Stepping up Stop Smoking Services

Smoking is the main cause of differences in life expectancy between rich and poor in Wales (as in the UK as a whole), and costs the NHS an estimated £386 million a year, about 7% of the NHS budget. With this kind of impact on people’s lives and the NHS, the Welsh Government aims to reduce the proportion of people in Wales who smoke from the current 23% to just 16% by 2020.  This is equivalent to more than 15,000 people quitting each year for the next 10 years.

Given that only about 3% of all attempts to quit are usually successful, achieving this target will not only require a sea-change in people’s behaviour, but also a transformation of services to help people to quit.  A seminar in Cardiff yesterday heard from some leading figures in smoking cessation, from Wales and England, about what can be done. 

Four themes emerged from the presentations, which included sessions on smoking cessation in primary care, hospital-based services, community services and cessation support for pregnant women as well as a comparison between Wales and England.  These were:

1.    Services must meet the needs of the user

One of the most powerful messages was that ‘one size doesn’t fit all’ when it comes to help to quit smoking.  Lone parents with three children and very little money simply can’t get to regular stop smoking groups held several miles away. Elderly smokers with other health conditions living in rural Wales can’t get to stop smoking sessions held 15 miles away.  And young professionals wanting to kick the habit don’t want to take an afternoon off work to sit with a lot of wheezy older people in a church hall.  While the mantra wasn’t quite ‘choice, choice, choice’ there was definitely a recognition that there needed to be a wide variety of ways of getting help to quit.  

2.    Services need to be seamless

Easy to say but apparently much harder to do, it was clear that services are not joined up with smokers wanting to quit shuttling between GP, Stop Smoking Wales, hospital services and all too often falling down the gap.  And with every gap in the service the chances of a quit attempt failing increases, so the message was clear – build the bridges and make them strong.

3.    Engage health professionals

GPs, midwives and other health professionals have a critical role to play in helping people to quit, yet many do not see smoking cessation as a core part of their work. They may refer patients who smoke to other services, but too often help to quit is seen as somebody else’s job, which usually means nobody’s job.  Specialist midwife Lisa Fendall told us how the quit rates amongst pregnant women had soared when midwives visited women’s homes, armed with a baby doll to show the effect of smoking and a CO monitor for the mum-to-be.  GPs and midwives in Wales can and must do more.

4.    Change the approach to treatment

Smoking is still seen as a life-style choice not an addiction that needs treatment.  Gay Sutherland described the importance of immediate treatment to help smokers to quit, and argued that just as a health professional would be assertive in outlining the risks of not treating, say, diabetes so he or she should be pro-active in helping smokers to end their dependence on nicotine.  Immediate offers of medication or nicotine replacement therapy and support should be given rather than simply referring patients on to someone else – and this is backed by sound evidence.

Dr Peter Bradley of Public Health Wales reminded us that the downward trend in smoking prevalence has paused, which brings the opportunity to do something different.  On the basis on the evidence at the seminar, let’s hope that he does.

Victoria Winckler is Director of the Bevan Foundation. A full conference report will be published soon.