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HSE Tobacco Free Ireland Programme Implementation Plan 2022-2025 Contents Glossary .................................................................................................................................................................................................. 3 Introduction ............................................................................................................................................................................................ 5 The HSE Tobacco Free Ireland Programme in 2022 ............................................................................................................................ 6 Where to Next?
.................................................................................................................................................................................... 10 Action Plan 2022-2025 ......................................................................................................................................................................... 11 Glossary AND Assistant National Director AND EHS Assistant National Director Environmental Health Service BCO BIU CCO Breath Carbon Monoxide Business Information Unit Chief Clinical Officer COBT Carbon Monoxide Breath Testing HSE KPI Health Service Executive Key Performance Indicator MECC Making Every Contact Count MN-CMS Maternity Newborn Clinical Management System NCEC NSP OoCIO NWIHP TACU TFC TFIP National Clinical Effectiveness Committee National Service Plan Office of the Chief Information Officer National Women and Infants Health Programme Tobacco & Alcohol Control Unit, Department of Health Tobacco Free Campus Tobacco Free Ireland Programme TFIPG Tobacco Free Ireland Programme Group 3 HSE Tobacco Free Ireland Programme 2022 Introduction Improving the health and wellbeing of Ireland’s population continues to be a national priority and a key element of healthcare reform.
Tobacco control is a central element of the work undertaken by HSE Health and Wellbeing.

The HSE Health and Wellbeing function, under HSE Strategy and Research, is focused on helping people to stay healthy and well, reducing health inequalities and protecting people from threats to their health.
A number of our Policy Priority Programmes (Tobacco Free Ireland, Healthy Eating and Active Living, Sexual Health, Mental Health and Wellbeing, Alcohol, Healthy Childhood, Staff Health and Wellbeing) support people and communities to protect and improve their health and wellbeing; turning research, evidence and knowledge into action.
These Programmes, including the Tobacco Free Ireland Programme (TFIP); act as the authority on health, wellbeing and policy development for their subject matter, helping to build an intelligent health system that supports our population to be healthy and well.

The HSE Tobacco Free Ireland Programme (TFIP) was established in 2016 as part of the Healthy Ireland in the Health Services Implementation Plan.
It has a remit to mobilise the health services to improve health and wellbeing and play its part in the achievement of a reduction in smoking prevalence to less than 5% of the population by 2025.

The TFIP works to coordinate and lead tobacco control activity across the health services to ensure implementation of the HSE actions contained within the Governments’ Tobacco Free Ireland strategy.
Since the publication of the first HSE Tobacco Free Ireland Programme Implementation Plan (2018-2021), the HSE has undergone structural changes with Health and Wellbeing programmes now under the governance of HSE Strategy and Research.
Despite structural changes and the natural evolution of individual projects within the Programme, the overall objectives of the TFIP over the next four years are to: • • Prioritise the protection of children in all of our initiatives and contribute to the denormalisation of tobacco use for the next generation Support people to quit smoking and treat tobacco dependence as a care issue while targeting population groups with higher smoking prevalence and health inequalities.
This new plan (2022-2025) sets out the actions we will take to achieve these objectives.

This new plan (2022-2025) sets out the actions we will take to achieve these objectives.

We look forward to working with our colleagues across the Health Service and our various partners and stakeholders in our shared goal of creating a Tobacco Free Ireland for all.
Martina Blake National Lead, HSE Tobacco Free Ireland Programme Health and Wellbeing HSE Strategy and Research Helen Deely Interim Assistant National Director Health and Wellbeing HSE Strategy and Research 5 HSE Tobacco Free Ireland Programme 2022 The HSE Tobacco Free Ireland Programme in 2022 Since the establishment of the Tobacco Free Ireland Programme in 2016, smoking prevalence has declined in Ireland from 22% to 18% in 2021.
For the first time, 45 to 54 year olds (24%) are the most likely age group to smoke, with an increase of 6 percentage points since 2019.

Rates of smoking among 25 to 34 year olds (20%) (the age group with the highest prevalence of smoking in each previous survey) have declined by 6 percentage points since 2019.
While we continue to make significant progress in reducing the overall prevalence of tobacco use in Ireland, smoking continues to be the leading cause of preventable death and disease with approximately 4,500 deaths and 44,000 hospitalisations annually (State of Tobacco Control, 2022).

The burden of death and disease is also not shared equally across the population.
While smoking persists in being more common in lower socioeconomic groups compared to higher socioeconomic groups, the gap in smoking status between the groups has widened.

In 2015, compared to those in higher socioeconomic groups, those in lower socio-economic groups were 2.1 times more likely to currently smoke.

In 2021, compared to higher socioeconomic groups, those in lower socio- economic groups were 3.7 times more likely to currently smoke having adjusted for age and gender differences.
It goes without saying that 2020 and 2021 have been unprecedented years for the entire healthcare system with all services coming under immense strain due to the COVID-19 pandemic.

We have seen extraordinary responses from staff across the HSE including some staff in Health and Wellbeing who were redeployed to work in various areas of the COVID response.
Stop Smoking Services were prioritised as part of the COVID response as the protection of respiratory health at a population level was identified as an important factor in reducing COVID related morbidity and mortality.

The cyber attack on the 13th May 2021 also meant that services were disrupted and that staff had to find new and innovative ways of working.
The HSE IT system for monitoring and recording stop smoking service delivery was impacted for a period of 10 weeks which made service delivery challenging.

