Elspeth Pound

Impact of UK National Health Service smoking cessation services: variations in outcomes in England

Objectives: To determine the extent to which UK National Health Service (NHS) smoking cessation services in England reach smokers and support them to quit at four weeks, and to identify which service and area characteristics contribute to observed outcomes. Design: Ordinary least squares regression was used to investigate local smoking outcomes in relation to characteristics of health authorities and their smoking cessation services. Setting: 76 health authorities (from a total of 99) in England from April 2000 to March 2001. Main outcome measures:Reach—number of smokers attending cessation services and setting a quit date as a percentage of the adult smoking population in each health authority. Absolute success—number of smokers setting a quit date who subsequently reported quitting at four weeks (not having smoked between two and four weeks after quit date). Cessation rate—number of smokers who reported quitting at four weeks as a percentage of those setting a quit date. Loss—percentage lost to follow up. Results: A range of service and area characteristics was associated with each outcome. For example, group support proved more effective than one to one interventions in helping a greater proportion of smokers to quit at four weeks. Services based in health action zones were reaching larger numbers of smokers. However, services operating in deprived communities achieved lower cessation rates than those in more prosperous areas. Conclusions: Well developed, evidence based NHS smoking cessation services, reflecting good practice, are yielding positive outcomes in England. However, most of the data are based on self reported smoking status at four weeks. It will be important to obtain validated data about continuous cessation over one year or more in order to assess longer term impact.

National survey of the new smoking cessation services in England

Objective To examine the early implementation of the new National Health Service (NHS) smoking cessation services and assess implications for their future. Design Quantitative study. Setting NHS smoking cessation services in England, spring 2001. Method Postal survey of all smoking cessation coordinators (managers) in England. Results The response rate was 69 per cent. Three quarters of the coordinators reported that no prior smoking cessation services had existed in their area, 42 per cent had no experience of running clinical services for patients, and one in five reported employing very few or no smoking cessation advisors with previous clinical experience in smoking cessation or any other field. Some coordinators were experiencing difficulties in recruiting and retaining staff, the most common reasons being short-term funding or the lack of appropriate experience. Nevertheless, almost 60 per cent of the coordinators reported that the smoking cessation services were working at full capacity at the time of the survey. Services were offering a range of smoking cessation interventions that were mostly in line with the evidence base. Conclusion Evidence based smoking cessation services were set up across England within a short period of time. The majority of staff employed initially had little or no previous experience relevant to their posts and large numbers have been trained in smoking cessation skills. As ring- fenced funding of smoking cessation services came to an end in March 2003, it is important not to lose this substantive investment in skills and infrastructure and ensure that the services are incorporated into mainstream funding, with a proper career structure for smoking cessation service staff.