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Working Environment - NICE guidelines

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https://www.gov.uk/government/consultations/consultation-on-reforms-to-social-housing-allocations/consultation-on-reforms-to-social-housing-allocations

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https://www.england.nhs.uk/long-read/nhs-vaccination-strategy/

Vaccination strategy

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NICE Guideline on housing:

Integrated health and social care for people experiencing homelessness

https://www.nice.org.uk/guidance/ng214/chapter/Context

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Context | Integrated health and social care for people experiencing homelessness | Guidance | NICE

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This guideline covers providing integrated health and social care services for people experiencing homelessness. It aims to improve access to and engagement with health and social care, and ensure care is coordinated across different services

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HOUSING

Recommendation on how to reduce health risks associated with living in cold homes

https://www.nice.org.uk/guidance/ng6

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Policy on tobacco use in England.

https://www.gov.uk/government/publications/towards-a-smoke-free-generation-tobacco-control-plan-for-england

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https://www.nice.org.uk/guidance/ng70/resources/air-pollution-outdoor-air-quality-and-health-pdf-1837627509445

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Overweight and Obesity weight management.

https://www.nice.org.uk/guidance/ng246

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Overview | Overweight and obesity management | Guidance | NICE

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This guideline covers the prevention and management of overweight, obesity and central adiposity in children, young people and adults. It brings together and updates all NICE’s previous guidelines on overweight and obesity. For more details see update information. It does not cover pregnancy

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Childhood obesity a plan for action.

Taking out 20% of sugar products.

Putting £10 million a year into school healthy breakfast clubs to give children a healthier start to their day.

Making healthier options available in the public sector

Helping all children to enjoy an hour of physical activity every day

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FIVE YEAR FORWARD VIEW FOR MENTAL HEALTH

https://www.gov.uk/government/publications/five-year-forward-view-for-mental-health-government-response

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1. Human Resources- Policies including matters such as Confidentiality, Equal opportunities,Disciplinary and Grievance.

2. Health and Safety Policy and Procedure

3. Lone Working Policy and Risk Assessment

4. Whistleblowing Policy

Link: https://www.futurehsc.com/about-us/policies-and-procedures/#:~:text=Human%20Resources%20-%20Policies%20including%20matters,Service%20User%20Development%20and%20Involvement

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Children's wellbeing and schools bill

https://assets.publishing.service.gov.uk/media/679910efd4f0d327e7707193/Childrens_wellbeing_and_schools_bill_-_Policy_summary_notes.pdf

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Extent of measures

The Tobacco and Vapes Bill will be a landmark step in creating a smoke-free UK.

It will introduce a smoke-free generation by gradually phasing out the sale of tobacco products across the country: the bill makes it an offence to sell tobacco products, herbal smoking products and cigarette papers to anyone born on or after 1 January 2009. Children born on or after this date will never be able to be legally sold tobacco products, breaking the cycle of addiction and disadvantage.

The products in scope include:

cigarettes

hand rolled tobacco

cigars

cigarillos

pipe tobacco

waterpipe tobacco products (for example, shisha)

chewing tobacco

heated tobacco

nasal tobacco (snuff)

herbal smoking products

cigarette papers

https://www.gov.uk/government/publications/the-tobacco-and-vapes-bill-creating-a-smoke-free-uk-and-tackling-youth-vaping/tobacco-and-vapes-bill-creating-a-smoke-free-uk-and-tackling-youth-vaping

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Tobacco and Vapes Bill: creating a smoke-free UK and tackling youth vaping factsheet

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The Tobacco and Vapes Bill will be a landmark step in creating a smoke-free UK.

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Pregnancy

“There are factors that can increase the risk of harm to the unborn baby and many of these are influenced by health inequalities.

The Health Secretary announced his ambition to reduce stillbirth, neonatal death and maternal death by 50% by 2030. In January 2019, that ambition was accelerated to achieve 50% reductions in stillbirth, maternal mortality, neonatal mortality and serious brain injury by 2025.”

https://www.gov.uk/government/publications/healthy-beginnings-applying-all-our-health/healthy-beginnings-applying-all-our-health?

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Office for Health Improvement and Disparities

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Healthy beginnings: applying All Our Health

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Note: the Public Health England team leading this policy transitioned into the Office for Health Improvement and Disparities (OHID) on 1 October 2021.

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Guideline

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This resource was developed in response to requests for clearer direction from central government about the safeguarding responsibilities of local authorities.

It is designed to highlight examples from areas where effective practice has been identified and to emphasise what works in protecting survivors and those at risk of female genital mutilation (FGM).

This resource pack was updated:

in November 2015 to reflect legislative changes

in May 2016 to reflect the publication of statutory guidance on FGM

in February 2019 with some minor amendments

in February 2020, wholesale

It equips commissioners both with the data they need to understand the scale of the problem in their area and with an insight into some of the tools they can use to combat it effectively.

This pack includes:

case studies where FGM has been experienced by girls and women in the UK

information on what local authorities and others can do to raise awareness of FGM in their local area

links to support organisations, clinics and helplines which can help people who think they might be at risk

Disclaimer

External links were selected, reviewed and identified as effective practice on combating FGM when this resource was published. However, the Home Office is not responsible for the content of external websites. We do not maintain or update them; we cannot change them; and they may be changed without our knowledge. Other information and effective practice on FGM is freely available and the content on this website is therefore not exhaustive.

If you have documents or material you would like to be included in this resource, please email FGMEnquiries@homeoffice.gov.uk.

Warning

Some of the content in the links included in this resource pack contain images or accounts which readers may find distressing.

FGM is illegal in the UK. It is a practice which takes place worldwide in at least 30 countries in Africa, Asia and the Middle East. It also takes place within parts of Western Europe and other developed countries, primarily among immigrant and refugee communities.

FGM has been classified by the World Health Organization into 4 types; these are described in more detail on the World Health Organization website.

FGM is a complex issue - despite the harm it causes, some women and men from affected communities consider it to be normal to protect their daughters and their cultural identity.

Some people believe that FGM is a way to ensure virginity and chastity. It is sometimes done to preserve girls from sex outside of marriage and from having sexual feelings. FGM is often claimed to be carried out in accordance with religious beliefs, but it is not supported by any religious doctrine.

3. Legislation

FGM is illegal in the UK. In England, Wales and Northern Ireland, civil and criminal legislation on FGM is contained in the Female Genital Mutilation Act 2003 ("the 2003 Act"). In Scotland, FGM legislation is contained in the Prohibition of Female Genital Mutilation (Scotland) Act 2005. The Female Genital Mutilation Act 2003 was amended by sections 70-75 of the Serious Crime Act 2015.

Criminal law in England and Wales

Under section 1 of the 2003 Act, a person is guilty of an FGM offence if they excise, infibulate or otherwise mutilate the whole or any part of a girl's or woman's labia majora, labia minora or clitoris. To excise is to remove part or all of the clitoris and the inner labia (lips that surround the vagina), with or without removal of the labia majora (larger outer lips). To infibulate is to narrow the vaginal opening by creating a seal, formed by cutting and repositioning the labia.

