Royal colleges urge NHS England to ensure tobacco dependence treatment for every smoker

Presidents of the medical royal colleges, the chair of council of the RCGP, and over 800 doctors, health professionals and academics are calling on NHS England to ensure that tobacco dependence treatment is provided for every smoker cared for by the NHS, as part of the long-term plan.

In a letter to NHS England’s chief executive Simon Stevens, published in the BMJ today, they point out that treatment for tobacco dependency is one of the most cost-effective healthcare interventions, with the potential to produce substantial in-year savings by reducing demand on the NHS.

Professor Andrew Goddard, President of the Royal College of Physicians (RCP), said:

It is vital that tobacco dependence treatment for all smokers is part of the NHS long-term plan if we are to ensure the sustainability of the NHS and the wider social care system.

It is vital that tobacco dependence treatment for all smokers is part of the NHS long-term plan if we are to ensure the sustainability of the NHS and the wider social care system

Professor Andrew Goddard, president of the RCP

Professor Wendy Burn, president of the Royal College of Psychiatrists (RCPsych) said:

Smoking rates are much higher among those with mental illness compared to the rest of the population. Therefore, it is crucial as part of meeting the government’s commitment to parity for mental health that there are effective and comprehensive treatment services in place to meet their needs.

Professor Lesley Regan, president of the Royal College of Obstetricians and Gynaecologists (RCOG) said:

Pregnancy is a significant opportunity to help women stop smoking, so improving the health of the mother, her baby and the wider family that she influences. Reducing smoking rates is also key to achieving the Government’s goal of halving stillbirth and neonatal deaths by 2025. The NHS needs to ensure all pregnant smokers have access to evidence based support that will help them stop.

We know that smoking can lead to many serious, long-term health conditions that present in general practice on a daily basis, and cost the NHS billions of pounds a year

Professor Helen Stokes-Lampard, chair of the Royal College of GPs

Professor Russell Viner, president of the Royal College of Paediatrics and Child Health (RCPCH), said:

Rates of infant mortality in England already lag behind other comparative wealthy nations and if the status quo remains, they are predicted to rise to 140% higher than comparable wealthy nations by 2030. Maternal smoking is one of the leading modifiable risk factors for infant mortality, so if we are to eliminate this disparity we need to do much more to support mothers, and other family members, to quit smoking.

Professor Helen Stokes-Lampard, chair of the Royal College of GPs, said:

We know that smoking can lead to many serious, long-term health conditions that present in general practice on a daily basis, and cost the NHS billions of pounds a year. We also know that smoking cessation services can help to reduce our patients’ dependence on smoking, so it’s important that this is reflected in the forthcoming NHS long-term plan, in the best interests of our patients’ long-term health and wellbeing, and the NHS as a whole.

Notes to editors

FULL TEXT OF LETTER

Dear Simon

Government’s ambition for a 5-year improvement in disability free life expectancy by 2035 [1] is one we can all share, but if it is to be achieved the NHS has to ensure that tobacco dependence treatment is provided for every smoker cared for by the NHS.

Smoking is the leading cause of years of life lost in the UK, [2] responsible for half the difference in life expectancy between richest and poorest [3]. Smokers lose on average 10 years of life [4], and for every death caused by smoking it is estimated that another twenty people are suffering from serious illnesses attributable to smoking [5]. Smoking can also end life before it has even begun, with maternal smoking one of the leading modifiable risks for infant mortality in the UK [6].

Treatment for tobacco dependency is one of the most cost-effective healthcare interventions, with the potential to produce substantial in year savings by reducing demand on the NHS [7]. For example, smokers are five times more likely to get influenza, a major contributor to winter pressures, [7] and babies of mothers who smoke are more likely to be born prematurely, and to require emergency or sustained healthcare [6]. Stopping smoking improves life expectancy and quality of life for every patient, from cancer to cardiovascular and respiratory disease, through maternity to mental health, yet tobacco dependence treatment is not offered as a matter of course to all smokers accessing healthcare.

Health Ministers have made clear their support for the RCP proposals [8] [9]. NHS England must now ensure that treatment for tobacco dependence is integral to the long-term plan. This is vital not just for the health and wellbeing of individual smokers and their families, but also for the sustainability of the NHS and the wider social care system.

Yours sincerely

Professor Andrew Goddard, president of the Royal College of Physicians; Professor Wendy Burn, president of the Royal College of Psychiatrists; Professor Lesley Regan, president of the Royal College of Obstetricians and Gynaecologists; Professor Russell Viner, president of the Royal College of Paediatrics and Child Health; Professor Helen Stokes-Lampard, chair of council of the Royal College of General Practitioners – the letter has also been signed by over 800 other doctors, healthcare professionals and academics.

References

  1. Department for Health and Social Care. Prevention is better than cure - our vision to help you live well for longer. https://wwwgovuk/government/publications/prevention-is-better-than-cure-our-vision-to-help-you-live-well-for-longer 2018
  2. Steel, N. et al. Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2018 (392) 1647-1661
  3. Fair Society, Healthier Lives. Marmot review University College London, 2010 http://www.ucl.ac.uk/gheg/marmotreview
  4. Doll R. Peto R. Boreham J. Sutherland I. Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ 2004;328:1519 https://www.bmj.com/content/328/7455/1519
  5. Cigarette smoking-attributable morbidity – United States, 2000. MMWR Weekly Report. 5 Sep. 2003 https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5235a4.htm
  6. Child Health in 2030 in England, RCPCH, October 2018
  7. Royal College of Physicians. Hiding in plain sight: treating tobacco dependency in the NHS. London: RCP, 2018. https://www.rcplondon.ac.uk/projects/outputs/hiding-plain-sight-treating-tobacco-dependency-nhs
  8. Prevention is better than cure – Matt Hancock's speech to IANPHI . DHSC. 5 November 2018. https://www.gov.uk/government/speeches/prevention-is-better-than-cure-matt-hancocks-speech-to-ianphi
  9. Hansard. HC vol 645 c 665 19 July 2018 https://hansard.parliament.uk/commons/2018-07-19/debates/AC4C0223-B31C-4AD8-A594-8CD963C96710/TobaccoControlPlan