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Innovation in Medicine 2018: Providing smoking cessation for patients in hospitals will save lives and money

A major new report released today by the Royal College of Physicians (RCP) calls for a radical change in the way the NHS treats smoking, by providing opt-out cessation services as a routine component of all hospital care.

The report, Hiding in plain sight: Treating tobacco dependency in the NHS, says that giving smokers the help they need to quit smoking while in hospital will save lives, improve quality of life as well as increasing life expectancy, and help to reduce the current £1 billion per year cost to the NHS of smoking by patients and staff. 

It also argues that:

  • Treating tobacco dependency is not just about preventing disease: in many cases it represents effective disease treatment. 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
  • Most health professionals receive little or no training in treating smokers
  • 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.

Key recommendations

To address all these issues, the report recommends:

  • As smoking cessation treatments save money for the NHS, in the short as well as the long term, they should be prioritised as a core NHS activity.
  • Smoking cessation should be incorporated, as a priority, as a systematic and opt-out component of all NHS services as a complement to local authority services, and delivered in smoke-free settings. It is unethical to do otherwise.
  • 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 – failing to do so is as negligent as not treating cancer.
  • 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, said:

This is 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.

Notes to editors

Professor Britton and Dr Agrawal and will be available for pre-interview (they work in Nottingham and Leicester respectively) and and live interviews in London on the day of release, Tuesday 26 June.  For further information and to arrange interviews please contact RCP head of PR and public affairs Linda Cuthbertson by phone on 020 3075 1254 / 07748 777919 or email at linda.cuthbertson@rcplondon.ac.uk.

Cost-effectiveness of smoking cessation compared to treatment of related diseases

The median incremental cost-effectiveness ratios (ICERs) of smoking cessation interventions and of COPD, statin and other CVD treatments were £634, £16,228, £11,103 and £7,556, respectively. Only one COPD and three CVD base case estimates had ICERs lower than the median for smoking cessation interventions, indicating that smoking cessation interventions are not only cost-effective in their own right, but especially so in relation to routine therapies for diseases caused or exacerbated by smoking that clinicians prioritise over smoking cessation.