Public Health England? They're having a laugh (at our expense)

Further to my previous post I've now read the long-awaited Stoptober 2016 campaign evaluation.

It didn't take long. If you exclude the cover, credits and contents, it amounts to just four pages.

God knows I appreciate brevity, but four pages?!!

Two of the four are devoted to 'Background', one and a half are described as an 'Overview', and there's a short three-paragraph 'Summary'.

And, er, that's it.

So what does the evaluation, which I first enquired about twelve months ago, tell us about Stoptober 2016? Very little, as it happens, apart from one startling admission:

Our modelling estimates that total incremental campaign driven quit attempts were 124,500 versus 385,000 in the previous year [2015] ...

In other words, the estimated number of smokers driven to attempt to quit as a result of Stoptober 2016 was a third of the number in 2015. And there is of course no evidence that they succeeded in quitting.

However, even the estimated figure is odd because I wasn't aware of any 'modelling' for Stoptober 2015. What we were told – by Public Health England in a press release issued on October 30, 2015 – is that 'over 215,000 smokers signed up to this year’s Stoptober'.

No mention there of 385,000 'campaign driven quit attempts' in 2015 so why include the figure in the 2016 evaluation?

More notable perhaps was the fact that in the press release that followed the conclusion of Stoptober 2015 Public Health England chose to ignore the fact that the number of smokers who signed up that year was 15 per cent lower than in 2014.

Few people would have been any the wiser had it not been for journalist Peter Russell who wrote an online report ('Fewer people joined Stoptober smoking challenge') that I linked to here.

Curiously, you may think, that article is no longer available on the website although Peter Russell continues to write for it.

Anyway, back to the Stoptober 2016 campaign evaluation. Confusingly:

Reported quit attempts were maintained at 2015 levels with 16% of all smokers reporting the key action of a Stoptober quit attempt.

Eh? One minute they're saying "campaign driven quit attempts were 124,500 [in 2016] versus 385,000 in the previous year", the next they're saying "reported quit attempts were maintained at 2015 levels". Which is it?

Leaving this aside, if there's a dominant theme in the report it's funding, or lack of. Frankly the four-page 'evaluation' is little more than a prolonged whinge about the budget and a plea for more money in 2017:

In 2016, competing priorities led to a significant budget reduction for Stoptober. Most notably, media spend was reduced from £3.1 million in 2015 to £390,000 in 2016 (an 87% reduction).

Given the lower budget, the strategic approach to delivering the campaign needed to evolve considerably.

Given the scale of the budget reduction in 2016, the Stoptober campaign performed well.

While the budget for PR declined by 20%, coverage remained very strong.

While the key campaign metrics (such as brand awareness and visibility) have been positive relative to the reduced budget, Stoptober was delivered at a smaller scale with lower absolute levels of visibility and awareness.

If future investment is maintained at 2016 levels the long-term health of the brand and participation can be expected to erode.

Hilariously it's no longer about the health of the nation. It's all about the 'health of the brand'!

In conclusion the evaluation declares:

Stoptober 2016 was successful in driving campaign cost efficiency, but this was done at the cost of reduced overall scale. Our modelling estimates that total incremental campaign driven quit attempts were 124,500 versus 385,000 in the previous year, but that three-year return on investment was £4.22 versus £3.42 in the previous year.

The campaign in 2016 has benefited greatly from four years of previous sustained investment. Without this it is likely that brand awareness and other key metrics in 2016 would have been lower.

The results suggest that Stoptober 2017 will start from a lower base of awareness, meaning that, without greater investment in 2017, Stoptober is likely to shrink further and more rapidly.

Incredibly this wafer-thin evaluation took a whole year to enter the public domain, and only after regular cajoling by Forest. Would they have published it without our persistence? I suspect not.

Clearly however there has been plenty of lobbying behind the scenes because, as we now know (thanks to another Forest FOI request), Stoptober 2017 was given a substantially increased budget with media spend rising from £390,000 in 2016 to £1.08 million in 2017.

Whether it was spent wisely and what the results were we'll have to wait and see. If the 2016 report is any guide, expect the Stoptober 2017 campaign evaluation to be published at the back end of October 2018.

