NHS ‘could save millions’ by tackling smoking

Monday 24 July 2000

Embargo: 00:01 Monday 24th July 2000

(In advance of Wednesday’s government announcement of the National Plan for the NHS)

When it comes to smoking, the NHS has still not embraced the full potential of the idea that “prevention is better than cure” and could save millions of pounds if it did. Evidence submitted to the Government’s modernisation review of the NHS published today [1] shows that helping smokers quit is one of the most cost-effective expenditures the NHS can make — yet it still attracts low priority from most health authorities and doctors. The report shows that although smoking cessation expenditure is TWELVE times as cost-effective as spending on cholesterol lowering statins, the NHS spends SEVENTEEN times as much on these drugs as on smoking cessation.

“The biggest source of waste in the NHS is not bureaucracy or incompetence, it is the decisions about how the NHS budget is used, and where it gets the best return for health and well-being for the money its spends. The NHS could save millions of pounds and thousand of lives by placing smoking in the mainstream of its activities and expenditure.” said Clive Bates, Director of ASH.

“The simple idea behind tackling smoking is that you effectively treat the 50 diseases associated with smoking before they actually happen.” said Dr. Ann McNeill, consultant to ASH and co-author of the evidence. “If the NHS tackles heart disease by prescribing long term medication or through heart surgery, rather than dealing with the most obvious risk factor, it is simply wasting money — no matter how efficiently they organise the operations or how well they bargain down the price of the drugs.”

ASH acknowledges that great progress has been made since 1998 and the evidence highlights three case studies of good practice, which show what could be done if the NHS moved smoking up its agenda: “We know there are some really good things happening out there, and the government has set up specialist clinics and made some drugs available on the NHS, but we haven’t yet seen smoking take the place it deserves in the mainstream NHS compared to, say, control of high blood pressure or cholesterol”, said Godfrey Fowler, Emeritus Professor of General Practice, University of Oxford.

The evidence recommends:

  • Action at all levels in the NHS to tackle smoking — especially GPs and hospitals
  • All proven drug treatments including nicotine replacement products to be available on prescription — and clear guidance to health authorities on the economics of smoking cessation.
  • Referral to NICE of the economics of smoking cessation and related pharmaceuticals
  • Funding by channelling tobacco taxation directly back to the smoker
  • Clear guidance on prescribing and improved integration of specialist and mainstream services

The acid test of modernisation test will be the weight given to preventing illness rather than picking up the pieces after someone is already ill. To coin a phrase, we want Milburn to be tough on disease, and tough on the causes of disease.” said Bates.

[1] McNeill A. & Bates C. Smoking Cessation in Primary Care: … how to spend NHS money much more effectively, ASH evidence to the NHS Modernisation Action Team on Prevention and Inequalities, July 2000. (pdf)

The evidence is endorsed by cancer and heart charities and many individuals.

Contact: Clive Bates 020 7739 5902 (w) 020 8800 1336 (h) 077 6879 1237 (m)

Dr. Ann McNeill 020 8650 0650 (w) 077 8522 6673 (m)

Professor Godfrey Fowler 01865 558331 until Friday 21st.