Staff working in stop smoking services demonstrated formidable resilience throughout this period and continued to provide quality care to clients.

Since the publication of the first HSE Tobacco Free Ireland Programme Plan (2018-2021), our stop smoking services and QUIT campaign have seen significant activity.
A total of 35,589 people have received intensive stop smoking support from a specialist HSE stop smoking advisor.

There have been over 2 million visits to quit.ie with 29,626 individual online QUIT plan sign-ups.

The QUIT mass media campaign has evolved through the I Will Survive iteration in 2017 to the current Last Stop Campaign.

A new QUIT Campaign is being planned and due to be launched in 2023.
A Clinical Guideline Development Group was established in 2017 to produce Ireland’s first Stop Smoking Clinical Guideline.

This group has reviewed and quality appraised existing international guidelines and literature in order to formulate recommendations to inform quality stop smoking care in the Irish setting.

These Stop Smoking Clinical Guidelines were developed under the auspices of the National Clinical Effectiveness Committee (NCEC) and subsequently endorsed by the Minister for Health.
A Quality Improvement Bursary scheme for Tobacco Free Campus Policy implementation was introduced in 2019.

This scheme has been very successful in engaging and encouraging services to progress tobacco control across various healthcare settings, with over 70 services completing the process to the end of 2021.

Since 2019, over €250,000 has been allocated to health services to further improve tobacco free environments across the health service.
The Programme has also supported Tobacco Free initiatives outside the health service, including the initial Not Around Us Campaign in Limerick in 2020.

Limerick Comhairle na nÓg was subsequently awarded a prestigious World No Tobacco Day Award by the World Health Organization (WHO) for their leading role in the development of the Not Around Us campaign.
The Programme has worked in partnership with Mental Health Services to improve the level of stop smoking care we provide to people using mental health services.

Mental Health services made up approximately 50% of all the services that engaged in the TFC Bursary Scheme, which demonstrates a new level of commitment from these services in addressing tobacco use.

Mental Health Ireland and the TFIP partnered to host a National Conversation Café on Smoking, Mental Health and Recovery in 2019.
This was the first time that mental health services users, staff and policy makers had been brought together to examine the relationship between smoking and mental health and to have an open, honest and direct conversation where all perspectives on this issue were articulated and recorded.
Smoke Free Start (initially funded through the Sláintecare Integration Fund) is a joint initiative between the TFIP and the National Women and Infants Health Programme (NWIHP), both of which have specific actions within their strategic plans to establish dedicated smoking cessation support services in Irish maternity services.
The project aims to develop capacity and capability in maternity settings to better diagnose and treat smoking in pregnancy through the introduction of routine breath Carbon Monoxide (BCO) testing at antenatal appointments and subsequent referral of pregnant women who smoke to, stop smoking services.

Dedicated, stop smoking services have been established at Cork University Maternity Hospital, the National Maternity Hospital and across all four maternity services in the South East.
This new Programme Plan (2022-2025) will continue to build on all of these initiatives as we strive to engage and work with everyone in Irish society to; a) protect children and the most vulnerable in society and b) provide quality stop smoking care to everyone who needs it in order to reduce the burden of disease and address the health inequalities created by tobacco use.
6 Tobacco Free Ireland Programme Plan 2022-2025 A Selection of Achievements 2018 - 2021 Smoking Prevalence and Delivery of Stop Smoking Services • Overall prevalence of tobacco use declined from 22% to 18%.

• Stop Clinical Guidelines developed, quality assured by the National Clinical Effectiveness Committee, Department of Health and endorsed by the Minister for Health.

• Quitmanager electronic patient management system tendered for, designed, developed and launched.
New functionality is being added to the system on an on-going basis.

• QUIT website redeveloped and redesigned in line with HSE digital roadmap.

• QUIT Campaign redeveloped through two iterations – I Will Survive (2017) and The Last Stop (2020).

Targeting Hard to Reach Populations • Successful business case prepared by TFIP for dedicated, midwifery led stop smoking services.
Services subsequently established at Cork University Maternity Hospital and The National Maternity Hospital as well as maternity services in the South East through the Sláintecare Integration Fund.

• A Healthy Living Business Case was prepared to support the delivery of dedicated stop smoking services in disadvantaged communities.

This saw significant investment in new staff working to provide stop smoking support and for the provision of stop smoking medication.
The We Can Quit Programme was incorporated into the TFIP and identified as a key programme within the new Sláintecare Healthy Communities Programme.

• National Conversation Café, Smoking and Mental Health co-produced in 2019 through a partnership with Mental Health Ireland, mental health service providers, service users and family supports.
Promoting Tobacco Free Environments • Over 70 services engaged in Tobacco Free Campus quality improvement which saw them participate in a bursary scheme to further improve policy implementation across the health service.

• • • Treatment of tobacco dependence and Tobacco Free Campus Policy implementation now included in routine inspections by the Mental Health Commission.

Tobacco control priorities and actions identified for all CHO and Hospital Group Healthy Ireland Implementation Plans.
Ireland participated as an active member of the Global Network for Tobacco Free Healthcare Services and continues to hold a position on the GNTH Board.

Education and Health Promotion • Tobacco module developed for the Making Every Contact Count online e-learning programme and launched.

• Maternity specific Making Every Contact Count module developed along with resources to support clinicians.

