Smoking remains one of the biggest killers in this country. 64,000 people die from smoking related illnesses in England every year and it’s estimated that for every person who dies due to a smoking related illness, there are another 30 who will suffer from serious smoking related diseases. While smoking is most commonly associated with lung cancer, it can also cause 15 other cancers and over 100 other diseases. This means that 2 out of every 3 smokers will die due to a smoking related disease.

Tackling smoking remains the leading modifiable cause of health inequalities.

Tobacco dependence treatment is effective and improves the health and wellbeing of the person smoking and their family, as well as saving them money.  Helping people tackle their tobacco dependence is a key component of the NHS Long Term Plan and forms the NHS’s contribution to wider government action to deliver the 2030 ambition for a smoke free generation.

Smoking and hospital stays

Being in hospital is a significant event in someone’s life and people can be more open to making healthier choices. The Long Term Plan commits to providing NHS funded tobacco dependency treatment to all inpatients who smoke, with everyone admitted overnight being able to access services by the end of 2023/24.

To support roll-out we are working with the British Thoracic Society and Action for Smoking and Health (ASH) to provide additional support.

• British Thoracic Society webpages
• ASH Long Term Plan focused webpages

More resources are also available for systems implementing services on the NHS Prevention Programme NHS Futures platform (you will have to request to join, but access will be given normally within 2 working days)

• NHS Prevention Programme NHS Future’s webpages

Smoking and pregnancy

Smoking is also the single greatest modifiable risk factor for poor outcomes in pregnancy, with nearly 1 in 10 women still smoking when their baby is born. The harms associated with smoking relate not only to the mother but also to the unborn child, where we see a doubling of the likelihood of stillbirth and tripling of the likelihood of sudden infant death. We also see smoking rates concentrated among pregnant women from poorer backgrounds, with women from the poorest 10% of the population six times more likely to smoke than those from the most affluent 10%. This is why we are rolling out a separate offer for all pregnant women who smoke, allowing them to access treatment while in direct contact with maternity services. This will be rolled out to every maternity service by the end of 2023/24.

One of the most important actions a woman who smokes can take to reduce the risk of poor pregnancy outcomes is to stop smoking. The Saving Babies’ Lives Care Bundle’ (SBLCB) is an evidence based best practice guide, for providers and commissioners of maternity care across England to help pregnant women stop smoking and reduce perinatal mortality rates.  The newest version builds on previous guides to ensure services are engaging with mothers so they can access support available to them, throughout their pregnancy, to help them quit smoking.

Tobacco treatment services are being rolled out across a range of NHS settings. The following films show how the Phoenix Team at the Kings Mill hospital, which is part of the Sherwood Forest Hospitals NHS Foundations Trust, developed its service to assist pregnant women to get the real time support to quit.

Saving Babies Lives – Kings Mill Hospital

Heidi and Misha – operational for NHS HCP

Case study with Phoenix team lead, mum and baby

Smoking and mental health

People with serious mental illness experience a disproportionate impact from smoking. While standard tobacco dependency treatment can be effective in supporting people with a severe mental illness to quit, there is evidence that a bespoke service can be more effective. The third Long Term Plan commitment for tobacco is therefore focussed on ensuring tobacco dependency treatment services are available to people with a severe mental illness in the community.

To support implementation, we have commissioned a national quality improvement programme, Quality Improvement in Tobacco Treatment (QuITT), working specifically with mental health trusts to support them to successfully embed a treatment programme for their patients who want support to stop smoking. This process will put patients and staff at the heart of service design and delivery, securing clinical and senior leadership endorsement for tobacco dependency services within these settings.

Plans are underway to mobilise community mental health tobacco services from 2023/24, with the first new early implementer sites starting delivery this year.

Further resources