Offences of FGM

It is an offence for any person (regardless of their nationality or residence status) to:

If the mutilation takes place in England or Wales, the nationality or residence status of the victim is irrelevant.

Failing to protect a girl from risk of FGM

If an offence under sections 1, 2 or 3 of the 2003 Act is committed against a girl under the age of 16, each person who is responsible for the girl at the time the FGM occurred could be guilty of an offence under section 3A of the 2003 Act.

FGM taking place abroad

It is an offence for a UK national or UK resident (even in countries where FGM is not an offence) to:

perform FGM abroad (sections 4 and 1 of the 2003 Act)

assist a girl to carry out FGM on herself outside the UK (sections 4 and 2 of the 2003 Act)

assist (from outside the UK) a non-UK person to carry out FGM outside the UK on a UK national or UK resident (sections 4 and 3 of the 2003 Act)

An offence of failing to protect a girl from the risk of FGM can be committed wholly or partly outside the UK by a person who is a UK national or a UK resident. The extra-territorial offences of FGM are intended to cover taking a girl abroad to be subjected to FGM.

Any person found guilty of an offence under sections 1, 2 or 3 of the 2003 Act faces up to 14 years' imprisonment, a fine or both. Any person found guilty of an offence under section 3A of the 2003 Act faces up to 7 years' imprisonment, a fine or both.

Under provisions of the law which apply generally to criminal offences, it is also an offence to:

aid, abet, counsel or procure a person to commit an FGM offence

encourage or assist a person to commit an FGM offence

attempt to commit an FGM offence

conspire to commit an FGM offence

Any person found guilty of such an offence faces the same maximum penalty for these offences under the 2003 Act.

Civil law in England and Wales

Under section 5A and schedule 2 of the 2003 Act, provision is made for FGM Protection Orders. An FGM Protection Order is a civil law measure which provides a means of protecting and safeguarding victims and potential victims of FGM. They contain conditions to protect a victim or potential victim. Those might, for example, involve surrendering a passport to prevent the person at risk from being taken abroad to undergo FGM, or a requirement that nobody arranges for FGM to be performed on the person being protected.

Those who may apply for an FGM Protection Order are:

the person who has undergone or is at risk of FGM

a local authority

any other person (for example the police, a teacher, a charity or a family member), with the permission of the court

An application for an order may be made at a Family Court in England and Wales; there is no fee. A court can be asked to consider an application straightaway when necessary, and can make an FGM Protection Order without the respondent(s) being present. Civil legal aid is available to victims, potential victims and third parties who seek to make, vary or discharge an FGM Protection Order, subject to meeting the relevant means and merits criteria. If the conditions in the FGM Protection Order are not followed, this is called a breach. It can be dealt with either by the Family Court as a contempt of court, or as a criminal offence, with a maximum penalty of five years' imprisonment.

This link shows what you need to do to apply for a FGM Protection Order, including links to the application forms.

Other aspects of the legislation

The 2003 Act also:

guarantees lifelong anonymity for survivors of FGM (section 4A of the 2003 Act)

places a mandatory duty on health and social care professionals and teachers to notify the police where they discover that FGM has been carried out on a girl under 18 years of age during the course of their work (section 5B of the 2003 Act)

provides for statutory guidance on FGM (section 5C of the 2003 Act)

This infographic from the National FGM Centre provides a summary of the legislative position.

4. Case studies

Some examples of good partnership working between voluntary and community sector organisations and local authorities are available to download, including the following FGM case studies:

interpreting, awareness-raising and advice

multi-agency approach

positive working between midwife and GP

5. Prevalence of FGM in England and Wales

Given the hidden nature of FGM, the exact number of women and girls in the UK who have undergone it is unknown. A 2015 study based on 2011 census data estimated that:

approximately 60,000 girls aged 0 to 14 were born in England and Wales to mothers who had undergone FGM

approximately 103,000 women aged 15 to 49 and approximately 24,000 women aged 50 and over who have migrated to England and Wales are living with the consequences of FGM. In addition, approximately 10,000 girls aged under 15 who have migrated to England and Wales are likely to have undergone FGM

The study also reported that:

women who have undergone FGM do not only live in urban centres in England and Wales: while many affected women live in large cities where migrant populations tend to be clustered, others are scattered in rural areas

no local authority area is likely to be free from FGM entirely: in many areas, the estimated prevalence is low, but there are still some women who may be affected by FGM

London has the highest prevalence rate in England and Wales, with an estimated 2.1% of women affected by FGM

outside London, the highest estimates were for Manchester, Slough, Bristol, Leicester and Birmingham

NHS Digital publishes statistics about patients with FGM who are treated within the NHS in England. This is crucial in understanding the extent of FGM in England as identified through the delivery of healthcare services.

" Characteristics of children in need " (see tab C3 of the tables document) data, which contains statistics on children referred to and assessed by children's social services, includes the numbers of occasions in each local authority area in England where FGM was identified at the end of the assessment.

To get an indication of how widespread FGM is in the local area, and what policies or training are in place, local agencies could look at the NHS Enhanced Dataset statistics and relevant research on prevalence.

They can also ask questions to ensure that the best possible support and preventative measures are put in place which are tailored to maximise outcomes. These may include:

which FGM-affected communities live in the area and how many members of these communities are there?

is there a policy on FGM, and who is accountable for leading and implementing it?

which body is responsible for FGM prevention?

what training is there for professionals such as health, teaching and safeguarding workers?

what steps have been taken to use the statutory guidance on FGM?

are designated senior staff for child protection in schools aware of FGM and have they ensured that their staff are aware of the potential risks?

Appendix 2 of this document shows how Coventry City Council estimated the prevalence of FGM in its area.

Read more about the worldwide prevalence of FGM and terms used for FGM in other countries.

6. Working together with voluntary and community sector organisations

A coalition of charitable trusts set up the Tackling FGM Initiative which funded community projects. As part of this work, an independent evaluation was carried out, highlighting what works in community engagement activity as well as a best practice guide for communities tackling FGM. Both can be found through the above link.

This study shows the results of focus groups carried out by AFRUCA with a range of African communities in Greater Manchester. It sets out the comments of people in those communities about FGM and what can be inferred from those about the prevalence of FGM in Greater Manchester, and makes recommendations for improvement.

Midaye is a grassroots organisation offering a wide range of services to ethnic minorities in the West London area, with a focus on those who speak Arabic and Somali. It organises and regularly delivers community engagement events and training for the community and other professionals.

7. FGM statutory multi-agency guidance

The Serious Crime Act 2015 amended the FGM Act to provide for statutory guidance on FGM. This guidance is intended to help to:

further increase awareness of FGM and improve compliance with good practice

increase referrals and reports to the police

afford victims and survivors of FGM the greatest possible protection

The statutory guidance was published on 1 April 2016, with some minor updates made in 2018 and 2019. The guidance draws on the previous FGM multi-agency practice guidelines and was updated to capture the legal changes introduced by the Serious Crime Act 2015, new guidance for health professionals, new sources of data on FGM, wider safeguarding responsibilities, duties and resources for professionals, and other minor changes. It also includes information on the FGM mandatory reporting duty.