But whether the media spend budget is £390,000 (2016), £1.08m (2017) or £3.1m (2015), it's taxpayers' money and I see very little in this report to justify the use of any public money on a glorified PR campaign whose 'success' seems to be judged less on actual quit smoking attempts and more on media profile.

As for Stoptober 2017 embracing e-cigarettes, am I the only person to be rather cynical about this belated move?

While it's true that Public Health England has been an advocate of e-cigarettes as a quit smoking tool for a couple of years now, I suspect the real reason Stoptober 2017 jumped on the vaping bandwagon is because it will allow the campaign to claim credit for the general reduction in smoking rates, especially if smoking cessation continues to be driven not by Stoptober support tools but by smokers switching to e-cigarettes (ie non-Stoptober support tools).

It certainly wouldn't be the first anti-smoking initiative to claim credit for quit smoking attempts that are largely unrelated to the campaign in question.

Anyway, I think I've dredged as much as I can from this. If I'm finding it boring I can't imagine what it's like for you. If you've read this far, well done!

At last! The Stoptober 2016 campaign evaluation report

Rightly, Public Health England has come in for a heap of criticism over the last 48 hours.

It follows a report in the Sunday Times ('Cut in drink limit ignored advice') which is behind a paywall but Chris Snowdon – who was responsible for the FOI request that led to it – has the full story here.

The headline ('The new drinking guidelines are based on massaged evidence') gives you a flavour but the article goes into enormous detail and it's worth reading in full. For those who have neither the time nor the inclination it concludes:

The more that we learn about the process that generated the new guidelines, the more questions are raised about Public Health England. Far from being an honest broker in this story, the agency seems to have acted more like an activist group working towards a particular conclusion. Its relationship with the anti-drink lobby, which extends to holding its Alcohol Leadership Board meetings at the offices of a temperance group, is worryingly cosy for a state agency. Its decision to appoint leading anti-alcohol campaigners such as Ian Gilmore and Katherine Brown (both of the Alcohol Health Alliance) to the guidelines committee shows that it has become politicised.

This bias was on display again at the start of this year when Public Health England published an error-strewn policy document which it released it to the media with a headline claim that was so incorrect that it had to be retracted. That report was put together by the same familiar faces who dominated the guidelines review process. The revision of those guidelines may seem a relatively minor achievement for the anti-drink lobby. You can ignore them, after all. But, as the minutes of one GDG meeting say, it is ‘important to bear in mind that, while guidelines might have limited influence on behaviour, they could be influential as a basis for Government policies’. That is why the guidelines are important and, I would suggest, it is why Public Health England went to such lengths to change them.

Less important, perhaps, but equally revealing is Public Health England's cavalier approach to Stoptober, the annual taxpayer-funded anti-smoking campaign.

As readers know I've been chasing this taxpayer-funded quango for almost a year to get the Stoptober 2016 evaluation report. The reason I think it's important is simple.

Shortly after Stoptober 2015 concluded it was revealed that the number of smokers who registered for the quit smoking campaign that year was down 15 per cent on 2014.

I was keen therefore to find out how many smokers had registered for Stoptober 2016. Part of the response I got from Public Health England on November 18, 2016, read:

The strategy for Stoptober 2016 was to focus on overall participation rather than sign ups to PHE tools. As such, the evaluation will focus on quits at a population level. It is expected that all strands of the evaluation will be finalised early February.

In other words, with Stoptober quit smoking attempts in apparent freefall (my interpretation), Public Health England moved the goalposts and decided Stoptober should take credit for the general fall in the official smoking rates, a decline that was due in no small measure to smokers switching to e-cigarettes (a product Stoptober only endorsed this year).

Anyway, as I have explained previously, February came and went with no sign of an evaluation report. Despite this Public Health England went ahead and quietly increased the budget from £390,000 to £1.08 million.

In August I submitted a further FOI request and was told, a few weeks later, that the evaluation document would be published “during Stoptober 2017”.

On October 16, halfway through this year's campaign, I enquired again and was told the document would be uploaded “in the next two weeks”.

