Table of contents


Background papers: Lifestyle and wider determinants :: Smoking and tobacco control [Update in progress] :: Summary

Cigarette smoking remains the leading cause of preventable death in England today; it is estimated to be responsible for up to 86,500 deaths per year.[1]

“Smoking has been identified as the single greatest cause of preventable illness and premature death in the UK. …it is estimated that half the difference in survival to 70 years of age between social class I and V is due to higher smoking prevalence in class V."[2] On average, those killed by smoking have lost 10–15 years of life.[3]

Smoking is a key driver of demand for the NHS, causing the majority of respiratory diseases, around 30% of cancers, and nearly one in five cases of cardiovascular disease, as well as being a contributory factor in diabetes and many other disease disorders.[4]

The local smoking prevalence in Medway has dropped from 31.8% in 2008 to 24.9% in 2010. These are based on national synthetic estimates and there is a need for more local data either through surveys or through an augmentation of the Annual Health Survey for England.

Smoking results in considerable use of NHS services—in 2007/08, an estimated 440,900 admissions to NHS hospitals in England among adults over the age of 35 were attributable to smoking.[5] This is nearly 1,200 per day and 5% of hospital admissions in that age group.

Stop smoking services should aim to treat a minimum of 5% of their local population of smokers in a year, but should take local needs into account. This is a minimum recommendation and the current national average is just under 10%.[6] In 2010/11 the Medway Stop Smoking Service treated 7.5 % of the local population.

Key issues and gaps

Smoking prevalence in Medway is 24.9%, however, there is a significant variation across the Medway area and smoking is a major reason for health inequalities. Helping people to stop smoking is a key part of the business of NHS services across Medway and four-week quitting remains a challenging target.

Motivating people to stop smoking

• Currently there are no local data on the prevalence of smoking and there is a reliance on national synthetic estimates. This needs to be addressed through either local surveys or through an augmentation of the Health Survey for England.
• Continued focus on primary and secondary care is required, with an extension of this to frontline Council services, particularly in ensuring that sufficient and appropriate staff are trained in Brief Intervention, good quality Brief Advice/Intervention is given, and that referrals to stop smoking service are made proactively.
• Evidence has shown that mass media campaigns are effective in reducing smoking prevalence and are associated with stop smoking activity. The reduction in the Department of Health-funded national mass media campaigns may result in a drop in activity/numbers accessing treatment.
• Increased working with General Practitioners (GPs) to continue to refer patients that smoke to the stop smoking service.

Smoking cessation services

• The stop smoking service currently offers the 'abrupt quit' model to smokers wanting to quit.

• It is unknown whether the current service provision adequately meets the needs of a certain groups with high smoking prevalence, such as those with mental health problems.
• The smoking status amongst some pregnant women at point of booking and point of delivery is not being recorded and is causing confusion and results in inaccurate recording.
• The lack of mobile technology and connectivity problems causes duplication in recording of patient outcomes. This is also causing an increase in use of financial and human resources. Improvements in this area will streamline processes, improve security and accuracy and enhance customer focus.
• Engaging midwives to carry out carbon monoxide testing (CO) as per NICE guidance and to participate in level 1 and level 2 training.
• The uptake of staff from Children's centres to access training to enable them to offer professional advice on smoking cessation.
• IT systems at the acute trust not robust enough to support an electronic referral system.
• Releasing staff from duties at the acute trust in order for them to attend the 1-hour Brief Training Programme.

Protection from tobacco-related harm

• Continue to raise awareness of tobacco control beyond health partners and highlight the impact to other agencies and departments, including: fire and rescue; housing; social care; and Human Resources.
• Lack of understanding of the scale of illicit tobacco sales and counterfeit tobacco
• Challenging to enforce the legislation about smoking in cars
• Legislation for plain packaging of cigarettes not passed.

Stopping Young People from starting to smoke

• There is a lack of uptake of educational establishments working in partnership with the stop smoking service to design, deliver, monitor and implement stop smoking prevention activities.
• No power to influence, investigate or accountability to implement the five NICE guidance recommendations.
• Limited number of proactive schools supporting schools based interventions to prevent the uptake of smoking among children.
• Number of young people accessing the 'go it alone programme', indicate that the outcomes are un-measurable.

Improving evidence base

• There is little published evidence of the effects of interventions that focus on cessation activity in adolescence. In 2010/11 23,229 smokers aged under 18 set a quit date, achieving all self-reported quit rate of 32% (7,327) quitters. Proportionately on a national basis 3% of service users aged 18 or under set a quit date. In Medway, 154 young people set a quit date in 2010/11 and of those, 54 quit successfully and achieved a 35% success rate. This equated to 4% of service users setting a quit date from the under 18 age group.


[1]   Twigg L, Moon G, Walker S. The Smoking Epidemic in England 2004; Health Development Agency. .
[2]   Wanless D. Securing Good Health for the Whole Population: Final Report 2004; Department of Health. .
[3]   Crosier A. Smoking and health inequalities 2005; Action on Smoking and Health. .
[4]   Action on Smoking and Health. All Party Parliamentary Group on Smoking and Health
[5]   Diment E, Harris J, Jotangia D, et al. Smoking, drinking and drug use among young people in England in 2008 2009; The NHS Information Centre. .
[6]   Department of Health. Service delivery and monitoring guidance, 2011/12 2011;