Guidance

The CLeaR improvement model: excellence in tobacco control

Updated 18 March 2020

1. Introduction

The government published ‘Towards a smoke-free generation: tobacco control plan for England’ in July 2017 and this provided the impetus for a refresh of the CLeaR model.

PHE is pleased to endorse this latest version, as well as new ‘deep dive’ self-assessment tools on specific topics relating to smoking in acute settings, mental health settings, pregnancy, illegal tobacco and niche tobacco products, such as smokeless tobacco and shisha.

These resources provide practical help to commissioners and service providers and move England inexorably towards a truly tobacco-free future.

This guide will help you to use the self-assessment tool to accurately evaluate and score your activity.

2. About CLeaR

CLeaR is an evidence-based approach to tobacco control that every local authority and tobacco control alliance can use.

CLeaR stands for the 3 focuses of the model:

1. Challenge for your existing tobacco control services, based on evidence of the most effective tobacco control methods, as outlined in NICE Guidance and ‘Towards a smoke-free generation: tobacco control plan for England’.

2. Leadership for comprehensive action on tobacco control.

3. Results demonstrated by the outcomes you have achieved measured against national and local priorities.

Placing the local strategic priorities at the heart of these focuses will give the CLeaR results a greater impact in your area.

The CLeaR model offers:

• a free self-assessment tool for measuring the success of local action to address harm from tobacco
• an opportunity to bring local partners together to discuss the range of local tobacco control efforts and reinforce efforts and priorities
• a voluntary peer-assessment process, which provides independent challenge to your self-assessment and access to a recognised quality mark
• a chance to benchmark your work on tobacco control over time and against others

It is important to emphasise that CLeaR is not an inspection regime or external audit. Results from your self-assessment process belong to your locality and exist only to help identify areas of strength, opportunities for development and improve local tobacco control.

3. CLeaR self-assessment

You can start using the CLeaR improvement model straight away by completing the free self-assessment questionnaire.

The self-assessment will enable you to:

• evaluate your local action on tobacco control
• ensure that local activity follows the latest evidence-based practice
• identify priority areas for development and help with effective planning
• monitor improvements to your services over time

Results from the self-assessment are for local use only and will not be shared with PHE. We would recommend that the self-assessment process is refreshed periodically (at least every 2 years) to monitor any changes and reinvigorate local action.

3.1 CLeaR enhanced offer

An ‘enhanced offer’ from PHE is available in support of the self-assessment. This locality-based half-day workshop is an opportunity for influential partners to come together to learn more about the CLeaR process and to begin the self-assessment process. For more information please contact CLeaRTobaccoTeam@phe.gov.uk.

4. CLeaR peer assessment

A CLeaR peer assessment takes place after the self-assessment has been completed. It is an in-depth look at your tobacco control activity, led by a small team of trained tobacco control experts.

This optional peer assessment provides:

• a facilitated day enabling influential partners to look in depth at the evidence that supports the self-assessment
• an independent report to ratify your score and identify local strengths and areas that will benefit from further development
• the opportunity to learn from practice elsewhere by taking part in other peer-assessment visits as an external peer assessor
• a list of resources and further information relevant to the assessment
• the right to use the CLeaR logo on local promotional material

If you decide to proceed with a peer-assessment visit, it will take place in your locality on a date agreed between the local area and the peer team. There will be a charge of £2,500 to cover the cost of the external assessment.

For more information, please contact CLeaRTobaccoTeam@phe.gov.uk.

5. CLeaR deep dives

CLeaR deep-dive self-assessments focus on a specific area of tobacco control and take a day of a co-ordinator’s time to complete.

There are 5 topics available, which include:

• stopping smoking in acute settings and maternity
• stopping smoking in mental health settings
• stopping smoking during and after pregnancy
• illegal tobacco and compliance with regulations
• niche tobacco products

The deep dives can be used alongside the main assessment, or as standalone assessments. Currently, there are no plans to offer peer assessment for deep dives.

6. Using the CLeaR improvement model

The CLeaR improvement model is based around a simple questionnaire.

By appointing a co-ordinating officer, you can ensure completion of the CLeaR questionnaire takes no longer than 2 days. The optional CLeaR peer assessment will take approximately 1 more day.