• New SPHE Junior Cycle tobacco lessons developed as part of the new Healthy Choices module.
• The first State of Tobacco Control in Ireland Report was published in 2018 along with two secondary analysis reports; Youth Smoking in Ireland and Adult Smoking in Ireland.
For further information on tobacco control activities in the Health Service, please see the relevant End of Year Reports on the TFI web pages - https://www.hse.ie/eng/about/who/tobaccocontrol/ 7 HSE Tobacco Free Ireland Programme 2022 Smoking Prevalence 2015 2021 Total Daily Occasional Total Daily Occasional 23% 19% 4% 18% 16% 2% Prevalence of Smoking by Age 2015 15-24 25-34 35-44 45-54 55-64 65-74 75+ Prevalence of Smoking by Gender 2015 Male Female 24% 21% 19% 32% 26% 25% 18% 12% 0% 2021 2021 15-24 25-34 35-44 45-54 55-64 65-74 75+ 15% 20% 21% 24% 19% 12% 7% Male Female 20% 17% Likelihood of Smoking by Socio-Economic Status 2015 29% Routine and manual occupations 16% Higher managerial, administrative and professional occupations 15% Intermediate occupations 2021 31% Routine and manual occupations 11% Higher managerial, administrative and professional occupations 17% Intermediate occupations Quitting Smoking in 2021 44% 2021 29% 29% of current smokers are either trying to quit or actively planning to do so.
44% of those who smoked in the previous year have tried to quit.

8 Tobacco Free Ireland Programme Plan 2022-2025 E-Cigarettes 4% 4% 5% 2017 2018 2019 5% 2021 Disease Burden of Tobacco Use in Ireland 4,512 Deaths Attributable to Smoking in 2019 44,081 No.
Hospitalisations Attributable to Smoking Intensive Cessation Support 2018-2021 QUIT Plan Sign-Ups 2018-2021 2018 2019 2020 2021 Total 2018 2019 2020 2021 Total 10,608 9,235 7,145 8,601 35,589 8,951 6,500 7,755 6,420 29,626 The Covid 19 response affected service delivery in 2020 and 2021.

Economic Burden of Tobacco Use in Ireland € 460m Health Service € 1.6bn Exchequer € 9bn Loss of Welfare from Morbidity and Mortality 9 HSE Tobacco Free Ireland Programme 2022 Where to Next?
In January 2022, the TFIP (with the NCEC) officially launched National Stop Smoking Clinical Guidelines.

For the first time in Ireland, we now have clear and comprehensive guidance on what good stop smoking care looks like.

In addition to describing good stop smoking care for the general public who use our primary care, community and hospital services, the guidelines also set out recommendations for stop smoking care in maternity and secondary mental health services.
For healthcare professionals, the guidelines recommend three simple and easy to remember steps that healthcare professionals can take in day-to-day practice to help people who smoke to stop: • Firstly, routinely ask people about their smoking; • Secondly, discuss the harm caused by smoking and advise them to stop; • and thirdly, offer them evidence-based stop smoking care including stop smoking medications and referral to a HSE stop smoking advisor.
These three safe, effective and clinically sound steps can increase the chance of someone becoming smoke-free by two to four fold.

The guidelines were developed with oversight of the National Clinical Effectiveness Committee and were recommended for approval to the Minister for Health following a robust quality assurance process including international peer review.
The TFIP looks forward to implementing these guidelines across our health services, with relevant stakeholders and partners over the coming years.

The implementation of clinical guidelines will continue to see a strong focus in addressing tobacco use among pregnant women and mental health services users and specific actions for these populations are identified in the clinical guideline implementation plan (Appendix A).

The QUIT Campaign will continue to be visible across various media platforms.
The campaign will undergo a new transformation in 2022 with new TV and radio ads to be developed and produced for launch in January 2023.

The Tobacco Free Campus Quality Improvement Bursary initiative will continue into 2022/2023.

All applicant services will be required to submit a quality improvement plan to identify actions.

Applications will then be reviewed and scored by an audit and assessment team to provide an unbiased review of each services progress.
A financial award will then be granted to a select number of services who demonstrate innovation, sustainability and internal compliance building in Tobacco Free Campus Policy implementation.

The revised HSE Tobacco Free Campus Policy will be consulted on and subsequently launched.

A revised implementation toolkit will be launched alongside the new policy to support services to begin/continue to improve policy implementation.
As the Tobacco Free Ireland Programme moves into 2022, there will be continuous focus in all our work on providing quality stop smoking care to those that need it most (e.g.

people in disadvantaged communities, people with mental health problems and pregnant women).

HSE advisors will continue to innovate, using technology in order to provide a high quality service to their clients.
The QUIT Campaign will continue to direct and encourage those who smoke to engage with our suite of Stop Smoking Services in order to significantly increase the chances of quitting for good.

Tobacco endgame is a concept in tobacco control which envisions a tobacco-free future and involves policies, plans and interventions that aim to end the tobacco epidemic.
Through current government policy Tobacco Free Ireland, our country is one of a small number of countries that has committed to moving its efforts from tobacco control to tobacco endgame.

Reflecting this commitment, the principal target of the TFI Programme is to lower smoking prevalence in Ireland to <5% by 2025.

To this end, the HSE TFI Programme has completed an omnibus survey in early 2022 to measure public knowledge of and attitudes to tobacco endgame in Ireland.
The findings from this survey will be used to support and advocate for future Irish tobacco endgame policy planning.

