Case study

CLeaR assessment: Durham County Council tobacco control

Information about the self-assessment and peer review process undertaken by Durham County Council to review their tobacco control measures.

Durham county council pick up their CLeaR award

Durham county council pick up their CLeaR award.


In the UK, diseases linked to smoking account for 64% of premature deaths in people under 65.

In England, the estimated cost to the public of smoking is £13.8 billion per year in terms of lost output.

County Durham has an estimated 91,937 people who smoke within its boundaries. The estimated cost to society of smoking in Durham is £124.4 million a year.

Durham County Council have put together a 5 year action plan to combat the effects of tobacco in their area between 2013 and 2017.

CleaR assessment

To help monitor and discover how individual components of their tobacco control plan was working, Durham agreed to assess their services using the CLeaR assessment programme in 2014.

This assessment allows local public health organisations to rate their own tobacco services. Action on Smoking and Health (ASH) developed the assessment with various public health partners.

What was involved

The first step for Durham’s tobacco control alliance partners was to work together to complete a tobacco control self-assessment.

This allowed them to analyse where they thought they were doing well and where they were struggling with tobacco control in their boundaries.

Dianne Woodall, Public Health Portfolio Lead for Tobacco Control, Durham County Council, said:

Completing the self-assessment was an interesting process which helped the alliance not only to identify our strengths, it also gave us an opportunity to discuss, debate and formally record aspects we felt we needed to improve our approach and delivery.

These aspects were then used as part of structuring the peer assessment to help us achieve the desired outcomes from partners and partner organisations.

Following the self-assessment, Durham decided to request a peer assessment. This would let fresh eyes look at their tobacco control plans and offer an unbiased assessment of their own.

Durham submitted a portfolio of evidence setting out their strategy and tobacco control measures, before receiving a team of CLeaR assessors for a day.

Peer assessment

In March 2015 a CLeaR team visited Durham to undertake the peer assessment. The team was made up of 6 people from 5 different organisations, including 2 from Public Health England.

The peer assessment day was divided into 2 parts:

  1. presentations to assessors by tobacco control partners
  2. interviews with important organisations and feedback


The morning session consisted of a series of presentations for the CLeaR team, which included:

  • a welcome session explaining CLeaR
  • vision and leadership presentations by lead members, officers and the Director of Public Health
  • a partnership health check


The afternoon session was made up of small interview sessions, with the CLeaR team talking directly to:

  • marketing and communications
  • trading standards and environmental health
  • stop smoking services, including maternity services

CLeaR results

The peer assessors used the results of their findings to put together a full report detailing the strengths and weaknesses of Durham’s strategy and action plan.

What’s working well

Durham’s strengths in tobacco control include:

  • well maintained leadership and funding for local and regional tobacco control
  • commitment to tackling smoking related inequalities
  • commitment to tackling smoking in mental health services
  • reductions in smoking in pregnancy through the Baby Clear programme
  • high quality local stop smoking services

What could be better

The CLeaR assessment also set out areas where Durham’s tobacco control plans could make changes:

  • adult prevalence rates are falling, but trend data on prevalence for routine and manual smokers is less clear

  • build up clinical leadership and engagement to be more effective champions of tobacco control across acute sector and with Clinical Commissioning Groups (CCGs)

  • opportunities to engage further with health visitors, midwives and dental health teams to keep children and families smoke free

  • extend prevention work on smoke free playgrounds to include sports grounds

Next steps

Councillor Audrey Laing, Support Cabinet Member and Chair of Tobacco Alliance, Durham County council, said:

The peer assessment took place in 2015 and was a very positive experience for all involved.

The report has since been shared with the Health and Wellbeing Board and has resulted in more partner engagement.

It has also helped the alliance review and shape the tobacco alliance action plan for 2015 to 2016.

Further information

Public Health England provides support and training for local public health organisations to undertake the assessment. Please contact for more information.

Published 15 September 2015