8. National Helpline

The NSPCC operates a free national FGM helpline, which offers guidance to thousands of people, including professionals. The FGM helpline is staffed by specialised practitioners, who are all trained to identify the risk of FGM. The helpline can offer advice and support: if you are worried about a child who is at risk of FGM, if somebody has already undergone an FGM procedure or if you have any questions regarding FGM.

The helpline is available seven days a week between the following hours: Monday to Friday 8am to 10pm and Saturday and Sunday 9pm to 6pm. You can call and choose to remain anonymous on 0800 028 3550 or email fgmhelp@nspcc.org.uk.

9. Safeguarding

The action we take to promote the welfare of children and protect them from harms such as FGM is everyone's responsibility. Everyone who comes into contact with children and families has a role to play.

More information is available in the following guidance:

The Children and Social Work Act 2017 provides for the replacement of Local Safeguarding Children Boards (LSCBs) with a more flexible system of multi-agency arrangements, led by the three safeguarding partners: the local authority chief executive; the accountable officer of a clinical commissioning group; and a chief officer of police. While education settings are not named as one of the three key statutory partners, they are an extremely important relevant agency and all local areas must detail how education settings are included in the partnership.

These new safeguarding partnerships play an important role in challenging safeguarding practice and assessing how effective these services are. Every local authority should be part of a safeguarding partnership.

Working Together to Safeguard Children 2018 provides the statutory guidance in England for the three safeguarding partners, who will be required to make joint safeguarding decisions to meet the needs of local children and families. They will be jointly responsible for setting out local plans to keep children safe and improve their wellbeing, and will be accountable for how well agencies work together to protect children from abuse and neglect. They will also be responsible for identifying serious child safeguarding cases which raise issues of importance in relation to the area and reviewing cases where they consider it appropriate.

The law underpinning the new safeguarding arrangements came into effect on 29 June 2018. Local areas in England had up to 12 months from this date to develop and publish their arrangements. All local areas have now published their plans and all local arrangements should now be being implemented.

Since 31 October 2015, regulated health and social care professionals and teachers in England and Wales have been subject to an FGM mandatory reporting duty. They are legally required to report 'known' cases of FGM in under 18s, which they identify in the course of their professional work, to the police. You can read procedural information on the duty and a factsheet (with translations) for communities.

10. Local authorities

Below are some examples of FGM strategies and action taken by local authorities.

The National FGM Centre is a partnership between Barnardo's and the Local Government Association which aims to achieve a systems change in the provision of services for children and families affected by FGM. It has specialist social workers embedded in a number of local authorities to provide support in cases where FGM, breast flattening or child abuse linked to faith or belief are a concern - for example, providing advice and guidance to frontline professionals and applying for FGM Protection Orders. They have produced this guide for councillors about FGM. The Centre also provides a 'knowledge hub' of information and guidance about FGM, trains professionals (see Section 16) and engages with communities.

In 2015 a group of organisations produced a guide for local authorities with recommendations for fighting FGM at a local level.

Bromley Safeguarding Children Partnership have developed an FGM Awareness App which is designed to help professionals who are responsible for child safeguarding to understand FGM, the law, the context in which FGM takes place and their safeguarding responsibilities.

In 2013 Coventry City Council became the first local authority in the UK to support a full council motion to condemn FGM. In 2016 a two year programme of work was commissioned to embed the REPLACE approach, building on existing assets within communities to ensure that they could tackle FGM and continue the work once the funding had ended. The project trained over 3,500 professionals, recruited 90 community champions from 15 affected communities and involved a range of community events which harnessed the commitment of 1,964 people to effect change locally. The local authority carries out ongoing work to raise awareness, train staff and support its partners; it is also developing a Strategic Statement outlining its ongoing aim to end FGM. Coventry uses the 4Ps model (Prepare, Prevent, Protect, Pursue) to tackle FGM. Coventry Haven Women's Aid also runs a Friendship Group from 10-12 on the first and third Mondays of every month, at Coventry Central Library (Smithford Way), which provides help and support to survivors of FGM.

In 2017 Leeds City Council set up a new FGM strategic multi-agency group partnership which brought together health, education, West Yorkshire Police and third sector agencies to develop a co-ordinated approach to tackling FGM across Leeds. The group organised a conference on FGM in May 2018. They have also supported the Black Health Initiative, who were successful in receiving funding through the Home Office's counter-extremism Building A Stronger Britain Together programme, with which they reached out to and raised awareness with community groups, and developed a FGM toolkit.

The Leeds Safeguarding Children Partnership (LSCP) also implemented an under-18s Pathway to guide professionals more effectively. Leeds is also a pilot area for the national FGM clinics (see Section 12), which saw the opening of the Blossom Clinic in Leeds during October 2019. The clinic is supported by a local mental health charity, Touchstone, who are now providing a mental health and an advocacy service. Leeds has set up and is developing a credible voices group within the community to help raise awareness, educate, identify gaps in service and develop the Leeds response to FGM by feeding into the FGM Steering group who report to the LSCP. They are also working in partnership with Bedfordshire University who will be undertaking an evaluation of the Leeds response to FGM and "honour"-based abuse.

In 2016 Nottingham City Council passed a motion to become the country's first 'zero-tolerance' city of FGM. Partners including police, health, education, social care and the voluntary and community sector together produced an action plan, reviewed quarterly, for ending FGM in a generation in Nottingham. Mojatu Foundation are a key partner driving this agenda forward, providing support and awareness training for partners and offering comprehensive support services for survivors. In 2019 they trained a network of faith and youth ambassadors who work within their communities to raise awareness of zero tolerance, and produced a series of short videos which were released on social media at the end of the school summer team at the same time as letters to schools about the 'cutting season' - see https://www.facebook.com/mojatu.foundation/videos/864295247276539/ and https://www.facebook.com/mojatu.foundation/videos/681275118966253/.

Nationally, Operation Limelight is a multi-agency safeguarding operation at the UK border which focuses on harmful practices such as FGM and forced marriage. It is a national operation delivered by Police and Border Force. Delivery partners can include local children's social care departments, and health and third sector organisations which specialise in responding to harmful practices. Often delivered before and after the three main school holidays, Limelight targets flights connecting to locations where there is high prevalence of FGM and forced marriage. It seeks to raise awareness of harmful practices, identify vulnerability and safeguard those at risk. It also seeks to develop intelligence and identify possible perpetrators.

This document has been designed by the Metropolitan Police Service to assist those engaged on Operation Limelight to have sensitive conversations with passengers regarding FGM.

Avon and Somerset Police work in close collaboration with statutory partners, the third sector and affected communities to develop and refine their response to FGM. There is a particular focus on increasing public awareness through education and health messaging and through the empowerment of women and girls to resist gender-based violence. The cooperation and insight of affected communities are critical to the success of these approaches. Avon and Somerset Police also work with police and partner colleagues from the South-West area to ensure sharing of information, consistency of practice and peer support in responding to FGM and other forms of "honour"-based abuse.