2021 brought significant investment to Health and Wellbeing with funding being allocated to support the development of an area- based approach to community health and wellbeing improvement, with a particular focus on areas of deprivation.
This investment for health service initiatives is focused on the implementation of an enhanced Health and Wellbeing Programme within areas that have the greatest levels of disadvantage and highest proportion of young families.

The funding will be used to deliver evidence informed services to improve local population health and wellbeing outcomes.
Many new staff have been recruited to this new Sláintecare Healthy Communities Initiative and we look forward to working with our colleagues in the community to implement these new programmes into 2022 and beyond.

10 Tobacco Free Ireland Programme Plan 2022-2025 Theme 1: Provide Leadership for the Implementation of the HSE Elements of Tobacco Free Ireland Action No.
Action 1.1 1.2 1.3 1.4 Develop a suite of key performance indicators to monitor the impact of HSE funded tobacco control interventions, programmes and services with a particular focus on targeted tobacco control initiatives to address higher smoking prevalence in identified hard to reach and high prevalence population groups Support effective implementation of the Healthy Ireland and Tobacco Free Ireland Action Plans and ensure the TFIP priorities are included in the HSE National Service Plan and relevant operational plans.
Identify resource implications to deliver actions contained within this plan.

Ensure Public Health Medicine leadership for TFIP is in place, through a recognised Consultant in Public Health Medicine role established as part of the HSE implementation of a Consultant- led Public Health Model in line with the recommendation of the Crowe Horwath Report and the Scally Scoping Inquiry into the CervicalCheck Screening Programme.
Deliverables Responsible Timeframe Commence Complete 2022 2025 TFIP and TFIPG CHO/HG Suite of KPIs identified annually and published in HSE National Service Plan.

Consider and develop new KPIs to monitor our effectiveness in reaching disadvantaged population groups.

Tobacco KPIs assigned to CHOs and Hospital Groups/Regional Health Areas.
Monitor delivery of tobacco specific KPIs across all Slaintecare Healthy Communities Programmes which have a focus on addressing tobacco use in identified disadvantaged areas.

Monitor the delivery of stop smoking services and develop referral pathways across the Enhanced Community Care Chronic disease hubs Inclusion of Tobacco KPIs in annual HSE National Service Plan, CHO and Regional Area plans.
TFIP and TFIPG 2022 2025 TFI actions identified in CHO, Hospital Group Healthy Ireland Plans and Regional Health Area plans (as these develop).

Funding estimates bids (for development of new stop smoking services/programmes) agreed and submitted to DoH for consideration where appropriate.

Continue to advocate for funding to provide access to free stop smoking medication to all who access the standard treatment programme through the HSE QUIT service.
Regularised Public Health Medicine leadership for TFIP in place, through a recognised Consultant in Public Health Medicine role established as part of the HSE implementation of a Consultant-led Public Health Model.

TFIP 2022 2025 TFIP and CCO Office 2022 2023 11 HSE Tobacco Free Ireland Programme 2022 Action No.
Action Deliverables Responsible Timeframe Commence Complete TFIP 2022 2025 TFIP 2022 2025 1.5 1.6 Engage with international health colleagues to access different expertise and facilities, network and share learning across tobacco control initiatives and programmes.

Government Departments and state agencies (including the HSE) will continue to liaise and work with non-governmental organisations in order to achieve policy aims set out in this plan.
Membership of the Global Network of Tobacco Free Healthcare Services (GNTH).

Membership of Coalition of Nurses and Health Professionals Against Tobacco.

Membership of the European Quitlines Group.

Membership of Social Marketing to Tackle Addictions European Group.

TFIP to chair and administer at least three meetings annually of the Tobacco Free Ireland Partners Group.
TFIP to submit feedback to cross governmental policy consultation processes (as they arise) to embed tobacco control actions in future planning.

Theme 2: Protection of Children, Denormalisation of Tobacco Use and Promotion of Tobacco Free Environments Action No.

Action 2.1 Promote the quality improvement of Tobacco Free Campuses for all healthcare facilities and support the development of tobacco free environments across external organisations such as sporting and recreational facilities.
12 Deliverables Responsible Timeframe Commence Complete TFIP 2022 2025 Support the implementation of the HSE Tobacco Free Campus Policy for all HSE and HSE funded services.

Advocate for funding to continue to incentivise and support quality improvement of our HSE Tobacco Free Campus policy through continued Quality Improvement Bursary initiatives.

Support the implementation of TFC through educational webinars, events etc.
Tobacco Free Campus training videos for healthcare staff developed and promoted to HSE staff and management Engage with the National Estates Office to incorporate TFC policy provisions in the development of all new sites and buildings.

Support the implementation of the ‘Not Around Us’ Campaign and any other tobacco free environment initiatives nationally in partnership with local authorities, educational institutions and other partners.

Tobacco Free Ireland Programme Plan 2022-2025 Action No.
Action Deliverables Responsible Timeframe Commence Complete 2022 2023 2.2 Revise the HSE Tobacco Free Campus Policy in consultation with key stakeholders.

Publish and communicate a revised HSE Tobacco Free Campus Policy.

Human Resources TFIP Update Publish and disseminate a revised ‘How to Implement HSE Tobacco Free Campus Toolkit’ to support managers and staff in quality improving TFC implementation.
Publish and communicate the revised Protecting HSE Staff from Second Hand Smoke in Domestic Settings Policy.

