Tobacco Dependency Treatment in HMP Hydebank Wood. Multi-disciplinary pilot project in prison setting.

Tobacco Dependency Treatment in Prison Population in Northern Ireland.(NI) HM Prison Hydebank Wood is a medium security site housing around 300 young male offenders and women. Although smoking prevalence is reducing overall across the UK, with latest NI figure at 17%, (NI Statistics and Research Agency 2021) higher areas of concentration remain with a figure of 78% recorded in prison population (Education Management Information System 2021). South Eastern Trust has responsibility to provide healthcare to all three prison sites in NI. Tobacco use is the only legal product that will kill half of its users (British Thoracic Society 2018) and it continues to be the single greatest cause of health inequalities. The provision of behavioural support, alongside appropriate medications, is the gold standard treatment for tobacco dependence and will deliver the highest recorded outcomes of smokers quitting long term. (NICE Guidance NG92 2018). Early conversations with key stakeholders was essential, as was liaison with the Engagement Leads, to confirm there was a need, and to help shape the service we offered. Our core service delivers smoking cessation to acute care, including mental health and maternity clients. Working with unfamiliar organisations such as prison health, prison services and primary care required persistence, negotiation and excellent communication pathways. Gaining access to prison facilities and IT systems, setting up prescribing protocols and medicines administration processes required multi-disciplinary and cross-departmental partnership, and although this was frustrating and time consuming at times, many of these systems will be easily replicated as the service is developed across other sites. The use of Quality Improvement skills attained during our involvement in the British Thoracic Society Tobacco Dependence QI programme in acute care, have been invaluable. We have listened to service user needs, for example, in the development of a Stop Smoking workbook specifically designed around the prison setting daily routine. The service has been developed and delivered with funding for 0.2 WTE, and within this challenging capacity, the results have exceeded targets from Public Health Agency NI. Figures for Hydebank Wood clinic April 2022-March 2023 Number of referrals =128 Receiving advice = 90 And info Set quit date =30 Quit at 4/52 =18 (CO verified ) 60% Public Health Agency NI require quit figures only, harm reduction is not currently measured. This service offers person –centred care, with an empathetic, non- judgemental approach and the comments from the service users speaks volumes for how much the team are appreciated. Robust evidence of the value for money of evidence based stop smoking interventions (BTS 2021) however, the real benefits of this particular project will be the long-term health benefits to the clients and their families and a small but we would hope, not insignificant movement in reducing health inequalities. We are proud to be involved in the overall aim of the prison service of NI which is: ‘not to punish people further but to enable change,so they come out fitter, more educated and enabled to become part of the community they return to.’