting Prisons Network.

Potential for collaborative commissioning of offender
health across a wider foot print rather than just on
existing PCT areas for example on a county or North
West basis.

Offender Health needs to be a key feature in the
development of Health and Wellbeing Boards (HWB’s).

Widening access to smokefree areas in prisons, for
example smokefree landings.
CONCLUSIONS
The provision of comprehensive stop smoking support in prisons can have marked successes with
positive outcomes for staff, prisoners, their families, and the wider community and for public health
goals.
It is clear from the mapping activity that there is scope to review and develop the delivery of stop
smoking service provision in individual establishments within existing resources and without the
need for additional investment. However in order to meet the best practice requirements in full
individual establishments and commissioners may wish to consider investing in additional resources
to increase capacity and support comprehensive delivery.
A number of the North West prisons have enhanced the delivery of services by a systematic review
of internal delivery processes. Following a systematic process review it has been feasible to put in
place a number of structural/system changes that have increased access, reduced waiting lists,
enhanced attendance figures and improved the quality of the service provided. In many areas the
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Community Stop Smoking Teams have trained additional prison staff to increase workforce capacity
and build a strong skills and knowledge base.
Attention has been given to the administration of schemes and mechanisms put in place to reduce
the abuse of NRT and so reduce pharmacy costs.
This document has drawn together the learning and best practice from the mapping activity and
provides a framework to support the delivery of a comprehensive and integrated service. It outlines
what can be put in place to ensure the delivery of a quality service. Individual establishments,
service commissioners and public health teams would benefit from additional support in carrying
out a stop smoking service review utilising this delivery framework.
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REFERENCES
Baybutt M, Hayton P & Dooris M (2006). Prisons in England & Wales: An important public health
opportunity? Chapter in Douglas S, Earle S, Handsley S, Lloyd C & Spurr S (eds), A Reader in
Promoting Public Health: Challenge & Controversy. Milton Keynes: Open University Press, pp. 237245.
Brooker C, Fox C, Barrett P & Syson-Nibbs L (2009). A Health Needs Assessment of Offenders on
Probation Caseloads in Nottinghamshire & Derbyshire: Report of a Pilot Study. Lincoln: CCAWI
University of Lincoln.
Department of Health (DH) (1999).The Future Organisation of Prison Healthcare. London:
Department of Health.
Department of Health (DH) (2002). Health Promoting Prisons: A Shared Approach. London:
Department of Health.
Department of Health (DH) (2003). Acquitted: Best Practice guidance for developing smoking
cessation services in prisons. London: Department of Health.
Department of Health (DH) (2004). Choosing Health: Making Healthy Choices Easier. London:
Department of Health.
Department of Health (DH) (2007). Improving Health, Supporting Justice. London: Department of
Health.
Department of Health (DH) (2011). Healthy Lives, Healthy People: A Tobacco Control Plan for
England. London: Department of Health.
Dooris M (2006). Healthy settings: challenges to generating evidence of effectiveness. Health
Promotion International, 21(1): 55-65.
H.M. Prison Service (HMPS) (2003). Prison Service Order (PSO) 3200 on Health Promotion. London:
HM Prison Service.
H.M. Prison Service (HMPS) (2006). Prison Service Order (PSO) 3050 Continuity of Healthcare for
Prisoners. London: HM Prison Service.
H.M. Prison Service (HMPS) (2007). Prison Service Instruction 09/2007. Smoke free legislation: prison
service application. London: H.M Prison Service.
MacAskill S & Hayton P (2007). Stop Smoking Support in HM Prisons: The Impact of Nicotine
Replacement Therapy. Includes Best Practice Checklist. London: Department of Health.
Online:http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/d
h_073032.pdf
Marmot M (2010). Fair Society, Healthy Lives: Strategic Review of Health Inequalities in England Post
2010. UCL Institute for Health Equity.
18
Payne-James JJ, Green PG, Green N, McLachlan GMC, Munro MHWM & Moore TCB (2010).
Healthcare issues of detainees in police custody in London UK. Journal of Forensic and Legal
Medicine, 17(1): 11-17.
University of Central Lancashire (UCLan) (2011). Prisons and Criminal Justice Settings Stop
Smoking Training: Knowledge and Skills Competency Framework.
World Health Organization (WHO) (1986). Ottawa Charter for Health Promotion. Geneva: WHO.
World Health Organization (WHO) (1980). Health for All. Geneva: WHO.
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USEFUL LINKS
www.uclan.ac.uk/hsdu
www.healthysettings.org
Healthy Settings Unit
University of Central Lancashire
www.ctcr.stir.ac.uk
Centre for Tobacco Control Research University of Stirling
www.tobaccofreefutures.org
Tobacco Free Futures
(Formerly Smoke Free North West)
www.ukctcs.org
UK Centre for Tobacco Control Studies
www.ncsct.co.uk
NHS Centre for Smoking Cessation and Training
www.ash.org.uk
ASH Action on Smoking and Health
www.nosmokingday.org.uk
No Smoking Day 2012
www.roycastle.org
The Roy Castle Lung Cancer Foundation
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CONTACT DETAILS
Stephen Woods
North West Tobacco Control Co-ordinator, Prisons & Criminal Justice Settings Demonstration
Project, UCLan
[email protected]
01772 893651
07891 614692
Michelle Baybutt
Intervention Manager UCLan
[email protected]
01772 8933764
www.healthysettings.org.uk
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