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NHS must support smokers to quit says Royal College Physicians

Fresh has echoed calls in a new report from the Royal College of Physicians for a significant change in the way the NHS treats smoking – ensuring all smokers are provided with support to quit from the moment they are admitted as a routine part of all hospital care.


The report is published on the same day that one NHS Trust in the North East, Northumbria Healthcare NHS Foundation Trust, shares its own smokefree journey with colleagues from across the country.


In the NHS's 70th anniversary year, giving smokers support to quit while in hospital will save lives, improve quality of life and increase life expectancy for all smokers, as well as reducing the £1 billion a year cost to the NHS from current smoking by patients and staff.  It would support the broader work led by local authorities and complement their local community stop smoking services.


Smokers who start smoking at the start of adult life lose an average of 10 years of life expectancy, or around 1 year for every 4 years of smoking after the age of 35.  Smoking is a recognised cause of numerous cancers, COPD, heart disease and stroke, but it also increases the risks of conditions such as diabetes, arthritis, flu, asthma and dementia. For hospital patients smoking also increases the risks of infection and slows down wound healing after surgery.


In the North East, it is estimated that the NHS faces an annual bill of around £127.5m as a result of 1.2 million GP consultations, over 256,000 hospital admissions and outpatient visits, and 693,133 GP prescriptions every year.


The RCP report 'Hiding in plain sight: Treating tobacco dependency in the NHS' from the RCP's Tobacco Advisory Group makes a list of recommendations, including:

  • identifying smokers and supporting them to quit doubles quit rates and smokers should be  identified and receive cost-effective treatment to help them quit

  • smoking cessation should be a systematic, "opt-out" part of all NHS services, and delivered in smoke-free settings

  • allowing electronic cigarettes to be used on NHS sites to support smokers to remain smoke-free and help to sustain smoke-free policies

  • training in smoking cessation should be introduced into all healthcare professional training

  • smoking cessation treatments save money for the NHS in the short term and long term - and should be prioritised as a core NHS activity


The RCP report says that treating tobacco dependency is not just about preventing disease but can often help with disease treatment. It also says smoking treatment tends to be squeezed out, even in the management of diseases caused by smoking, by other, less cost-effective interventions.


67-year-old James Degnen from Middlesbrough (below) had to undergo major vascular surgery for blocked veins in his legs at the start of 2017 and faced a stark choice – quit smoking or lose a leg. He said: "The surgery was the real turning point for me. It's important for doctors and nurses to keep talking to patients about stopping smoking.  Medical professionals spend a lot of time and effort in saving people's lives and people do heed their warnings."




Tony Kell, 52, from Benwell, Newcastle, quit smoking after a heart attack in October 2014 completely changed his life. He said: "People need to be made more aware of the dangers of smoking. It wasn't until the consultant told my wife that I needed to undergo surgery to insert a stent, that it hit me. Seeing my wife burst into tears because she was so worried was the biggest turning point for me. I stopped smoking there and then and haven't touched a cigarette since."


Ailsa Rutter, Director of Fresh, said: "Smoking is our biggest killer and cause of ill health. Our doctors, nurses and GPs are in a unique position to alter the course of a patient's long term health and help them to quit. Not doing so means we are failing our patients.


"The link between smoking and lung cancer has been known since 1954 – and in the NHS's 70th anniversary year, this is a reminder that still not enough is being done when smokers enter hospital. The evidence is strong that helping smokers to stop is very cost effective, saves lives and will save the NHS millions of pounds and will help the North East get to a point when 5% or fewer people smoke.


"There are some excellent examples of where hospitals are making a real difference, but we need all hospitals to now be doing this systematically and treat smoking alongside other conditions.


"Many smokers would like to be able to quit and entering hospital can be a very significant moment. This would represent an important extension to the excellent work by local authorities to reduce smoking and improve health in our communities."


Amanda Healy, Director of Public Health for County Durham and Chair of the North East Network of Directors of Public Health, said: "With smoking rates now at their lowest ever level in the North East, local authorities have done a huge amount of work to encourage and support smokers to quit and are best placed to reach people via stop smoking services in our most in-need communities.


"In the North East we have seen the biggest falls in smoking in England, but we still have a long way to go given our levels of smoking and health inequalities. We have already worked closely with NHS colleagues to reduce smoking rates in pregnancy and are committed as a system to increase the focus on support for stopping smoking"


Dr Tony Branson, Medical Director for the Northern Cancer Alliance and Joint Chair of the Smokefree NHS/Treating Tobacco Dependency Regional Taskforce, said:  "Tobacco is the single biggest cause of cancer and is one of the main causes of hospital admissions. As providers of healthcare we must be more proactive in asking about smoking and providing help and support to quit.


"The NHS is more stretched than ever before but treating tobacco dependency is one of the single most effective ways we can improve outcomes for patients, and reduce the chances of them being re-admitted to hospital.


"This is a vital opportunity for the NHS to tackle this issue and help us reduce the burden of smoking related diseases on our wards and across local communities."


Much progress has already been made in the North East including:

  • A vision to cut smoking rates to 5% across the North East by 2025 has been backed by health and local government leaders and young people in the region.

  • A Smokefree NHS/ Treating Tobacco Dependency taskforce has been set up to work with NHS Trusts to ensure all patients who smoke are offered support to quit, with a goal of April 2019 for all the region's NHS Trusts to be implementing NICE guidance for smoking.

  • The regional babyClear initiative has helped reduce smoking during pregnancy from 22% to 16.4%, and resulted in a doubling of quitting rates among women who smoke.

  • In 2016 Northumberland Tyne and Wear NHS Foundation Trust and Tees Esk and Wear Valley NHS Trust became the first trusts in the region to go 'smokefree'.


  • Northumbria Healthcare NHS Foundation Trust went smokefree in March 2018. Staff offer smokers support to refrain from smoking whilst in care. Patients who are admitted either as an emergency or planned admission, will be offered nicotine replacement therapy (NRT) in the form of patches and inhalator and will be offered a referral for ongoing support. The trust allows the use of e-cigarettes in grounds.