Greater Manchester Police work closely on FGM with local and national partners, including Greater Manchester Combined Authority, to raise awareness and encourage people to report it. The Force has a Strategic Lead for Harmful Practices and has a network of officers across its districts to provide specialist advice and support. Greater Manchester Police support Operation Limelight during the summer period at Manchester International Airport.

Project Azure sits within the Metropolitan Police Service's (MPS) Continuous Policing Improvement Command and is the MPS strategic response to tackling FGM and other harmful practices such as child abuse linked to faith or belief, forced marriage, "honour"-based abuse and breast flattening. They also provide a coordination role nationally for Operation Limelight. Their mission is to work together with partners to prevent FGM, to identify and protect victims from harm, and to identify and prosecute offenders.

Operation Sentinel is a force-wide operation aimed at enhancing the service provided by West Midlands Police and its partners to victims across the force area who are especially vulnerable. A particular focus has been applied to "honour"-based abuse, FGM, domestic abuse, child sexual exploitation and human trafficking. Sentinel aims to ensure that police, partner agencies (such as local councils, charities and support services) and the community work together more effectively and share information to fight these crimes.

Police and Crime Commissioners have also undertaken a range of actions in their local areas. Get in touch with your local Police and Crime Commissioner to find out more information.

12. Health in England

FGM has no health benefits and it harms girls and women in many ways. It is important that survivors of FGM receive targeted healthcare support, for both their physical and mental health needs.

Specialist clinics

For women aged 18 or over who are not pregnant, England has eight National FGM Support Clinics (NFGMSC), which are holistic, community-based clinics which offer a range of support services delivered by a multi-disciplinary team. These include physical assessments and treatment (including deinfibulation if required), counselling, safeguarding information and access to an FGM Health Advocate. There will be onward support to a specialist consultant if additional support is required. There are eight clinics, of which five are in London (Brent, Croydon, Hammersmith, Tower Hamlets, Waltham Forest); the other three are in Birmingham, Bristol and Leeds. This link provides further details.

Women who are pregnant and who have undergone FGM can access support through their local maternity pathway. This leaflet from the National FGM Centre provides information for women whose FGM has been identified in pregnancy.

Girls under 18 years who have or are suspected to have undergone FGM can access support through the specialist paediatric service at University College London Hospitals (UCLH).

The Oxford Rose Clinic, based at the John Radcliffe Hospital in Oxford, is a confidential service providing support for women and girls who have experienced female genital mutilation or cutting (FGM/C). It holds fortnightly clinics which offer a wide range of types of care to patients.

Midaye offers bilingual health advocacy to FGM-affected communities in Chelsea and Westminster Hospital, the Sunflower clinics at Saint Mary's Hospital and Queen Charlotte's and Chelsea Hospital FGM clinics in London, on a weekly basis. It also works in community-based venues, GP practices and other venues as appropriate.

Psychotherapy and psychosocial services

Case histories and personal accounts taken from women show that FGM can be an extremely traumatic experience for girls and women, which stays with them for the rest of their lives.

The World Health Organization has noted that young women receiving psychological counselling for FGM in the UK have reported feelings of betrayal by parents, incompleteness, regret and anger. There is increasing awareness of the severe psychological consequences of FGM for girls and women, which can become evident in mental health problems and drug and alcohol dependency.

A 2005 study from the American Journal of Psychiatry based on research in African communities affected by FGM showed that women who had undergone FGM experienced the same levels of post-traumatic stress disorder (PTSD) as adults who had been subjected to early childhood abuse, and that the majority (80%) of the women suffered from affective (mood) or anxiety disorders.

The fact that FGM is culturally embedded in a girl's or woman's community does not protect her against the development of PTSD or other psychiatric disorders. Professionals, particularly those in the health sector, should ensure that mental health support is made available to assist girls and women who have undergone FGM, as well as treatment for any physical symptoms or complications.

Female Genital Trauma: Guidelines for Working Therapeutically with Survivors of Female Genital Mutilation provides recommendations for psychological therapists and counsellors to facilitate therapy with adult women who have undergone female genital mutilation/cutting (FGM/C).

Examples of community-based FGM services in local areas include:

the Dahlia Project, run by Manor Gardens Welfare Trust

FORWARD provide psychological and psychosocial educational support nationally

Information about mental health services in your area can be found on the NHS website.

Reporting and recording FGM

There are three requirements on NHS organisations and professionals to record and share information about FGM and risks relating to it. These are the Mandatory Reporting Duty, the Enhanced Dataset and the FGM - Information Sharing system (FGM-IS).

the FGM Mandatory Reporting Duty is a legal duty provided for in section 5A of the FGM Act 2003 (as amended by the Serious Crime Act 2015). It requires regulated health and social care professionals and teachers to report to the police cases of FGM in girls under 18 if, in the course of their professional duties, they see signs or symptoms indicating that a girl has undergone FGM or if she tells the professional that she has undergone it. Complying with the duty does not breach any confidentiality requirement or other restriction on disclosure which might otherwise apply.

NHS Digital collect data about women and girls who have undergone FGM and who are being cared for by the NHS in England. This is the FGM Enhanced Dataset (see Section 5). The purpose of this data collection is to build a national picture of prevalence, and to support work in the NHS to prevent and treat FGM. The data is collected whenever a woman is identified in a healthcare setting in England as having undergone FGM, and the FGM could have happened at any point in the past. This means that the Enhanced Dataset will record cases which are not eligible for mandatory reporting (for example, where FGM is identified in a patient who is over 18).

the FGM-IS (FGM - Information Sharing system) is a national digital system which shares information within the healthcare record of a girl under 18 - if she has a family history of FGM - between authorised healthcare professionals and administrative staff across England. FGM-IS supports effective early intervention and ongoing safeguarding of girls who are potentially at risk of FGM.

Resources from government:

Resources from the Royal Colleges:

Other resources:

The NHS London Safeguarding team and the Royal College of GPs worked in collaboration with Building Bridges and Mojatu Foundation to co-produce an FGM easy read.

The NHS London Safeguarding team, in partnership with Leeds Clinical Commissioning Group, Leeds FGM Blossom Clinic, the Sunflower Clinic and Imperial College Healthcare NHS Trust have developed an animation based on trauma informed care, to support health professionals to have conversations with survivors of FGM regarding cervical screening.

Cervical screening FGM resource
13. Schools in England

From September 2020, Relationships Education will be compulsory for all primary pupils. Relationships and Sex Education (RSE) will be compulsory for all secondary pupils and Health Education will be compulsory for all pupils in state-funded schools.

RSE will cover the concepts of, and laws relating to, sexual consent, sexual exploitation, abuse, grooming, coercion, harassment, forced marriage, rape, domestic abuse and FGM, and how these can affect current and future relationships.

In infant and primary schools, effective sex and relationships education within PSHE can help pupils keep themselves safe from harm through building their confidence to ask for help, learning that their body belongs to them and giving them the language to describe private parts of their body. The Sex Education Forum and PSHE Association have advice and guidance on effective teaching and learning in sex and relationships education and PSHE.