As of this morning there was still no sign of it on the PHE page of the government website (I'd been looking for it every day since October 16) so I sent yet another email:

Now that Stoptober 2017 is finished and a fortnight has elapsed since the Stoptober team confirmed that the Stoptober 2016 evaluation was complete and would be uploaded on to the PHE website “in the next two weeks”, I still can’t find it. Can you send a link or send me a copy or, if it is still not available, ask the team to explain why?

This afternoon I received this reply:

Thank you for your email. The Evaluation was published on the gov.uk website on 26 October 2017.

Thankfully I was also sent a link to this page – Stoptober 2016 campaign evaluation – because I would have struggled to find it otherwise.

That's because there is no reference to it on the PHE page on the gov.uk website. To find it you have to click on a link that says 'See all our publications' and you won't find it immediately because it's buried in a long list of publications and is only visible when you click 'Next' which takes you to yet another page.

To be fair you could key 'Stoptober 2016' into the search engine but you have to be hunting for it. Idle browsers are very unlikely to stumble upon it. The fact that Public Health England waited until almost the end of this year's campaign before publishing the 2016 evaluation also speaks volumes.

Anyway, having finally got my hands on a copy of the four-page (!) report Stoptober 2016 campaign evaluation I suppose I ought to read it. Watch this space.

PS. Don't hold your breath for the Stoptober 2017 campaign evaluation. After all, why would government prioritise a review of the use of public money on such a noble cause?

Pets mean prizes for far-sighted tobacco control campaigners

Yesterday, on the back of a poll commissioned by Forest, I wrote about smoking in the home. 

I also highlighted the fact that since talk of banning smoking at home had come up in Scotland a couple of weeks ago ASH Scotland had desperately tried to backpedal (see Why ASH Scotland does not support a ban on smoking in the home).

Forget the fake protestations, I suggested. The idea that this is not a long-term ambition of the tobacco control industry is beyond belief. And today comes further evidence of how they intend to achieve it.

BBC Breakfast and Five Live Breakfast both featured reports highlighting the fact that, for the first time, veterinary groups and the Royal College of Nursing are working together to raise awareness about the alleged damage second-hand smoke can do to pets.

The initative follows research carried out by the University of Glasgow that "found that dogs, cats and small animals such as guinea pigs and birds are just as much at risk from secondhand smoke as people."

The BBC, needless to say, promoted all this without (to the best of my knowledge) a word of opposition. In fact the video they posted online early this morning was little more than a party political broadcast for the Tobacco Control Party.

A few hours later BBC News posted a written report online (Second-hand smoke linked to pet deaths and illnesses, experts say). This time it featured the video and a couple of comments including a quote from me.

You can read our full response here (Pets being used as a "weapon" in the war on smoking, says Forest) but the bigger picture is this.

Most tobacco control campaigners know that legislation to ban smoking at home crosses a line and so they distance themselves from it.

Does that mean a smoker's home is his castle? Far from it. A de facto ban on smoking at home is still very much on the table and this is now the tobacco control industry intends to achieve it:

One, encourage neighbours to complain about 'smoke drift' from one property to another.

Two, encourage councils and local housing associations to restrict and then ban smoking in social housing (including stairwells and other spaces).

Three, guilt trip parents until they stop smoking anywhere children are present.

Four, guilt trip pet owners until they quit smoking in homes with any domestic animal.

You see, no legislation required – well, not until a handful of renegades are left lighting up and the only way to stop it is to threaten them with fines and other penalties including eviction or their children being taken into care.

Tobacco control activists will deny it but their goal couldn't be clearer. Today the BBC was a willing pawn in propaganda war on smoking.

Oi! Hammond! No!!!

I don't need to tell smokers how expensive it is to buy tobacco.

The UK is currently the second most expensive place in Europe to buy cigarettes and hand-rolling tobacco.

Ireland is the most expensive (their recent Budget pushed a pack of 20 cigarettes up to €12) but the UK isn't far behind.

Next month Philip Hammond will present his first Autumn Budget, having switched the Budget from the spring.

At the last Budget in March he announced that duty on tobacco products would increase by two per cent above inflation (the so-called tobacco escalator that was reintroduced by George Osborne in 2010).

As a result a packet of 20 cigarettes went up by 35p and the price of a 30g pack of rolling tobacco (which is now the minimum pouch size) went up by 42p.