Update, Publish and disseminate a revised suite of resources to support implementation of the policy.

Tobacco lessons developed, piloted and published for Healthy Choices Units 1, 2 and 3.

Revise the HSE Second Hand Smoke in Domestic Settings policy for the protection of staff.
Work with the Health and Wellbeing Education Team and partners to develop the tobacco elements of the revised SPHE Junior Cycle Curriculum.

Engage with HIQA and the Mental Health Commission to lobby for inclusion of TFCP as part of their audit criteria.

HIQA/MHC supported to include TFC policy and the treatment of tobacco dependence as part of their audit criteria.

Work with partner agencies e.g.


Spunout to develop targeted tobacco control programmes and campaigns to support cessation/prevent initiation.

Tobacco content on Spunout website developed and monitored on an on-going basis.

Communications packs developed for partners for National No Smoking Day, World No Tobacco Day, New Year Campaign etc.

TFIP 2022 2023 TFIP 2022 2023 H&WB Education Team TFIP 2022 2023 TFIP 2022 2025 TFI Partners Group Review, revise and publish Quit 4 Youth training resources.
Quit 4 Youth resource revised and published.

TFIP 2022 2024 Training programme to support resource developed and training delivered.

Develop an awareness training programme for youth workers on nicotine addiction, prevention of E cigarette initiation and initiation of smoking.

Prevention of youth initiation of E cigarettes and smoking for out of school settings developed in conjunction with relevant stakeholders.
TFIP & Stakeholders 2023 2024 2.3 2.4 2.5 2.6 2.7 2.8 13 HSE Tobacco Free Ireland Programme 2022 Theme 3: Legislative Compliance and Regulating the Retail Environment Deliverables Responsible Timeframe Identify this action in the HSE Environmental Health Service Operational Plan.

Undertake annual assessment of national inspection and compliance levels to inform targeting of resources to areas of greatest non-compliance and inconsistency.

Enforcement, compliance levels & legislative provisions reviewed.
Non-compliant businesses/ services targeted.

Joint DOH TACU and HSE group to review all tobacco control legislation quarterly.

Convictions published quarterly on the HSE website.

Included as a composite part of the developing National Tobacco Control Operational Unit.

Commence Complete AND EHS 2022 2025 AND EHS 2022 2025 AND EHS 2022 2025 AND EHS 2022 2025 Joint DOH TACU and HSE group to review all tobacco control legislation quarterly.

AND EHS 2022 2025 Action No.


Action Continue to promote compliance with all provisions of the Public Health (Tobacco) Act 2002 as amended, particularly the workplace legislation.

Develop capacity within the HSE’s Environmental Health Service to maintain consistent and sustained enforcement of all aspects of the tobacco control legislation.

Monitor the effectiveness of the current tobacco free legislation, including the review of existing exemptions and the monitoring of compliance with these provisions.
Develop special investigation capacity within the HSE’s Environmental Health Service to assess compliance by tobacco and E-cigarette manufacturers.

Examine and monitor the existing tobacco legislation to ensure that it is inclusive of contemporary forms of communications.

3.1 3.2 3.3 3.4 3.5 14 Tobacco Free Ireland Programme Plan 2022-2025 Theme 4: Treat Tobacco Dependence as a Healthcare Issue Action No.
Action Deliverables Responsible Timeframe Commence Complete 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 Publish National Clinical Effectiveness Committee approved Stop Smoking Clinical Guidelines.

Implement newly published Stop Smoking Clinical Guidelines implementation plan (42 actions).

Review existing national standards for the Intensive Cessation Support Programme and publish renewed peer reviewed standards.
Complete an assessment of the delivery of stop smoking services in the HSE and develop recommendations for future service delivery.

Support the MECC programme to train frontline healthcare workers to deliver brief interventions for smoking cessation as part of their routine work.
Train healthcare staff to deliver intensive stop smoking support and provide ongoing professional development and mentoring for staff to ensure delivery of a quality service Stop Smoking Clinical Guidelines published and formally launched.

TFIP 2022 2022 See Appendix A for Clinical Guideline Implementation Plan.

TFIP 2022 2025 Standards reviewed and published.

TFIP 2022 2022 Review of stop smoking services completed and published.

TFIP 2022 2022 Support MECC Team to provide training to frontline staff.
Review and revise MECC tobacco content as part of overall content review process.

Train mentor and support healthcare staff as accredited stop smoking advisors as appropriate.
TFIP 2022 2025 MECC Team TFIP 2022 2025 Support the implementation of stop smoking services including access to free stop smoking medication for HSE staff Advocate for stop smoking support to be provided through staff health & wellbeing budgets and programmes Work with the National Women and Infants Health Programme (NWIHP) to develop and agree evidence based tobacco control actions which include establishing dedicated onsite services across our maternity services.
These should be included in NWIHP action plans.

Advocate for and prepare business cases to establish dedicated onsite stop smoking services for pregnant women at all maternity hospitals as per maternity and TFI strategies.

See Appendix A for Clinical Guideline Implementation Plan for further actions to address tobacco use in pregnancy.

TFIP 2022 2025 TFIP NWIHP 2022 2025 15 HSE Tobacco Free Ireland Programme 2022 Action No.
Action Deliverables Responsible Timeframe 4.9 4.10 4.11 4.12 Commence Complete TFIP 2022 2025 Work with Mental Health Services to advocate for and support the development of on-site stop smoking services for acute and community mental health services.

