Project outline

The NHS Long Term Plan includes funding for every trust over a 3-yearperiod to develop an in-house (NHS) based tobacco dependence treatment service for pregnant women. The service must be established, offered and delivered by end of 2023/24. The 2021/22 operational Planning Guidance included a specific Long Term Plan objective in the Maternity Transformation Programme (MTP): make new NHS smoke free pregnancy pathways available for up to 40% of maternal smokers by March 2022.

The recommended model for pregnant women is more intensive than models for the non-pregnant population and should be delivered within maternity services – in house. It expands on recommendations in NICE guidance NG92 to drive engagement: despite good referral rates to Local stop smoking services and outcomes when engaged, many women do not convert their referral to an appointment/quit. This is often not picked up until later in the pregnancy. The recommended model also builds on the Saving Babies’ Lives Care Bundle version 2 (SBLCBV2), where all pregnant women should be assessed for carbon monoxide (CO) exposure at booking, the 36-week antenatal appointment and other appointments as appropriate. By focusing on the referral and treatment elements of SBLCBV2 and NG92, the model aims to increase engagement and improve outcomes.

Why is this project needed?

In Norfolk and Waveney, there were 8,870 births in 2019/2020, of which 2.7% (240 babies) had a low birth- weight (under 2.5kg), with 27 stillbirths. In 2020, national 8.9% of women smoked at time of delivery. In Norfolk and Waveney, the smoking at time delivery rate (SATOD) is significantly higher than the national average at 13.6% and remains outliers for the East of England. SATOD rates vary between districts in Norfolk and Waveney, due to varying levels of deprivation and of the average ages of mothers with higher smoking prevalence in areas of great deprivation and amongst 18- to 34-year-olds.

The prevalence of smoking in pregnancy is higher in women who have never worked or are routine and manual workers. Within Norfolk the highest rates of smoking in pregnancy are in West Norfolk and Great Yarmouth.

Expected outcomes

The vision for Norfolk and Waveney reflects the nationally recommended model for maternity, within the context of the local demographic. Tobacco dependence treatment for pregnant women will be provided in-house, with the development of a new NHS based service. Each trust will have dedicated tobacco dependence specialists who will be linked to specific continuity of carer teams, to provide evidence-based and personalised support.

The Norfolk and Waveney LMNS has identified James Paget University hospital (JPUH) as the pilot site. JPUH has the highest prevalence of smoking in pregnancy in Norfolk and Waveney which is intrinsically linked to health inequalities, starting in the area of greatest need is the most equitable approach. JPUH will fully implement ‘Continuity of Carer’ by December 2021 which the Smokefree Pregnancy Advisors will work alongside and will facilitate locality-based education/ support packages for professionals and families, with the goal of reducing SATOD rates to >6% in line with the national ambition.