At the same time Hammond announced the introduction, from May 20, of a minimum excise duty based on a packet price of £7.35, pushing the minimum price for a packet of 20 cigarettes up to £8.82.

Premium brands meanwhile went up to £10.26 (or more) per pack.

The fear is Hammond will take advantage of the new Autumn Budget to hike tobacco duty for a second time in nine months, which would be almost unprecedented.

Yesterday Forest published two briefing notes. The first highlights 'The effects of tobacco duty on households across the income distribution'. The second notes the 'The impact of using the retail price index in the tobacco duty escalator'.

Neither are what I would call bedtime reading but the press release offers a basic explanation:

Chancellor urged to reject a second tobacco duty increase this year

AUTUMN BUDGET – Campaigners have urged the Chancellor to help consumers who are “just about managing” and reject a second increase in tobacco duty this year.

According to the smokers’ group Forest, tobacco duty costs those with low incomes a far larger proportion of their income than those on higher incomes and further hikes would only exacerbate this unfairness.

Measuring expenditure on tobacco duty as a percentage of disposable income, in 2015/16 tobacco duty cost the average household in the lowest income bracket almost eight times what it cost the average highest earning household.

Although the average household among middle earners spent 38 per cent more on tobacco duty than the poorest households, as a percentage of disposable income the poorer households were still worse off.

Tobacco duty, says Forest, costs the poorest households 2.3 per cent of their disposable incomes compared to 0.3 per cent in the wealthiest households.

Simon Clark, director of Forest, said: “Tobacco duty is a regressive tax because it hurts low income households more than the average household and far more than the wealthiest households.

“In order to help those who, in Theresa May’s words, are ‘just about managing’, we urge the Chancellor to resist the temptation to increase tobacco duty for a second time this year."

Forest also claim the use of a “flawed” measure of inflation has cost smokers an additional £1.35 billion in tobacco duty since 2010.

According to the group, the practise of increasing tobacco duty using the retail price index (RPI) rather than the consumer price index (CPI), which experts believe is a more accurate measurement of inflation, has resulted in smokers being unfairly overtaxed.

The duty escalator, which was reintroduced in 2010, increased the price of tobacco every year by inflation plus two per cent. Inflation, says Forest, was calculated using the RPI not the CPI. This, says the group, has resulted in smokers paying even more duty than they should reasonably have been expected to pay.

Forest estimates that smokers were overtaxed by almost £46 million in 2010/11, rising to £252 million in 2016/17. The forecast for 2017/18 is almost £310 million which means smokers will have been overtaxed by over £1.35 billion since 2010.

Clark added: “Smokers have been punished enough for their habit. Tobacco duty is already scandalously high without the Chancellor using a flawed measure of inflation to extract even more money from the pockets of law-abiding consumers.”

Let's hope the PM and her Chancellor are listening.

Taoiseach and health minister head nominations for nanny state awards

The Times (Ireland edition) has an exclusive report about our Farewell to Freedom Dinner in Dublin next month (see previous post).

The paper naturally focussed on the Golden Nanny Awards we are presenting to the politicians and NGOs that have done most to put Ireland into the top three of Chris Snowdon's Nanny State Index.

The full list of nominations will be published before the event which takes place on November 13. In the meantime, in the words of The Times:

Nanny state champions make rights group fume.

Coming soon: Farewell to Freedom dinner featuring the Golden Nanny Awards

Delighted to announce a brand new Forest event.

Next month in Dublin we are hosting a Farewell to Freedom dinner featuring the inaugural Golden Nanny Awards.

'Farewell to Freedom' is a nod to what is currently happening in Ireland – the introduction of plain packaging of tobacco, the forthcoming sugar tax and calls for minimum pricing of alcohol.

It's not a good time to be a consumer in Ireland and the introduction of a sugar tax could push the country even higher in the Nanny State Index. (Ireland currently sits at #3 behind Finland and the UK.)

The event, on Monday November 13, will feature a drinks reception on a smoking terrace with fireplace and heaters, followed by a three-course meal and after dinner 'entertainment' including the Golden Nanny Awards.

