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Doctors call for a ‘radical change’ to the way NHS treats smoking

Cessation services should be a routine part of hospital care

Jo Carlowe

Tuesday, 26 June 2018

A major new report released today by the Royal College of Physicians calls for a "radical change" in the way the NHS treats smoking.

The report Hiding in plain sight: Treating tobacco dependency in the NHS, from the RCP’s Tobacco Advisory Group, suggests cessation services should be provided as an opt-out service as a routine component of all hospital care.

Not only will giving smokers the help they need to quit save lives, argue the experts, but it will help reduce the current £1 billion per year cost to the NHS of smoking by patients and staff.

Treating tobacco dependency is not just about preventing disease: in many cases it represents effective disease treatment, states the report, adding: “Clinicians working in all areas of medicine can improve their patients’ lives by helping them to quit.”

Current models of delivering stop smoking services separately from mainstream NHS services, while successful in the past, may now not be the best approach because the patient has to seek help themselves, the report argues.

In addition it highlights the fact that most health professionals receive little or no training in treating smokers, and that the NHS does not collect data on smoking treatment delivery, or have a payment tariff for treating tobacco dependency.

Smoking treatment also tends to be squeezed out, even in the management of diseases caused by smoking, by other, less cost-effective interventions, the report states.

To address these issues, the report recommends:

  • Smoking cessation treatments should be prioritised as a core NHS activity
  • Smoking cessation should be incorporated as a systematic and opt-out component of all NHS services, and delivered in smoke-free settings
  • As systematic identification of smokers and delivering cessation support doubles quit rates, health service commissioners should ensure that smokers are identified and receive cost-effective smoking interventions
  • We should allow e-cigarettes to be used on NHS sites to support smokers to remain smoke-free and help to sustain smoke-free policies
  • Legislation requiring hospitals to implement completely smoke-free grounds should be introduced, as the current guidance isn’t being implemented
  • Training in smoking cessation should be introduced into all undergraduate and postgraduate healthcare professional training curricula and as mandatory training for the entire NHS healthcare professional workforce.
Professor John Britton, chair of the RCP’s Tobacco Advisory Group and lead editor of the report, said: “Treating the more than one million smokers who are admitted to hospitals every year represents a unique opportunity for the NHS to improve patients’ lives, while also saving money. For too long the NHS has failed to take responsibility for smoking, while prioritising other, less effective activity. Smoking, the biggest avoidable cause of death and disability in the UK, is hiding in plain sight in our hospitals and other NHS services; the NHS must end the neglect of this huge opportunity to improve our nation’s health.”

Dr Sanjay Agrawal, consultant in respiratory and intensive care medicine, University Hospitals of Leicester NHS Trust and a member of the RCP Tobacco Advisory Group, described it as an "open goal" for the NHS.

“We can save lives and save money by applying simple effective treatments in the same way that we do for millions of other patients - these treatments are very low cost. The changes would be pretty straightforward to make and we would start reaping the benefits in the first year, taking some of the strain off the NHS. The changes we have recommended have been tried and tested in the UK and Canada and have made a significant impact, so it’s time to apply this approach across the NHS.”

Responding to today’s report, Professor Dame Parveen Kumar, British Medical Association board of science chair, said: “While rates of tobacco use continue to decline, almost one in six adults still smoke, and smoking remains the leading cause of premature death in the UK, so it’s imperative those who want stop smoking feel fully supported by adequately funded, targeted smoking cessation services

“Patients in hospitals often receive advice and support to quit smoking but we must improve training and resources for health workers to ensure this becomes a routine part of caring for all smokers seeking NHS services, particularly people with long-term conditions and mental health problems.”

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