Considerable scope for improving how local areas tackle smoking

Source: NHE Mar/ Apr 17

Amanda Sandford, information manager at Action on Smoking and Health (ASH), discusses the need to strengthen local relationships in tackling smoking.

Few will dispute the fact that the NHS and social care services are in crisis mode. Whilst there is no single solution, what is clear is that with an ageing population the pressures on the NHS and social care are certain to increase. 

Several reviews have already pointed to the need to focus more on preventing ill health to relieve the strain on our beloved NHS. In October 2014, NHS England published its Five Year Forward View which noted that without further annual efficiencies and real-term funding increases, there would be a “mismatch between resources and patient needs of nearly £30bn a year by 2020-21”. The report went on to recommend “a radical upgrade in prevention and public health”. 

Meanwhile, a King’s Fund report estimated that even after additional government funding, there remains a predicted shortfall of more than £20bn by 2020. This funding gap is highly unlikely to be closed by efficiency savings alone, so radical action is needed to improve public health through preventative strategies if the NHS is not to suffer a continuing and progressively more damaging funding crisis.  

Tackling smoking must be a priority. Smoking remains the single largest cause of preventable premature death. Across the UK, smoking is responsible for nearly 100,000 deaths a year. And for every death it’s estimated that about 20 smokers will be suffering a smoking-related disease. The costs of smoking to society are huge: in England alone, the burden on the NHS is approximately £2bn a year, while the cost to society as a whole is estimated to be £14.2bn – about £5bn more than the government receives in tax on tobacco products. 

The good news is that there is strong evidence of the cost-effectiveness of interventions to reduce smoking, particularly the stop smoking services that were established across England in 2001. The specialist services, together with stop smoking medication, saves the government more money than they cost because of their healthcare and economic benefits.  NICE has estimated that for every £1 invested, £2.37 will be saved on treating smoking-related disease and lost productivity. What’s more, an independent review found that the services have been successful in reaching smokers in lower socioeconomic groups amongst whom smoking rates are higher than average.     

Difficult decisions 

However, faced with central government funding cuts, local authorities and CCGs are having to make difficult decisions regarding the prioritising of public health services. ASH research found that almost three out of five councils cut their smoking cessation budgets last year. Additionally, a number of CCGs are now refusing to fund the prescription of nicotine replacement therapy and other pharmacotherapies by GPs.  

Some cuts have been justified on the grounds that they are focusing more on those most in need, such as pregnant women who smoke. Whilst it’s important that women do receive support to quit when pregnant, it is a false economy to restrict stop smoking support to just this group. Smokers who are given professional support in addition to pharmacotherapies are up to four times more likely to quit as those attempting to quit unaided.   

For tobacco control to work effectively at local level, there needs to be a close relationship between local authorities and the trusts and CCGs in their area.  A survey of local tobacco control leads, by ASH and Cancer Research UK, found that some parts of the NHS are more engaged in tobacco control than others. In particular, relationships with GPs and CCGs were not as strong as their potential contributions to tobacco control warrant. Other research by the British Thoracic Society found that smoking cessation in secondary care was “woefully short” of national standards, with regards to helping people to stop smoking and enforcing smoke free premises. This suggests that there is considerable scope for improved communication and co-operative working between NHS bodies and local authorities to tackle smoking.   

As long as smoking continues to cause thousands of deaths and poor quality of life, it should be treated as a ‘vital sign’, not only clinically for individual patients but as an overall indicator of NHS sustainability.

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