Funding estimates bids (for development of new stop smoking services/programmes) agreed and submitted to DoH for consideration where appropriate.
See Appendix A for clinical guideline implementation plan for further actions to address tobacco use among those with mental health difficulties.

Implement the We Can Quit Programme under the auspices of the Sláintecare Healthy Communities Initiative.

We Can Quit group programmes completed annually across Sláintecare Healthy Community Networks as per NSP.

TFIP 2022 2025 Continue to develop improve and work to integrate QUITManager with existing IT systems in the Health Service.
See clinical guideline action plan as it relates to QUITmanager.

TFIP OoCIO 2022 2025 Develop online stop smoking medication prescribing training module for healthcare professionals.

(Recommendation 10 in Clinical Guideline implementation plan).

Medication Training Module scoped, designed and developed with external provider.

Module made available to healthcare professionals.

TFIP 2022 2022 Theme 5: Monitor Tobacco Use and Prevalence and Evaluate Effectiveness of All Interventions Action No.
Action Deliverables Responsible Timeframe On-going surveillance of tobacco and e-cigarette use through HSE Tracker Survey, Healthy Ireland Survey, Health Behaviour in School Children Surveys and European School Survey Project on Alcohol and Other Drugs.

Carry out ‘Blue Sky Thinking’ Tobacco Endgame Survey and publish report.

Engage with an academic partner to carry out a realist review of financial incentives to stop smoking to inform future programmes.

HSE Tracker Survey published quarterly.


Healthy Ireland Survey published annually.

Complete secondary analysis of national survey data periodically.

Publish Second State of Tobacco Control Report.

Survey carried out with external provider.

Tobacco Endgame Survey Report completed and published.

Financial Incentives to Stop Smoking Realist review completed by academic partner.
5.1 5.2 5.3 16 Commence Complete AND EH 2022 2025 DoH TFIP TFIP 2022 2022 TFIP 2022 2023 Academic Partner Tobacco Free Ireland Programme Plan 2022-2025 Action No.

Action Deliverables Responsible Timeframe Commence Complete 2022 2025 TFIP HSE Communications 5.4 Evaluation built in to the QUIT campaign and cessation service provision and carried out as appropriate.

Completion of monthly evaluation of digital display media.

Completion of quarterly web statistics using Google analytics.
Completion of You-tube tracking.

Quarterly analysis of conversion rates from digital partnerships.

Completion of quarterly and annual audit on media spend.

Completion of Quarterly tracking of media coverage measurements.

Completion of monthly audit of cessation service provision against target.

Completion of omnibus research awareness to monitor campaign awareness and effectiveness.

Completion of monthly evaluation of social media engagement.
Completion of monthly and quarterly audits of quitplan sign ups to monitor campaign effectiveness.

5.5 5.6 5.7 Develop and produce new QUIT TV and Radio Campaign.

TV and radio campaign for QUIT developed.

Tender for a new QUITline service which will include a new workplace outreach service.

Evaluate all stop smoking services and programmes and Monitor throughput, reach of tobacco users through QuitManager system.

Complete tender and sign contract for new service provider.
Establish, advertise and monitor new workplace outreach stop smoking service.

Quarterly reports supplied to the BIU.

NSP Tobacco KPIs reported quarterly in arrears.
2022 2023 TFIP HSE Communications TFIP and 2022 2025 HSE Communications TFIP 2022 2025 17 HSE Tobacco Free Ireland Programme 2022 Appendix A Stop Smoking Clinical Guideline Implementation Plan Implementation Action Stakeholders Expected Outcome To be Completed Review TFIP governance to ensure that implementation of these guidelines is a key focus TFIP Review HSE TFI partners group to ensure collaboration and leadership in place to drive and guide guideline implementation including: - Establishment of a Stop Smoking Clinical Leadership Forum to engage and mobilise health professionals and - Establishment of a Stop Smoking Spearhead Forum to ensure focus on heath inequalities and priority groups Recognise and regularise specialist in public health medicine leadership for the TFIP as a key national public health programme in line with recommendation of Prof Scally in his scoping review on CervicalCheck (https://assets.gov.
Plan for audit, monitoring and evaluation Develop sustainability plan for ongoing implementation of the guideline beyond year 3 Develop communication plan to widely communicate guideline across the health service TFIP TFIP TFIP TFIP TFIP Raise public awareness/expectations around identification & treatment of smoking as key element of healthcare TFIP Year 1 Year 1 Year 1 Year 2 Year 3 Year 1 Year 1 National level leadership, governance and programme planning in place to drive implementation of guidelines across a multi-annual programme plan National level leadership, governance and programme planning in place to drive implementation of guidelines across a multi-annual programme plan National level leadership, governance and programme planning in place to drive implementation of guidelines across a multi-annual programme plan Better use of data to inform implementation of the guideline Guideline more likely to be sustained Awareness of smoking cessation among healthcare professionals - Changes in knowledge, attitudes and practice by HCPs - Increased uptake of recording tools by HCPs - Increased numbers referred to stop smoking services from various settings Awareness of smoking cessation among healthcare professionals - Changes in knowledge, attitudes and practice by HCPs - Increased uptake of recording tools by HCPs - Increased numbers referred to stop smoking services from various settings Tobacco Free Ireland Programme Plan 2022-2025 Implementation Action Stakeholders Expected Outcome To be Completed 8 9 Incorporation of guideline into existing hospital letters/correspondence in advance of appointments/admission etc.
TFIP Continued rollout of MECC training (online via www.makingeverycontactcount.ie and face-to-face) to healthcare professionals.