'The Nannies' will highlight the role of leading politicians and NGOs in promoting a nanny state agenda.

The event is supported by Hibernia Forum, a free market think tank, the Dublin Salon discussion group ('Everything begins with debate'), Students for Liberty Ireland and Consumer Choice Center.

If it's a success we plan to take the concept to London, Edinburgh and even Brussels. Watch this space.

Funnily enough we had a minor panic yesterday morning when we discovered that Ireland had been drawn to play a World Cup qualifying match against Denmark in Dublin on November 14, the original date for our event.

Invitations had already started going out but the restaurant – which is usually closed on Mondays – very kindly agreed to open for us on Monday 13th.

Hopefully that's the only hiccup between now and then but I wouldn't put money on it.

BCH: results of consultation on extending 'smokefree' zone to nearby streets

I suppose I ought to write about the outcome of a consultation conducted last year by Birmingham Children's Hospital (BCH).

You may remember it. I wrote about it here (Action alert – hospital wants to extend smoking ban to nearby streets) and here (Why 'smoke-free' consultation should be declared null and void) and invited readers to submit a response.

The consultation report has been sitting in my inbox for a few weeks. I'd like to say the outcome was a victory for those who opposed extending the hospital's 'smokefree' zone to neighbouring streets but I can't because there was a majority in favour.

That said, it was hardly a great win for BCH. I say that because it took a Freedom of Information request to get the hospital to reveal the existence of the report which wasn't on its website.

Nor had the results of the consultation been reported by the local media, which suggested two things. Either they hadn't been released or the results were insufficiently robust to merit any coverage.

Anyway, after submitting an FOI request in August I was sent a copy of the report (Proposal for a smoke-free zone around BCH: consultation responses) plus this brief summary:

• Birmingham Children’s Hospital remains a smokefree site. There has been no recent change in this.
• As outlined prior to last year’s consultation, any changes to ask people not to smoke around the hospital would need to be developed as a proposal with the local authority. At this stage, no formal proposal has been made. However, our consultation showed that the vast majority of respondents who actually use the hospital, live in Birmingham or use the streets around our site were in favour of a smokefree zone, and we therefore continue to explore ways of achieving this.

The 19-page report, dated November 8, 2016, is slightly more interesting. Here are three things I noted. One:

More smokers were strongly against the zone than were for it. Previous smokers were more evenly split between supporting and being against the zone. The majority of support came from non-smokers.

I'm sure this won't won't surprise anyone. It is however another example of what I call the 'tyranny of the majority' and it's a problem for smokers because non-smokers now outnumber smokers five to one and those who express an opinion in surveys like this are invariably anti-smoking.

My guess is that most non-smokers don't feel strongly about people smoking in the street, regardless of whether it's near a hospital, but that also means they're unlikely to be motivated to take part in a consultation on the subject.  

Inevitably therefore what we're up against is a hardcore of anti-smokers plus members of staff who I imagine were encouraged to submit a response that, lo and behold, supported their employers' proposed policy.

Two, people are generally reluctant to ask smokers to move on not because they think they are interfering in someone else's business and it has nothing to do with them but because they are frightened to do so.

Indeed the most extraordinary comment in the entire report reads:

Having been a police officer for 30 years I feel it would be dangerous to get into conflict with people who are smoking.

Goodness, if an experienced police officer is intimidated by the thought of asking someone to stub out a cigarette or move further away from the hospital to smoke you wouldn't back them to protect you from a knife-wielding terrorist, would you?

Three, the hospital wants to ban smoking and vaping in nearby streets. This is based on responses to the question 'Should the zone apply to e-cigarettes?' and the following key points:

• Respondents in favour of the zone were largely for it applying to e-cigarettes.
• Several respondents highlighted that a zone might discourage quit attempts using e-cigarettes, although no respondents indicated that they personally would be affected in this way.

What I deduce from this is that respondents opposed to the zone were largely against it applying to e-cigarettes (I know I was) but very few (if any) vapers bothered to submit a response, presumably because it was promoted as a consultation about smoking. (Forest gets a mention in the report but there's no reference to any vaping-related organisations.)