Listed below are some helpful resources and information about FGM for schools and teachers.

Resources from government and the police

The Guidance for Schools: Safeguarding Young People from Sexual Violence, CSE and Harmful Practices explains what the police do in relation to a range of complex issues which affect young people in schools and colleges, including FGM. The police want to encourage information sharing so that partners within the safeguarding process can work together more effectively.

This guidance covers:

what the relevant legislation says

what options police have from both the safeguarding and enforcement perspectives

what resources are available to give readers a better understanding of each of these highly complex issues

what vulnerability signs schools could look for

suggestions as to how schools can respond to these hidden harms within existing referral procedures

The Harmful Practices Schools Charter is a partner-led document which seeks to encourage schools to adopt a preventative approach to educating children on all of these harmful practices, including FGM. Schools are encouraged to sign up to the Charter, as it represents a tangible and direct commitment from them to promote the delivery of inputs in schools which address harmful practices. Schools can use the principles supported by the Charter by incorporating them into lesson plans developed and delivered by school staff or by external providers. It also promotes the appropriate sharing of information through existing referral procedures.

Useful documents for teachers

The National FGM Centre has developed schools guidance on FGM, including a "conversation form" for logging concerns and raising them with pupils and parents and online training for staff in dealing with a disclosure of FGM. They have also produced FGM Flash Cards, designed for professionals to use with other professionals, parent(s)/carer(s), children and young people

The National FGM Centre in partnership with the Eve Appeal have collaborated in co-designing lesson plans for introducing FGM to young people, in Key Stages 1, 2 and 3.

Videos for schools

Integrate UK has produced the following three videos as resources for schools:

Oxford Against Cutting has produced the following short films for schools:

Are You Ready to Know? was created by and for secondary school students, and shows a conversation about FGM between a mother from the Gambia and her nine-year old daughter

Who Can You Tell? is a short film to encourage primary school children to talk to their teacher or school health nurse if they are worried about FGM or sexual harm and includes the NSPCC's PANTS message

See Section 17 for further films which may be relevant.

Other useful resources for schools and young people

The Guardian Project is a project run by NESTAC which coordinates care and support across Greater Manchester for girls and young women (up to 21 years of age) who are affected by or at risk of FGM. Advice, support and guidance are available for all professionals working to safeguard girls and young women from FGM across Greater Manchester. Contact: 07449 651 677 or guardian.project@outlook.com

14. Children's social care

All children's social care professionals should work in accordance with the guidelines in 'Working together to safeguard children' (2018) in England and 'Safeguarding children: working together under the Children Act 2004' (2004) in Wales.

The National FGM Centre has produced a number of useful resources:

Other resources and information about FGM for children's social care professionals include:

15. Leaflets

These materials are designed to help classroom teachers and professionals raise awareness of FGM and explore the stigma and common issues that often surround it.

Resources from government

'Female genital mutilation: the facts' leaflet - this sets out some of the key facts about FGM

'Statement opposing FGM' - this outlines what FGM is, the legislation and penalties involved and the help and support available. The statement is often referred to as a health passport, in that, if a woman or girl were to be taken abroad to undergo FGM, she could show this to people in her country of destination to show that FGM is illegal in the UK. This is also available in Amharic, Arabic, Farsi, French, Somali, Swahili, Tigrinyan, Turkish, Urdu and Welsh. Please contactFGMEnquiries@homeoffice.gov.uk if you would like printed copies of either document.

The following resources from other sources are also available:

From FORWARD:

Keeping Your Girls Safe From FGM - a pocket guide on safeguarding children during the summer holidays, which provides information on UK law, keeping girls safe whilst travelling abroad and professionals' statutory duty to report, as well as adding clarity for parents and guardians

FGM FAQs: A Campaigner's Guide for Young People - information for young FGM activists

Information, Services and Support Guide - a guide for young people who are interested in finding out more about FGM and the support services available

FGM and Islam - a leaflet developed by FORWARD, the Muslim Council of Britain and Muslim Spiritual Care Provision in the NHS. It clarifies that FGM is not a part of the Islamic religion

You can also:

16. Training

Education and training need to be provided for all health and social care professionals who may work with affected women and girls, or those at risk, and with their families. A focus on safeguarding is essential and it is also important to consider the issues of ethnicity, custom, culture and religion in a sensitive manner.

Local Safeguarding Partnerships are responsible for commissioning, monitoring and evaluating the effectiveness of the training, including multi-agency training, provided within their area to safeguard and promote the welfare of children. This is in line with their function to develop policies and procedures in relation to training of those persons who work with children or in services affecting the safety and welfare of children. Such policies and procedures may include specific training in relation to FGM. Further information can be found in the 'Working together to safeguard children' resource'.

It is recommended that FGM should be a part of all staff training on safeguarding. Any programme of training around FGM should include the following:

an overview of FGM (what it is, and when and where it may be performed)

the socio-cultural context, including the incorrect perception that FGM is a religious obligation

facts and figures

UK FGM and child protection law

medical complications

safeguarding children - the principles to follow when FGM is suspected or has been performed

the roles and responsibilities of staff

Professionals should receive training specific to their role. Below are some examples of the types of training available. Particular requirements will need to be assessed according to the professional sector.

Training from government and the NHS

Training from other sources

The information below has been provided by the organisations themselves. The Home Office has not observed the courses or their materials, so cannot provide assurance as to the content of the courses, and the listing of a course here does not represent an endorsement by the Home Office. Training from other organisations is available.

Birmingham and Solihull Women's Aid facilitates training on the issues of domestic violence, forced marriage and FGM for frontline professionals, schools and affected communities

Coventry University developed ' Petals ', the UK's first FGM web app, which gives advice on how to get support and deal with FGM. It can also be used by people who want to find out more about FGM and how it might affect them and others

The Dahlia Project, run by Manor Gardens Welfare Trust, is a North London-based project which provides training on FGM to health, social care and education professionals, as well as to students training in relevant professions. Training is delivered by a specialist FGM midwife and a community facilitator from an FGM-affected community, allowing participants to understand why FGM is practised, how it affects women and the role of professionals in preventing it

FORWARD provides an FGM Training Programme, an accredited and tailored developed training programme for professionals on FGM, and FGM awareness sessions for schools, as well as teacher training on FGM and how to respond to it appropriately

Freedom Charity provides training to staff teams and students at primary schools, secondary schools, universities and colleges, as well as public service professionals and community groups across England and Wales. Its provisions include:

a PSHE Association-accredited FGM/C lesson plan based upon the publication "Cut Flowers", a children's novel by Aneeta Prem

the Freedom Charity free phone App to provide secure advice and emergency contact for victims

the Red Triangle badge - a national symbol and campaign to raise awareness about FGM

IKWRO - Women's Rights Organisation provides training on all harmful practices including "honour"-based violence, forced marriage and FGM, to professionals, schools and affected communities

IMKAAN is a UK-based, Black feminist organisation and is the only national second-tier women's organisation dedicated to addressing violence against Black and minoritised women and girls i.e. women and girls who are defined in policy terms as Black and 'Minority Ethnic' (BME). As part of its Quality Assurance Framework, Imkaan has developed accredited quality standards and training for working with BME women and girls, and harmful practices, including FGM, forced marriage and "honour-based" violence