MECC Team 10 Inclusion of MECC training on undergraduate programmes MECC Team 11 Develop strategies for increasing access to and participation in MECC training MECC Team 12 Inclusion of MECC recording tools (smoking behaviour) across settings.
MECC Team 13 Roll out electronic record including smoking behaviour recording MECC Team 14 Support & full implementation of Tobacco Free Campus Policy Hospital Groups Community Healthcare Organisation TFIP 15 16 Development of referral pathways from various settings to stop smoking services Full implementation of QuitManager across all Hospitals TFIP TFIP Awareness of smoking cessation among healthcare professionals - Changes in knowledge, attitudes and practice by HCPs - Increased uptake of recording tools by HCPs - Increased numbers referred to stop smoking services from various settings Changes in knowledge, attitudes and practice by HCPs - Increased uptake of recording tools by HCPs - Increased numbers referred to stop smoking services from various settings Changes in knowledge, attitudes and practice by HCPs - Increased uptake of recording tools by HCPs - Increased numbers referred to stop smoking services from various settings Changes in knowledge, attitudes and practice by HCPs - Increased uptake of recording tools by HCPs - Increased numbers referred to stop smoking services from various settings Increased uptake of recording tools by HCPs - Increased numbers referred to stop smoking services from various settings Increased uptake of recording tools by HCPs - Increased numbers referred to stop smoking services from various settings Increased numbers referred to stop smoking services from various settings Increased numbers referred to stop smoking services from various settings Increased numbers referred
 to stop smoking services from various settings Year 1 Year 2 Year 2 Year 2 Year 2 Year 2 Year 1 Year 1 Year 3 19 HSE Tobacco Free Ireland Programme 2022 Implementation Action Stakeholders Expected Outcome To be Completed 17 Integration with GP IT systems (healthlink) 18 19 20 Training and access to referral module for staff in other settings including secondary mental health care settings Integration of Quitmanager with maternity information system (MN- CMS) Inclusion of financial resource requirement as part of annual estimates process and service planning 21 Tobacco Free Campus policy implementation across Mental Health TFIP TFIP TFIP Hospital Groups (regional & local level) - CHOs (regional & local level) - TFIP - National Women & Infants’Health Programme - HSE Mental Health (strategy & operations) TFIP Mental Health (Strategy & Operations) 22 Co-production of best practice guidance documents with Mental Health Ireland and others TFIP Mental Health (Strategy & Operations) Year 3 Year 3 Year 3 Year 3 Year 1 Year 1 Increased numbers referred to stop smoking services from various settings Increased numbers referred to stop smoking services from various settings Increased numbers referred to stop smoking services from various settings Evidence-based requests for additional funding - Changes in attitudes by secondary mental healthcare users towards Smoking and Smoking cessation.
- Changes in knowledge, attitudes and practice by HCPs.

- Increased numbers referred to Stop Smoking services from secondary mental health care settings.

- Changes in attitudes by secondary mental healthcare users towards Smoking and Smoking cessation.

- Changes in knowledge, attitudes and practice by HCPs.

- Increased numbers referred to Stop Smoking services from secondary mental health care settings.
20 Tobacco Free Ireland Programme Plan 2022-2025 Implementation Action Stakeholders Expected Outcome To be Completed 23 Raising public awareness/expectations around identification and treatment of smoking as core element of healthcare in secondary care mental health settings TFIP Mental Health (Strategy & Operations) 24 Inclusion of smoking cessation in care plans in mental health settings TFIP Mental Health (Strategy & Operations) 25 Staff awareness campaign around guideline and associated tools, specific to this setting.
TFIP Mental Health (Strategy & Operations) 26 Incentivisation initiatives e.g.

TFC bursary initiative TFIP Mental Health (Strategy & Operations) Year 1 Year 1 Year 1 Year 1 - Changes in attitudes by secondary mental healthcare users towards Smoking and Smoking cessation.

- Changes in knowledge, attitudes and practice by HCPs.

- Increased numbers referred to Stop Smoking services from secondary mental health care settings.


- Changes in attitudes by secondary mental healthcare HCPs towards smoking and smoking cessation.

- Changes in knowledge, attitudes and practice by HCPs.

- Increased numbers referred to stop smoking services from secondary mental health care settings.


