TOBACCO POLICY SPECIAL
Dr Tonya Gillis of the National Institute for Health and Clinical Excellence (NICE) discusses its role in advising the NHS on smoking cessation.
T
he Centre for Public Health Excellence at NICE has produced a suite of guid- ance focussing on evidence-based ways to tackle smoking and support smoking ces- sation.
It costs the NHS approximately £2.7bn a year to treat diseases caused by smoking. In addition to the wide range of diseases and conditions that are caused by cigarette smoking, it is also the primary reason for the gap in healthy life expectancy between rich and poor. Most smokers want to quit, so NICE guidance aims to ensure that the right services are put in place to help them to stop.
In 2008, the first fully comprehensive guidance on smoking cessation was issued by NICE to help ensure that stop smoking services are as effective as possible. The guidance, ‘Smoking cessation services in primary care, pharmacies, local authorities and workplaces, particularly for manual working groups, pregnant women and hard to reach communities’, is aimed at all pro- fessionals who have a direct or indirect role in helping people to quit smoking, includ- ing PCTs, local authorities and community and voluntary sectors.
It incorporates earlier NICE public health guidance on the effectiveness of brief smok- ing cessation interventions in primary care, guidance on workplace smoking cessation and earlier NICE guidance on pharmaco- logical therapies.
NICE recommendations include: • PCTs, SHAs and commissioners should set minimum realistic targets for their local populations, with an aim to treat at least 5% of their population who smoke each year, and to aim for a success rate of at least 35% at four weeks.
• NHS Stop Smoking Services should tar- get minority ethnic and socioeconomi- cally disadvantaged communities in the local population.
• NRT, varenicline or bupropion are rec- ommended as treatment options for peo- ple who are planning to stop smoking on
large numbers of people to quit smoking; however, smoking cessation rates are still lower among vulnerable groups, particular- ly pregnant women, people in routine and manual groups and those aged 20 or under.
The smoking cessation guidance focuses on these groups as they often need addi- tional support to help them give up smok- ing. Further guidance was published in 2010 on ‘Quitting smoking in pregnancy and following childbirth’, which updated and expanded on the recommendations in the 2008 guidance.
or before a particular date (target stop date) and alongside proven behavioural counselling and group therapy. • Personalised information,
advice and
support should be offered to pregnant women on how to stop smoking.
• Young people aged 12–17 should be of- fered information, advice and support on how to stop smoking. NRT may be used for young people over 12 years who show clear evidence of nicotine depend- ence and as part of a supervised regime.
• Employers should negotiate a smokefree workplace policy with employees or their representatives. This should include di- recting people who wish to stop smoking to services that offer appropriate sup- port, for example, the NHS Stop Smok- ing Services.
NHS Stop Smoking Services have helped PATHWAYS
Dr Gillian Leng, deputy chief executive of NICE and chief operating officer at NHS Evidence, told NHE: “There is masses of NICE public health guidance on smoking, and one of the ways we can help people find their way around it is by mapping it into a pathway format.
“We’re also doing work with [Director of the Centre of Public Health Excellence] Mike Kelly’s team to map in the resource consequences and the cost impacts that relate to the various different recommendations around smoking cessation, because we know public health audiences want to see that – ‘where am I going to get the biggest bang for my buck?’”
For more on NHS Evidence, see our full interview with Dr Leng on page 28
The new advice included: • Assessing a pregnant woman’s exposure to tobacco smoke through discussion and use of a CO test at their first ante- natal appointment and subsequent ap- pointments.
• Routinely referring women who smoke to NHS Stop Smoking services and pro- viding women with the NHS Pregnancy Smoking Helpline number.
• Suggesting to partners who smoke that they contact NHS stop Smoking Services for help to quit.
NICE has also issued guidance focussing specifically on school-based methods to prevent children and young people from starting to smoke. Research shows that children who start smoking before the age of 16 find it harder to quit and are twice as likely to continue to smoke as those who begin later in life – and are more likely to be heavier smokers. Recommendations include encouraging pupils to lead smok- ing prevention activities, and integrating discussions on the effects of tobacco use across a range of curriculum topics.
There is more NICE guidance on tackling smoking planned for publication in 2012 and 2013, on topics in- cluding helping people of South Asian origin to stop using smoke- less tobacco, and smoking cessation in secondary care - men- tal health services.
Dr Tonya Gillis FOR MORE INFORMATION
Further information on all published and forthcoming NICE public health guidance on tackling smoking is available at:
http://guidance.nice.org.uk/PHG
national health executive Nov/Dec 11 | 23
Image courtesy: Fresh
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