Health charity welcomes new stop smoking guidance but lack of services raises concerns
Action on Smoking and Health (ASH) welcomes new guidance published today (Wednesday 28th March) by NICE  on how to best support smokers to quit. It also welcomes the clear recommendations from NICE to health professionals about the advice smokers should be given on e-cigarettes.
However, the charity is deeply concerned that there are a declining number of specialist services around the country to implement this guidance.
An ASH/ Cancer Research UK  report published in January looking at the state of local support for people to quit found that in 2017 budgets for stop smoking services were reduced in half of local authorities in England, following reductions in 59% of local authorities in 2016, and in 39% of local authorities in 2015. In 2017, a specialist stop smoking service open to all smokers was provided by only 61% of local authorities.
Financial pressures due to the cuts to public health funding and the wider pressures on local government finances is the major culprit for the declining provision. A recent analysis by the King’s Fund found that in 2017/18 local authority funding for wider tobacco control faces reductions of more than 30%. Stop smoking services are one of the top four services in absolute planned cuts (£16 million). 
The lack of services for smokers are of particular concern for vulnerable groups such as pregnant smokers and those with a mental health condition. While smoking rates are steadily falling for the population as a whole there has been little change in people with a mental health condition  and rates among pregnant women have not fallen at all over the last 12 months .
Director of Policy, Hazel Cheeseman, said:
“It’s important to have good guidance but without services to make the guidance a reality then it becomes an academic exercise. This countries stop smoking services have been the envy of the world but they are being squeezed as a result of funding pressures. The Government needs to take action nationally to reverse this trend.”
ASH and other health organisations have been calling on the Government to plug the gap in funding through placing a levy on the tobacco industry to pay for the support smokers need .
Hazel Cheeseman added:
“Tobacco companies are among the most profitable in the world. In these difficult financial times it would be a win-win for the Government to legislate to require Big Tobacco to cover the cost of supporting smokers to quit.”
The new guidance from NICE provides welcome clarity for health professionals about e-cigarettes. The guidance is clear that they should provide accurate information to smokers about the substantially reduced risks of vaping compared to smoking and that people who smoke should not be discouraged from switching to e-cigarettes because the evidence is still developing. 
As there are no products currently licensed as medicines NICE was unable to recommend prescribing e-cigarettes at this time. If licensed products do become available then this could change in the future. Nicotine replacement therapies like gum and patches are cheap and highly cost-effective medicines and e-cigarettes would be a welcome addition to the armoury.
Hazel Cheeseman added,
“As e-cigarettes are the most popular aid for quitting it is good news that NICE recommends that health professionals should reassure smokers that they are substantially less harmful than smoking. Looking to the future it is hoped that some e-cigarettes will be licensed as medicines and could then be prescribed providing doctors with another tool to help smokers who want to quit.”
Notes and Links:
Action on Smoking and Health is a health charity working to eliminate the harm caused by tobacco use. For more information see: www.ash.org.uk/about-ash
ASH receives funding for its programme of work from Cancer Research UK and the British Heart Foundation.
ASH staff are available for interview and have an ISDN line. For more information contact ASH on 020 7404 0242 or out of hours Deborah Arnott on 07976 935 987 or Hazel Cheeseman on 07754 358 593.
 Feeling the Heat, the decline of stop smoking services in England: ASH/Cancer Research UK, Jan 2018 by ASH, funded by Cancer Research UK
 Local spending on public health: death by a thousand cuts, D Buck, King’s Fund, 3 Jan 2018
 The Stolen Years, ASH, May 2016
 Smoking at Time of Delivery Data, NHS Digital, March 2018
 Smoking Still Kills, ASH, 2015
 See NICE guidance NG92 on Stop smoking interventions and services 1.5.1:
For people who smoke and who are using, or are interested in using, a nicotine-containing e-cigarette on general sale to quit smoking, explain that:
- although these products are not licensed medicines, they are regulated by the Tobacco and Related Products Regulations 2016
- many people have found them helpful to quit smoking cigarettes
- people using e-cigarettes should stop smoking tobacco completely, because any smoking is harmful
- the evidence suggests that e-cigarettes are substantially less harmful to health than smoking but are not risk free
- the evidence in this area is still developing, including evidence on the long-term health impact.