Integrate UK is a youth-led charity which works towards gender and racial equality. It provides FGM training to front-line professionals, such as teachers and medical professionals

Luton All Women's Centre deliver training and awareness raising sessions in schools, to teachers and other professionals

Oxford Against Cutting provides workshops and lessons on FGM and forced marriage to staff teams and students at primary schools, secondary schools, universities and colleges in Oxfordshire, Berkshire and Buckinghamshire, as well as professionals and community groups. This is mostly free of charge - email info@oxfordagainstcutting.org. All workshops are delivered by facilitators from affected communities

17. DVDs and videos

To reach communities the Home Office has produced a DVD which features interviews with health professionals, survivors, campaigners, religious leaders and the NSPCC. This DVD will help supported advocates within communities, such as community leaders, to run educational sessions on FGM in trusted environments and to start conversations on the issue. This film is 8 minutes long. Please contact FGMEnquiries@homeoffice.gov.uk if you would like a copy. It is also available online:
Ending Female Genital Mutilation
In this short film, a survivor of FGM describes her experiences. Please note that this film has some content which viewers may find distressing.

The NHS has produced this 5-minute film ' FGM is child abuse ' about what FGM is and where to find help if you or someone you know is at risk of it.

These short, powerful animated films were developed by the Royal College of Midwives (RCM) in collaboration with:

the Royal College of Obstetricians and Gynaecologists (RCOG)

the Royal College of General Practitioners (RCGP)

the Royal College of Nursing (RCN)

health visitors

survivors of FGM

non-governmental organisations

a variety of local community partners

They involved close working with survivors of FGM to ensure that the stories told through the animations remained true to the realities of surviving FGM. Two of the films focus on the role which men must play in ending FGM.

FORWARD has produced a number of films:

Uncomfortable conversations: A Letter to My Husband - this film explores the impact of FGM on women and the difficulty in having the 'uncomfortable conversation' around FGM in relationships. It was developed by FORWARD and AIDOS as part of the Building Bridges between Africa and Europe to tackle FGM/C project. (9 minutes)

The True Story of Ghati and Rhobi - the story of two girls resisting their community's practice of FGM. With the help of community elders, they change the way their community treats a girl's transition into womanhood by ending the practice. The film is also available in Swahili. (6 minutes)

My Body My Rules: FGM Animation - an animated film aimed at raising awareness of FGM amongst primary school aged children in the UK. It was developed by FORWARD and Animage Films. (4 minutes)

Needlecraft: FGM Animation - An animated film aimed at raising awareness of FGM amongst older audiences. Developed by FORWARD and Animage Films. Please note that this video contains some images which some viewers may find distressing. (4 minutes)

Think Again: The Film - this film follows a 12-year-old's struggle between family honour and the facts about FGM. On discovering that her mother wants to take her back home to be "cut" she explores the implications FGM has on her life and the misconceptions which explain why the practice persists in the 21st century. (8 minutes)

SafeHands have produced three short films which offer insight into reactions to FGM and can be used by facilitators working with young people in communities to highlight, inform and educate on FGM:

BBC Three has produced this film: 'Things Not To Say To FGM Survivors and Campaigners'.

The Kurdish and Middle Eastern Women's Organisation (KMEWO) has produced a DVD - "For honour and love" - which includes scenes about control in relationships ("Lost in translation"), female genital cutting ("The holiday"), forced marriages ("A family affair [part 1]") and "honour" killings ("A family affair [part 2]"). The DVD is supplied with a booklet, which provides a summary of the message of each scene, a number of discussion points for use with groups of young people, and suggestions for further discussion.

For copies, please contact KMEWO:

by telephone: (020 7263 1027 or 07748 851 125)

by email: info@kmewo.com or sawsan@kmewo.com

by post: Kurdish and Middle Eastern Women's Organisation (KMEWO), Caxton House, 129 St John's Way, London, N19 3RQ

The following two, longer, international films are also available:

See Section 13 for some further films designed specifically for schools.

18. Support organisations, helplines and clinics

Local FGM support services

To find FGM support near you, try the FGM help and advice postcode finder.

Helplines

NSPCC's FGM helpline: (see Section 8 for further details)

National honour-based abuse helpline, run by Karma Nirvana: 0800 5999 247

Clinics

This link provides details of the eight community-based National FGM Support Clinics, for adult women who are not pregnant. (See Section 12 for further information.)

Government services

The Home Office FGM Unit:

provides outreach support to local areas to support them in developing their local response to fighting FGM and to raise awareness of the unit

identifies and highlights examples of effective practice across local areas and professional groups

promotes (and provides on request) available FGM resources

provides a free e-learning course in FGM, which anybody can take: Recognising and preventing FGM

works with the police, Border Force, the Crown Prosecution Service and the College of Policing to improve the identification and prosecution of offenders

maintains an overview of all Government work to fight FGM and works closely with the voluntary and community sector, survivors and professionals to develop cross-cutting policies and processes.

If you are interested in receiving any outreach support or have any other queries, please email the FGM unit at fgmenquiries@homeoffice.gov.uk. Please note that the unit cannot deal with individual cases of FGM.

The Forced Marriage Unit is a joint Foreign and Commonwealth Office and Home Office unit which leads on the Government's forced marriage policy, outreach and casework. It operates both inside the UK, where support is provided to any individual, and overseas, where consular assistance is provided to British nationals, including dual nationals. The Forced Marriage Unit can also assist British nationals overseas who are at risk of FGM. The unit can be contacted on 020 7008 0151 (or, from overseas, 0044 20 7008 0151), or by emailing fmu@fco.gov.uk.

You can contact the Police.

Other organisations

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Female genital mutilation: resource pack

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This resource was developed in response to requests for clearer direction from central government about the safeguarding responsibilities of local authorities. It is designed to highlight examples from areas where effective practice has been identified and to emphasise what works in protecting survivors and those at risk of female genital mutilation (FGM).

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Guideline:

https://www.gov.uk/guidance/homelessness-code-of-guidance-for-local-authorities/overview-of-the-homelessness-legislation

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Obesity in adults: prevention and lifestyle weight management programmes

https://www.nice.org.uk/guidance/qs111

# data[].attributes.attachment_link.title
Overview | Obesity in adults: prevention and lifestyle weight management programmes | Quality standards | NICE

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This quality standard covers preventing adults (aged 18 and over) from becoming overweight or obese. It includes strategies to increase physical activity and promote a healthy diet in the local population. It also covers lifestyle weight management programmes for adults who are overweight or obese. It describes high-quality care in priority areas for improvement

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Obesity in adults: prevention and lifestyle weight management programmes

https://www.nice.org.uk/guidance/qs111

# data[].attributes.attachment_link.title
Overview | Obesity in adults: prevention and lifestyle weight management programmes | Quality standards | NICE

# data[].attributes.attachment_link.description
This quality standard covers preventing adults (aged 18 and over) from becoming overweight or obese. It includes strategies to increase physical activity and promote a healthy diet in the local population. It also covers lifestyle weight management programmes for adults who are overweight or obese. It describes high-quality care in priority areas for improvement

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https://www.nice.org.uk/guidance/ng209

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How social housing is allocated?