6.1 Set your activity in context

By completing the first section of the questionnaire you will put your local action on tobacco control into context by identifying:

• your local authority’s highest strategic priorities
• the main strategies that your tobacco control activity contributes to
• local high-priority outcomes

These priorities may not necessarily be health-related, so might include helping children and young people to prosper, increasing prosperity, or reducing health inequalities. They should link to appropriate strategies that your tobacco control work will affect, for instance, targets on reducing health inequalities and child poverty.

6.2 Get the right people involved

To get the best out of the model, you will need a broad understanding of local policies that relate to your tobacco control work. It is most important that the self-assessment is completed in consultation with a wide range of partners, rather than by 1 or 2 individuals.

The information you need to draw on includes:

• a detailed understanding of the local approach to tobacco control at a strategic and operational level
• awareness of the local, supra-local or regional level tobacco control and stop smoking activities and partnerships
• an understanding of the broader policy drivers underpinning action on tobacco
• knowledge of developing governance and accountability arrangements in relation to local health and wellbeing boards and clinical commissioning groups
• detailed evidence on performance against your priority targets

6.3 Get the right people involved for deep dives

As with the CLeaR improvement self-assessment, the deep dives should ideally be completed as an alliance or specialist sub-group. While we would always advise involving the local authority tobacco control lead in the process, the specific nature of the topics means that they may not necessarily be the lead person.

For instance, when undertaking the ‘stopping smoking in pregnancy’ deep dive, localities may wish to involve the following members of staff, among others: CCG lead for maternity, head of midwifery, public health midwifery lead, obstetricians, midwives, stop smoking manager, stop smoking pregnancy lead, local tobacco control alliance lead, data analyst.

CLeaR team advice

Some localities find it helpful to complete the questionnaire in small groups or at their tobacco alliance meetings. Another good approach is to appoint a single author or co-ordinator and complete the questionnaire through a series of short 30-minute interviews with relevant staff.

6.4 Complete the questionnaire

The 3 principle focuses of the model are broken down into a number of related sections. Each section has a small number of questions to demonstrate a particular attribute or practice.

Consider whether or not you can demonstrate this practice in your organisation?

• if not, tick ‘no evidence of achievement’
• if you have evidence of some relevant practice, but there is room for improvement or development, tick ‘some evidence of achievement’
• if you can demonstrate clearly that the practice is common in your organisation, tick ‘strong evidence of achievement’

Answer the questions honestly, and in agreement with your partners where possible. Where you select ‘some evidence’ or ‘strong evidence’, make a note of examples you would use to illustrate your point in the comments and references column.

CLeaR team advice

If you are planning a CLeaR peer assessment, take this opportunity to collate electronic copies of relevant documents and evidence in one place, ready to share with assessors via web links, CD or memory stick. Remember, if you opt for an external peer assessment, your self-assessment score will be compared in the final report with the peer assessors` scores – so try and look at your services from the point of view of a stranger, and ensure your answers are well evidenced.

6.5 Calculate your score

The ‘Results’ sheet at the end of the tool will automatically calculate your scores for each section. Pay attention to areas where your locality has not scored as highly as you would wish, and identify where there are gaps in current practice. What could you develop further? Note these areas as your outline priorities for development.

7. Preparing for a peer assessment

In advance of the visit, the local self-assessment co-ordinator collects the evidence that supports the statements and scores agreed locally as part of that process. This evidence is shared with the lead peer assessor, preferably in an electronic format. The level of evidence provided should be sufficient to validate the self-assessment and concise enough not to be excessively burdensome for either the local co-ordinator or the peer-assessment team.

The visit will take the form of a workshop with a number of influential local partners, or as interviews with individuals or topic groups. These discussions will enable the peer-assessment team to explore your local tobacco control activity in greater detail and provide review scores for each of the CLeaR questions. Initial feedback to lead partners will be provided at the end of this day.

The lead peer assessor will provide localities with a written report, typically within 3 weeks of the peer-assessment visit. This will confirm the assessment team’s scores and observations in more detail, as well as identify useful resources. They will share the report with PHE for quality assurance purposes and it will not be shared with any other party.

8. Resources

Download the CLeaR model handbook.