Smoking cessation: Not letting up

Mary YatesNationally smoking rates are falling, but certain groups are falling behind. On No Smoking Day, addictions expert and Nurse Consultant Mary Yates asks what more we can do?

What is your experience of helping people to quit smoking?

South London and Maudsley NHS Foundation Trust started our smokefree journey on 1 October 2014 and the rate of smoking has reduced from 62% to 43.5% in in-patient services.

Where are we now?

It’s not where I want to be. The change is going in the right direction, but the pace is too slow.

Across the UK smoking rates continue to fall. Currently it’s 15% but remains much higher among people with mental health and learning disabilities. This means the efforts required in our services need to accelerate further to ensure these groups are not left behind.

What are the barriers to change?

In my view one of the biggest barriers to change is not embedding smoking cessation as part of every healthcare professional’s undergraduate training.

This is a topic that should be essential given that smoking remains a leading cause of preventable disease and premature death in this country and worldwide.  

But as a direct result, we too often fail to ensure patients' comfort in smokefree hospitals and repeatedly miss opportunities to support harm reduction and quit attempts.

It was hoped that the Health and Social Care Act (2012) would address inequalities and hand responsibility for public health functions to local authorities.  Sadly, the smoking cessation services provided by those local authorities have been reduced and in some cases cut completely. In many cases, existing initiatives have made little or no impact on tackling smoking in the mental health and learning disability population by not targeting effectively these groups with higher rates of smoking.

So in my view, changes are now needed to bring responsibility for treating tobacco dependence back into the NHS to fulfil the prevention ambitions set out in the NHS Long Term Plan (2019).

Matters are complicated by the complex commissioning system. Not all mental health commissioners recognise that supporting smokers to quit is something to demand as standard. 

Yet quitting is associated with less severe psychotic symptoms, less frequent relapses of depression, potentially less medication, reduced length of stay, fewer stigmas, reduced risk of physical health problems, and reduced poverty. 

What other intervention costing less than £300 can yield such outcomes?

How can we speed up change?

I want mental healthcare professionals to be less paternalistic and more ambitious.

This month in South London and Maudsley we have screened 88% of new admissions for smoking status, provided advice to 96% of identified smokers and referred 60% of smokers to specialist support. 

We have better data systems in place for tracking smokers, with 40% of current inpatients identified as smokers on admission.  We can be proud of this achievement but not complacent. We must use all the resources we have available and demand more to ensure we eliminate this significant inequality.

Smokers in our care need to quit, they want to quit, and they can quit with our support.

On National No Smoking Day – what can I do to make a difference?

Here are some ideas:

  • find out how to signpost smokers to get support in your area
  • show that you care by encouraging a smoker you know to get help
  • give some encouragement to smokers who are considering a change

The Giving brief advice on stopping smoking resource on the King’s Health Partners Learning Hub will help you confidently broach the issue with any patient you encounter and help you signpost towards free local services that could offer them support and treatments to quit for good. Simply login with your trust or university ID to enrol. 

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