Lives being saved with hospital support for smokers to quit
Lives are being saved and thousands of hospital admissions are being prevented in the North East and North Cumbria two years after the launch of a new regional service to help smokers in hospitals.
That is the message from NHS leaders at an event this week around helping to embed the NHS Long Term Plan across the region – helping hospital in-patients and maternity patients beat tobacco addiction when they are in contact with doctors, nurses and other NHS ward staff.
Since Tobacco Dependency Treatment Services were rolled out in full across 10 NHS Foundation Trusts by September 2022, at least 54,480 people have been identified as smoking on admission or at booking (maternity) and 30,140 people referred to in-house NHS tobacco dependency services.
The work is part of the NHS Long Term Plan to reduce the harms caused by smoking, to help people stay healthy and manage demand on NHS services and is supported by the North East and North Cumbria Integrated Care Board Smokefree NHS programme as part of a system-wide approach to reduce the biggest cause of preventable illness and death in the region.
The latest figures show North East adult smoking prevalence is the lowest it has ever been at 11% and North East and North Cumbria at 10.9%. The North East has seen the largest fall in smoking in England since 2005, when smoking rates were at 29%. This is a fall of 62% which now means the North East has the second lowest smoking rates in England.
However, smoking is still the biggest cause of cancer and has killed more than 125,000 people in the North East since the year 2000. Annually in North East and North Cumbria, smoking causes 36,930 hospital admissions and 4,770 premature deaths. It costs the North East and North Cumbria NHS £145m annually in health care costs alone.
The 12 local authorities in the region and the North East and NHS North Cumbria Integrated Care Board have a unique declaration for a smokefree future with a clear vision: “A smokefree future, free of the death and disease from tobacco, is needed, wanted and workable. This would improve the health and wealth of our region’s most disadvantaged communities more than any other measure.”
Dr Ruth Sharrock, Consultant Respiratory Physician and Clinical Lead for Treating Tobacco Dependency on behalf of North East and North Cumbria NHS, said: “We recognise in the NHS that being dependent on tobacco is a long-term condition that requires clinical treatment – not a lifestyle choice.
“Smoking is still the single biggest cause of preventable ill health, it takes away years of healthy life from the patients I see, and causes people to die early. The fact is that smoking not only causes cancer, heart disease, stroke, COPD and dementia but during the winter when demand on the NHS is at its highest, smokers suffer more severely from respiratory viruses such as flu.
“Most patients want to quit but don’t have the confidence or the support in place to quit successfully. Over the past two years in the North East and North Cumbria, we now have tens of thousands of examples where people have gratefully accepted the offer of support. For many who go on to quit, their health has been transformed.
“We are in a position in the NHS to make a lifesaving difference many years before a serious illness develops. If we can encourage more patients to be tobacco free, even if just for the duration of their treatment, we can improve recovery from illness, reduce the need for prescription medications and make it less likely to have to visit hospital again, and that will ease pressures on our NHS.”
Smoking is still the biggest cause of preventable illness with the latest figures showing up to two out of three lifelong smokers dying from tobacco, losing around 10 years of life on average. The Royal College of Physicians published its seminal report “Hiding in Plain Sight” in 2018 calling on clinicians to ensure all patients are offered support to quit smoking.
Former smoker Sue Mountain, from South Tyneside, was diagnosed with laryngeal cancer at 48 but said the proactive role now being taken by the NHS means fewer people will suffer from “the misery of cancer from smoking” and other diseases.
“It is so important this support is now available, and the NHS is encouraging people to stop and give the support,” said Sue, who first started smoking when she was 11.
“When you smoke you try to kid yourself. You pretend it’s not as harmful as they say. If a doctor or nurse doesn’t tell you it’s important you should quit, you tell yourself that it’s not a problem, or that they don’t think you can manage to stop. We now know so much about the terrible impact smoking has on health.
“People are getting diseases like cancer and COPD far too young. I don’t want one person going through what I did.”
Amanda Healy, Durham County Council Director of Public Health and chair of the Association of Directors of Public Health North East network added: “The North East has historically seen the highest rates of smoking in the country but in recent years we have experienced the biggest regional drop in smoking through working across local authorities and our NHS and with the regional tobacco control programme Fresh in place.
“The commitment made some years ago to set up a regional Taskforce to take forward this focus is a national example of excellence and compliment the system wide working with local authorities to support smokers in local communities to quit.”
Ailsa Rutter OBE, Director of Fresh and Balance and a former nurse who worked with heart attack patients added: “We know most smokers start as children and end up regretting it. Most try to quit but it can take a number of tries before succeeding or not managing to quit at all. My dad Stewart was one of them and he died aged just 61 from COPD, a preventable disease.
“It is vital that smokers get encouraged to stop as much as possible and supported to do so – but nowhere is more important than at a time when they are in hospital, when the message is clear it is a vital step for their health. All efforts give us the best chance possible of creating a Smokefree Future free of the death and disease of tobacco.”
Sir James Mackey, Chief Executive of Newcastle Hospitals NHS Foundation Trust, said: “As a Trust we want to make sure that our patients have every opportunity for support when they want to quit smoking, and we have fully supported the tobacco dependency work in Newcastle and across the region.
“The statistics are compelling around the harm that smoking does and the impact of tobacco dependency for smokers and their families. This has been especially so in our region where the most deprived members of our community have been hit hardest and are most likely to end up with serious, life-limiting illness and needing treatment in our hospital wards.
“We have very strong and clear reasons to take this issue seriously so that we can reduce inequalities, prevent illness, and help people to live healthy lives. This has to be a key part of our work to make every contact count in our clinical settings and give our patients the best immediate and long-term outcomes for their health.”
Tobacco dependency treatment/smoking cessation and smoking prevention not only prevents illness but is good value for money. After one year of quitting smoking risk of heart attack halves to that of a smoker while after 10 years quit lung cancer risk halves compared to a smoker.
What’s happening in the North East and North Cumbria?
1/ NHS Tobacco Dependency Treatment Services is being embedded in 10 NHS Trusts. All inpatients admitted in hospitals, or pregnant smokers who are engaged with maternity services, are asked about smoking and offered treatment to treat their tobacco dependence as part of their routine care. There are different pathways in hospitals for acute and mental health trusts and maternity.
All patients being admitted are asked if they smoke and are offered free Nicotine Replacement Products (NRT) on arrival to manage their cravings whilst in the hospital. This can help patients by improving recovery and reducing their chances of re-admission.
2/ Tobacco Dependency Treatment for people with severe mental illness – both in community mental health settings and primary care aimed at increasing numbers making a quit attempt, quitting smoking or reducing smoking.
3/ Tobacco Dependency in Pregnancy Initiatives: including leading the transition to the National Pregnancy Incentives Scheme across eight NHS Foundation Trusts
4/ Smoking cessation for people attending Targeted Lung Health Checks, including working with community stop-smoking services to offer support.
5/ Improving access to evidence-based quitting aids (e.g. vapes, varenicline & Cytsine) and promoting digital solutions such as the Smoke Free App to provide flexible behavioural support to smokers 24/7.