Opt-out smoking cessation services should be introduced across ‘every NHS setting’ says a new report from the Royal College of Physicians (RCP). This would include emergency departments, outpatient services, primary care and neighbourhood health services.
While smoking remains the UK’s ‘biggest avoidable cause of death and disability’ its impact is far from equal, says Smoking, health and social justice. One in five residents of Blackpool – one of the most deprived towns in the country – are smokers, compared to just 4 per cent of people in Woking.
When barriers to accessing services are removed, however, the ‘greatest number of successful quit attempts come from the least advantaged communities’, the report states. If opt-out quit services were introduced across the health service, ‘everyone who smokes and has contact with the NHS’ would be automatically referred to support unless they chose otherwise. Research by ASH last year highlighted that a number of acute hospitals and mental health trusts were now beginning to decommission their stop-smoking services as a result of budget uncertainty, risking the reversal of ‘hard-won progress’.
The elimination of smoking in the UK would see a potential ‘smoke-free dividend’ for the country’s economy of just under £11bn, says the RCP report, ‘lifting many families out of poverty and creating an estimated 135,000 jobs’. Lower employment levels among smokers as a result of smoking-related ill health account for just under £9bn in lost productivity a year, it continues, with premature deaths – particularly among experienced workers over 45 – resulting in a further £1.35bn in 2024 alone.
People experiencing homelessness or entering prison are more than six times more likely to smoke than the general population, the report adds, with the actual rate in the former group likely to ‘significantly higher than official figures suggest’. In addition to opt-out support services, the RCP is calling for a rebalancing of national tobacco polity towards ‘high prevalence and underserved groups’, as well as investment in improved data collection to target action towards ‘hidden populations’. A report from the University of York published late last year stressed that urgent action was needed to address the ‘unseen epidemic’ of tobacco-related deaths among people with mental health issues. People with conditions like depression, bipolar disorder or schizophrenia are around three times more likely to smoke than the general population, it said, shortening life expectancy ‘by up to 20 years’.
The tobacco and vapes bill, which aims to create a ‘smokefree generation’ by phasing out the legal sale of tobacco to anyone born after January 2009, finally passed into law at the end of last month.
‘The health effects of tobacco place an enormous and entirely preventable strain on the NHS,’ said RCP president Professor Mumtaz Patel. ‘The government has taken an important step forward with the Tobacco and Vapes Act, which will help create the first smokeo-free generation and deliver long term gains for public health. But we must also act now to help the millions of people already addicted to tobacco who desperately need support. Too many are still being missed.’
‘Put simply, smoking reinforces persistent cycles of disadvantage and inequality,’ added the college’s special adviser on tobacco, Professor Sanjay Agrawal. ‘Addressing it is a matter of public and economic urgency. Opt-out smoking cessation pathways reduce inequality by removing the barriers that prevent people from accessing treatment, particularly in more deprived areas where smoking rates are highest and awareness of support is lowest. NHS inpatient data already show that when support is offered as standard, the greatest quit success is seen among the least advantaged groups, delivering both health and economic returns. Opt-out reaches the people our current system consistently fails.’
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