Main points:

social housing wait list is 1.29 million in march 2023

150,000 children are in temporary accommodation/ homeless

Ideas including:!

Non UK nationals become eligible following 10 years of lawful residence

Local connection test, income test and anti-social behaviour ASB, that councils should run

66% did not agree with the connection test as it discriminates against certain groups with protected characteristics

Link- https://www.gov.uk/government/consultations/consultation-on-reforms-to-social-housing-allocations/outcome/government-response-to-the-consultation-on-changes-to-social-housing-allocation-tests

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https://www.nice.org.uk/guidance/ng246

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https://www.gov.uk/government/collections/e-cigarettes-and-vaping-policy-regulation-and-guidance

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https://www.gov.uk/government/publications/towards-a-smoke-free-generation-tobacco-control-plan-for-england

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SUICIDE PREVENTION

https://commonslibrary.parliament.uk/research-briefings/cbp-8221/

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Evidence on the impact of e-cigarettes, information on government policy and regulation, and guidance for organisations on vaping policies. Source: GOV.UK https://search.app/qjTzWRz5i7b9ZDbs6

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Indoor air quality at home

NICE guideline [NG149]

https://www.nice.org.uk/guidance/ng149/chapter/Recommendations

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1.1.2

Ensure the strategy or plan takes account of the housing conditions that put people at increased risk of exposure to poor indoor air quality and especially people who are particularly vulnerable to ill health as a result of such exposure (see box 1).

1.1.4

Encourage joint working between local authority departments, across different local authorities, with local health and social care providers, and with voluntary, community and social enterprise organisations and other organisations with interest in indoor air quality, to improve air quality in people's homes (see the sections on raising awareness of poor indoor air quality in the home and advice and information for the general population).

1.2.1

Develop a structured process so that health and social care professionals and housing and local authority staff can use existing referral pathways to help people request a housing assessment if poor indoor air quality has been identified or is suspected, for example, by using the housing condition factors in box 1.

1.3.1

Use existing communication strategies to ensure members of the public and relevant professionals (those involved in planning, designing, building, renovating and maintaining homes) are aware of:

the causes of poor indoor air quality

how residents' activities can affect indoor air quality

how health is affected by poor indoor air quality

who is particularly vulnerable (see box 1)

how to prevent or reduce poor indoor air quality.

1.3.2

Use existing professional development opportunities to ensure local authority staff who visit people in their homes (such as housing, healthcare and social care professionals):

1.4.1

Advise people on how to reduce damp and condensation and prevent mould. For example, by:

using background ventilation (such as trickle vents, or whole-house mechanical ventilation systems)

using mechanical ventilation (such as extractor fans), and opening windows where possible and safe to provide temporary increased ventilation

avoiding moisture-producing activities (such as air-drying clothes) indoors if possible, or improving ventilation if these cannot be avoided

repairing sources of water damage and ensuring that residual moisture is removed.

1.4.3

Tell people that the following activities may lead to poor indoor air quality and that they should think about increasing ventilation (by using extractor fans in the bathroom or kitchen, or opening windows if possible and safe):

using cookers, especially gas cookers

using open solid-fuel fires

using candles

using free-standing gas heaters

using cleaning products, household sprays or aerosols and paints

having a bath or shower

air-drying clothes in the home.

1.4.4

Advise private and social tenants to contact their landlord if:

ventilation is not adequate (for example, if the ventilation system is not working, trickle vents are blocked or damaged, extractor fans in the kitchen or bathroom are not working, or if excessive noise from the fans discourages their use)

repairs are needed to prevent water from entering their building

improvements to heating or insulation are needed to prevent condensation.

1.5.3

Advise people whose asthma is triggered by household sprays, air fresheners or aerosols to:

1.5.4

Advise people who are allergic to house dust mites how to reduce their exposure to them. This includes:

avoiding second-hand mattresses if possible

using allergen barriers such as mattress and pillow covers

washing bedding regularly.

1.5.6

Advise women who are pregnant that they are at increased risk of ill health from exposure to poor indoor air quality. Advise people who care for babies under 12 months old that the baby is at increased risk. Both groups should:

reduce their use of household sprays, air fresheners and other aerosols, and always follow product instructions

if possible, avoid or reduce activities that produce particulate matter such as using open solid-fuel fires or candles

always keep the room well ventilated during these activities.

See also recommendations 1.4.3, 1.4.4, 1.4.6 and 1.4.8.

1.7.1

Consider specifying building materials and products that only emit a low level of formaldehyde and VOCs. Use existing labelling schemes or other available information on product emissions (for example, on product labels) to make these specifications.

1.7.4

Ensure design strategies include provision for removing indoor air pollutants, for example by:

1.7.5

Design ventilation systems to reduce or avoid exposure to outdoor air pollution. For example:

ensure windows that open face away from sources of outdoor air pollution, such as busy roads

fit mechanical systems with filtration to protect against outdoor pollutants. (Also see the government clean air strategy 2019.)

1.7.6

When building dwellings or refurbishing them to improve thermal performance, ensure there is permanent, effective ventilation.

1.8.5

Ensure any variations to the heating and ventilation specification comply with design specifications and building regulations (see the Ministry of Housing, Communities and Local Government's advice on ventilation).

1.9.1

Use existing regulatory powers to:

1.9.2

Where a housing assessment has identified problems in private or public rented housing that may contribute to poor indoor air quality, ensure the property has:

1.9.3

Where a housing assessment has identified water damage in private or public rented housing, ensure that any water damage is repaired as soon as possible and the property has properly dried out.

1.9.4

Advise property managers and landlords to:

develop and undertake maintenance programmes for heating and ventilation systems

provide clear, easy-to-understand instructions telling residents how to use the heating and ventilation systems effectively.

1.9.5

Advise property managers and landlords about:

the health risks associated with poor indoor air quality

methods to control and minimise identified sources of indoor air pollution (see the section for architects and designers)

their responsibilities for maintaining the property.

1.9.6

Advise property managers and landlords to:

use low-pollutant-emission items when replacing furniture or flooring (for example, furniture or flooring with a low formaldehyde content and emission)

ensure rooms are well ventilated and that the manufacturer's guidelines for use of materials are followed

ensure there is adequate ventilation provision before installing a new cooker (especially a gas cooker).

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This guideline covers indoor air quality in residential buildings. It aims to raise awareness of the importance of good air quality in people's homes and how to achieve this

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https://www.nice.org.uk/guidance/ng214

Integrated health and social care for people experiencing homelessness

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Tobacco: preventing uptake, promoting quitting and treating dependence

Link:

https://www.nice.org.uk/guidance/ng209

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Tobacco: Preventing uptake, promoting quitting and treating dependence; 2021, updated 2023

LINK: Https://www.nice.org.uk/guidance/ng209

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Policy paper:

Smoke free generation: tobacco control plan for England (2020)

Main objectives:

To reduce the number of 15 year olds who regularly smoke from 8% to 3% or less.