In other words, by declining to engage in a consultation on a "proposal for a smoke-free zone around BCH", the vaping advocacy community has effectively given the green light to a policy which, if implemented, will prohibit both smoking and vaping in neighbouring streets.

Here are the full recommendations:

1. Given the strong support from the significant majority of the public, families and staff who regularly use the area around the hospital, BCH strongly believes that the introduction of a smoke-free zone around the hospital site is a positive step.

2. BCH believes it will improve the experience of visitors, whilst also offering an opportunity to communicate a consistent and important public health message.

3. Based on consultation feedback, BCH believes that the zone should include vaping and e-cigarettes, maintaining consistency with the hospital site itself.

4. BCH will initially pursue the introduction of a voluntary zone, supported through signage that highlights the importance of the zone to children and families visiting the hospital.

5. BCH recognises the views of a number of people that they would like to see a more formal, enforceable zone introduced. BCH will ensure that any implementation of zone is appropriately monitored, and will support exploration of a stronger approach if a voluntary zone fails to address sufficiently the level of concern that the consultation has highlighted.

The good news is that nothing much appears to have happened since the report was produced in November last year.

According to the hospital, in response to my FOI, "any changes to ask people not to smoke around the hospital would need to be developed as a proposal with the local authority. At this stage, no formal proposal has been made."

It's hardly a positive result but in the circumstances it'll do.

Full report here.

Stoptober 2017 limps on and we're still waiting for the 2016 evaluation

We're just past the midway point for Stoptober 2017.

I only wrote about this 16 days ago so you may remember that in November last year I requested a report from Public Health England on the outcome of Stoptober 2016.

This was treated as a freedom of information request and I was told that "all strands of the evaluation will be finalised in early February (2017)."

February came and went and nothing was published.

In August I submitted a further FOI request asking for a "full evaluation of the outcome of Stoptober 2016".

PHE, as I wrote here, responded as follows:

We are releasing an evaluation document of Stoptober 2016 during Stoptober 2017; this will be available on the PHE website ... The original publication date was delayed.

The FOI response was dated September 22. This morning I checked the PHE website again and I still couldn't find the document they said was going to be published "during Stoptober 2017".

OK, I know Stoptober still has 15 days to go but doesn't it strike you as odd that the evaluation document for 2016 has been delayed this long and still hasn't been published?

As I've commented before, the budget for Stoptober 2017 is substantially more than it was last year (£1.08 million versus £390,000 in 2016) so how can Public Health England justify that sort of increase without an evaluation of the previous year's campaign?

We know that the number of smokers signing up to Stoptober fell significantly in 2015 compared to 2014. That, I suspect, is why PHE moved the goalposts and decided not to ask smokers to register in 2016 as they had done previously.

Now – and quite blatantly in my view – PHE has procrastinated for as long it can, perhaps in the hope we'd give up asking awkward questions about the success or otherwise of an event whose greatest legacy is giving one or two minor celebrities a small pay day and a number of well-remunerated PR and advertising agencies a substantially larger one.

Update: I rang PHE this morning to ask when, exactly, the evaluation document for Stoptober 2016 is to be published.

I was asked to put my question in writing – again – so shortly before lunch I sent this email :

Further to our phone conversation, see FOI response attached. It includes the statement, 'We are releasing an evaluation document of Stoptober 2016 during Stoptober 2017; this will be available on the PHE website.

We are now beyond the midway point in the Stoptober 2017 campaign and it would be helpful to know when exactly the evaluation document for Stoptober 2016 will be made available.

Please note that my original enquiry, which was treated as an FOI, was made on 3rd November 2016. I received a response that stated: 'It is expected that all strands of the evaluation will be finalised early February.'

Now, here we are, in October 2017, and to the best of my knowledge the evaluation document for Stoptober 2016 is still unavailable.

Therefore my very simple question (not to be treated as another FOI request!) is: 'Can PHE give a date for the publication of the Stoptober 2016 evaluation document and, if not, what is the reason for the continued delay?'

If I get a reply today I'll let you know. I'm not holding my breath.

Update: I have had a reply, to be fair, from a very helpful FOI officer. The long-awaited document is complete apparently and will be uploaded on to the PHE website in the next 14 days.

You have to hand it to government. The speed at which civil servants work is breathtaking.