27 Development of prescribing tools detailing recommended stop smoking medications for various populations.
TFIP ↑ prescribed recommended pharmacotherapy supports Year 1 28 Education of HCP in prescribing of NRT & Stop Smoking Medications TFIP ↑ prescribed recommended pharmacotherapy supports Year 1 21 HSE Tobacco Free Ireland Programme 2022 Implementation Action Stakeholders Expected Outcome To be Completed 29 Development or update of Patient Information Leaflets TFIP ↑ prescribed recommended pharmacotherapy supports Year 1 30 31 32 33 34 Communications campaign specific to nurses and midwives to encourage inclusion of stop smoking medications in their scope of practice Increased number of nurses and midwives including stop smoking medications in their scope of practice HSE Communications Unit TFIP Nursing & Midwifery Board of Ireland Engagement with Department of Health re options to better support access to stop smoking medicines so as to increase use TFIP Potential removal of barriers (cost) to recommended treatment - Increased numbers using evidence-based pharmacological supports Year 2 Year 1 Review the delivery of stop smoking support services to ensure it is quality assured and it meets the need in terms of those with health inequalities TFIP Review of QUIT service complete Year 1 Development of on-site intensive cessation services to address any gaps in service identified TFIP New stop smoking support services established targeting hard to reach population groups Design and develop ‘high intensity support’ for Mental Health 35 Train staff in delivery of support in Mental Health 36 Develop mechanism to feedback data to mental health services on drug use 22 Recommended support for users of secondary mental health care settings, who want to quit smoking Recommended support for users of secondary mental health care settings, who want to quit smoking Recommended support for users of secondary mental health care settings, who want to quit smoking TFIP - Mental Health (Strategy & Operations) - Mental Health Ireland TFIP - Mental Health (Strategy & Operations) - Mental Health Ireland TFIP - Mental Health (Strategy &
 Operations) - Mental Health Ireland Year 1 Year 3 Year 3 Year 3 Tobacco Free Ireland Programme Plan 2022-2025 Implementation Action Stakeholders Expected Outcome To be Completed 37 Staff awareness campaign regarding guideline and associated tools, including prescribing tool TFIP - Mental Health (Strategy & Operations) - HSE Comms 38 Maternity-specific resource for face-to- face training of HCPs MECC Team 39 Training of midwives in the use of Carbon monoxide monitors as part of face-to-face training MECC Team 40 Continued integration of MECC with rollout of new maternity information system (MN-CMS) MECC Team 41 Phased implementation of rollout of COBT in all maternity units National Women & Infant’s Health Programme 42 Develop opt-out referral pathways from maternity units to stop smoking services National Women & Infant’s Health Programme Increased number of secondary mental health service users attempting to quit Smoking, and successfully quitting Smoking - Increased number of secondary mental health service users using Stop Smoking medications Changes in knowledge, attitudes and practice by HCPs Increased uptake of recording tools by HCPs, Increased numbers referred to stop smoking services from various settings Changes in knowledge, attitudes and practice by HCPs Increased uptake of recording tools by HCPs, Increased numbers referred to stop smoking services from various settings Changes in knowledge, attitudes and practice by HCPs Increased uptake of recording tools by HCPs, Increased numbers referred to stop smoking services from various settings Changes in knowledge, attitudes and practice by HCPs Increased uptake of recording tools by HCPs, Increased numbers referred to stop smoking services from various settings Changes in knowledge, attitudes and practice by HCPs Increased uptake of recording tools by HCPs, Increased numbers referred to stop smoking services from various settings Year 3 Year 1 Year 3 Year 1 Year 3 Year 3 23 HSE Tobacco Free Ireland
 Programme 2022 APPENDIX B Tobacco Free Ireland Programme Team Role National Lead Clinical and Research Lead Project Manager Project Manager Project Manager Project Manager Quit Manager Superuser Name Martina Blake Dr Paul Kavanagh Edward Murphy Elaine Buckley Aishling Sheridan Caitriona Reynolds Ellen McNamara Administration and Project Support Craig Melvin APPENDIX C Tobacco Free Ireland Programme Group National Cancer Control Programme TFIP TFIP Communications TFIP TUSLA TFIP CHO Representative Health Intelligence TFIP Group Chair Human Resources Environmental Health Service Older Persons Services Healthy Ireland Lead Acute Hospitals Disability Services Áine Lyng Aishling Sheridan Caitriona Reynolds Darina Carr Edward Murphy Eibhlin Smith Elaine Buckley Gabrielle O’ Keeffe Dr Paul Kavanagh Martina Blake Mary Ruane Dr Maurice Mulcahy Roisín Maguire Sarah McCormack Siobhán Lines Suzanne Moloney 24 Tobacco Free Ireland Programme Plan 2022-2025 APPENDIX D TFI Partners Group Healthy Ireland places significant emphasis on collaboration and partnership working.
The Tobacco Free Ireland Partners Group is a multi-agency partnership, chaired by the HSE Tobacco Free Ireland Programme and made up of representatives from across organisations with an interest in Tobacco Control.

The aim of the group is to provide a formal platform for discussion and dialogue between the HSE and non-governmental stakeholders on tobacco control.

This multi-agency working group helps to drive, coordinate and support the delivery of the priorities in the Tobacco Free Ireland strategy.
Alpha 1 Foundation ASH Ireland, Council of Irish Heart Foundation Asthma Society of Ireland Communications, HSE COPD Ireland Environmental Health, HSE Environmental Health Society Institute of Public Health Irish Cancer Society Irish College of General Practitioners Irish Dental Association Irish Heart Foundation Irish Thoracic Society National Cancer Control Programme National Women’s Council of Ireland Mental Health Ireland Pharmaceutical Society of Ireland Royal College of Physicians Ireland SpunOut Tobacco Free Ireland Programme, HSE Tobacco Free Research Institute References Department of Health (2015).
Healthy Ireland in the Health Services National Implementation Plan 2015-2017 Department of Health (2013).

Tobacco Free Ireland HSE Tobacco Free Ireland Programme Implementation Plan 2018 – 2021 (2018).

HSE Tobacco Free Ireland Programme The State of Tobacco Control in Ireland – Second Report (2022).

HSE Tobacco Free Ireland Programme 25 HSE Tobacco Free Ireland Programme 2022 HSE Tobacco Free Ireland Programme Implementation Plan 2022-2025