Reduce smoking among adults in England from 15.5% to 12% or less.

Reduce the inequality gap in smoking prevalence, between those in routine and manual occupations and the general population.

Reduce the prevalence of smoking in pregnancy from 10.7% to 6% or less.

Link:

https://www.gov.uk/government/publications/towards-a-smoke-free-generation-tobacco-control-plan-for-England

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smoking and vaping

https://www.nice.org.uk/guidance/ng209/chapter/recommendations-on-treating-tobacco-dependence#supporting-people-who-do-not-want-or-are-not-ready-to-stop-smoking-in-one-go-to-reduce-their-harm

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1.11.5

If someone does not want, or is not ready, to stop smoking in one go:

find out about the person's smoking behaviour and level of nicotine dependence by asking how many cigarettes they smoke - and how soon after waking

make sure they understand that stopping smoking reduces the risks of developing smoking-related illnesses or worsening conditions affected by smoking

ask them to think about adopting a harm-reduction approach (see the section on supporting people who do not want, or are not ready, to stop smoking in one go)

encourage them to seek help to stop smoking completely in the future

leave the offer of help open and offer support again the next time they are in contact. [2013]

1.12.1

Tell people who smoke that a range of interventions is available to help them stop smoking. Explain how to access them and refer people to stop-smoking support if appropriate. [2021]

1.12.2

Ensure the following are accessible to adults who smoke:

1.12.3

Consider NRT for young people aged 12 and over who are smoking and dependent on tobacco. If this is prescribed, offer it with behavioural support. [2018]

1.12.4

Do not offer varenicline or bupropion to people under 18. [2013]

1.12.5

Offer behavioural support to people who smoke regardless of which option they choose to help them stop smoking, unless they have chosen the Allen Carr Easyway in-person group seminar. Explain how to access this support. [2021, amended 2022]

1.12.6

Discuss with people which options to use to stop smoking, taking into account:

1.12.7

Advise people (as appropriate for their age) that the following options, when combined with behavioural support, are more likely to result in them successfully stopping smoking:

1.12.9

For adults, prescribe or provide bupropion, varenicline or NRT before they stop smoking:

For bupropion agree a quit date set within the first 2 weeks of treatment, reassess the person shortly before the prescription ends.

For varenicline agree a quit date and start the treatment 1 to 2 weeks before this date, reassess the person shortly before the prescription ends.

For NRT agree a quit date and ensure the person has NRT ready to start the day before the quit date.

In August 2022, varenicline was unavailable in the UK. See the MHRA alert on varenicline. [2018]

1.12.11

Explain how to use medicinally licensed nicotine-containing products correctly. This includes ensuring people know how to achieve a high enough dose to:

1.12.14

Advise adults how to use nicotine-containing e‑cigarettes. This includes explaining that:

e‑cigarettes are not licensed medicines but are regulated by the Tobacco and Related Products Regulations (2016)

there is not enough evidence to know whether there are long-term harms from e‑cigarette use

use of e‑cigarettes is likely to be substantially less harmful than smoking

any smoking is harmful, so people using e‑cigarettes should stop smoking tobacco completely. [2021]

1.12.15

Discuss:

how long the person intends to use nicotine-containing e‑cigarettes for

using them for long enough to prevent a return to smoking and

how to stop using them when they are ready to do so. [2021]

1.13.1

For people who want to stop smoking:

1.14.1

Give people information about the smokefree policy before their appointment, procedure or hospital stay. This should cover:

the short- and long-term health benefits of stopping smoking at any time; for example, stopping smoking at any time before surgery has no ill effects (although people may experience short-term withdrawal symptoms such as headaches or irritability from quitting), and people who stop in the 8 weeks before surgery can benefit significantly

the risks of secondhand smoke

the fact that all buildings and grounds are smokefree so they must not smoke while admitted to, using or visiting these services (see the section on policy)

the types of support available to help them stop smoking completely or temporarily before, during and after an admission or appointment (see the sections on behavioural support in acute and mental health services and supporting people who have to stop smoking temporarily)

about the different pharmacotherapies that can help with stopping smoking and temporary abstinence, where to obtain them (including from GPs) and how to use them. [2013, amended 2021]

1.14.20

For those who need to abstain temporarily to use acute and mental health services:

tell them about the different types of medicinally licensed nicotine-containing products and how to use them and

encourage the use of medicinally licensed nicotine-containing products to help them abstain and, if possible, prescribe them. [2013]

1.14.22

Offer behavioural support to people who want or need to abstain from smoking temporarily in all settings, including closed institutions for example. Support could include:

1.14.29

For staff in secondary care and closed institutions who do not want, or are not ready, to stop smoking in one go:

1.15.4

Reassure people who smoke that medicinally licensed nicotine-containing products are a safe, effective way to reduce the amount they smoke or to cut down before stopping. Also:

advise them that these products can be used as a complete or partial substitute for tobacco, either in the short or long term

explain that using these products also helps avoid compensatory smoking and increases their chances of stopping in the longer term

reassure them that it is better to use these products and reduce the amount they smoke than to continue smoking at their current level. [2013]

1.16.12

Collect and analyse data on the use of smokeless tobacco among local South Asian communities. For example, collect data from local South Asian voluntary and community organisations, dental health professionals and primary and secondary care services. This data should provide information on:

prevalence and incidence of smokeless tobacco use and detail on the people who use it (for example, their age, family origin, gender, language, religion, disability status and socioeconomic status)

people who use smokeless tobacco and do not use cessation services

types of smokeless tobacco used

perceived level of health risk associated with these products

circumstances in which these products are used locally

proportion and demographics of people who both smoke and use smokeless tobacco products. [2012]

1.16.16

Work with local South Asian communities to plan, design, coordinate, implement and publicise activities to help them stop using smokeless tobacco:

1.16.19

Provide services for South Asian users of smokeless tobacco either within existing stop-smoking support or, for example, as:

1.16.23

Ensure smokeless tobacco cessation services take into account the needs of people:

from different local South Asian communities (for example, by using staff with relevant language skills or translators, or by providing translated materials or resources in a non-written format)

who may be particularly concerned about confidentiality

who may not realise smokeless tobacco is harmful

who may not know help is available

who may find it difficult to use existing local services because of their social circumstances, gender, language, culture or lifestyle. [2012]

# data[].attributes.attachment_link.title
Recommendations on treating tobacco dependence | Tobacco: preventing uptake, promoting quitting and treating dependence | Guidance | NICE

# data[].attributes.attachment_link.description
This guideline covers support to stop smoking for everyone aged 12 and over, and help to reduce people’s harm from smoking if they are not ready to stop in one go. It also covers ways to prevent children, young people and young adults aged 24 and under from taking up smoking. The guideline brings together and updates all NICE’s previous guidelines on using tobacco, including smokeless tobacco. It covers nicotine replacement therapy and e-cigarettes to help people stop smoking or reduce their harm from smoking. It does not cover using tobacco products such as ‘heat not burn’ tobacco