Quality statement 3: Tobacco cessation support and treatment | Tobacco: treating dependence | Quality standards

Quality statement

People who want to stop using tobacco are offered tobacco cessation support and treatment by a healthcare professional. [2013, updated 2022]

Rationale

People who want to stop smoking or using smokeless tobacco should have access to a range of tobacco cessation support and treatment so that they can make their own choice of intervention based on their preferences, health and social circumstances, and previous experience of tobacco cessation aids. Although a combination of behavioural support with either varenicline, when available, short-acting and long-acting nicotine replacement therapy or nicotine-containing e-cigarettes (as appropriate for their age) is more likely to result in a successful quit attempt for those who smoke cigarettes, individual factors and preferences are also likely to be important.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly. Some localities may want to focus on equality of care depending on local needs, for example, by assessing care for particular socioeconomic or ethnic groups.

Process

The following process measure denominator uses a key point of contact for measurement purposes only.

Proportion of people attending a key point of contact who want to stop smoking or using smokeless tobacco, who are offered tobacco cessation support and treatment by a healthcare professional.

Numerator – the number in the denominator who are offered tobacco cessation support and treatment by a healthcare professional.

Denominator – the number of people attending a key point of contact who want to stop smoking or using smokeless tobacco.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

The Quality Outcomes Framework indicator SMOK004 reports the percentage of patients aged 15 or over who are recorded as current smokers who have a record of support and treatment within the preceding 24 months. The offer of support includes provision of pharmacotherapy or referral for support.

Outcome

a) Quit rates.

Data source: NHS Digital's statistics on NHS stop smoking services in England collects and reports data on people who smoke setting a quit date with an NHS stop-smoking service including self-reported and carbon monoxide-validated quit rates. No routinely collected national data for this measure has been identified for quit rates outside of NHS stop-smoking services. Quit rates can be collected from information recorded locally by healthcare professionals and provider organisation, for example from patient records.

Self-reported quit rates for people who use smokeless tobacco can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

b) Smoking prevalence.

Data source: NHS Digital's statistics on smoking – England reports smoking prevalence among young people aged between 11 and 15 years. Public Health Outcomes Framework 2019 to 2022 (Public Health Outcome Indicators 2019) includes indicators on smoking prevalence in 15 year olds (indicator number 2.09) and smoking prevalence in adults (indicator number 2.14).

What the quality statement means for different audiences

Service providers (for example, primary care services and stop-smoking services) ensure that systems are in place for people who want to stop using tobacco to have a discussion with a healthcare professional about the range of support and treatment available to help them quit. They ensure healthcare professionals are trained to provide tobacco cessation options and advice. They ensure that people have access to the range of tobacco cessation support and treatment, including referral to local specialist tobacco cessation services if available.

Healthcare professionals (such as GPs, providers of stop-smoking support and tobacco dependence specialists) are aware of the full range of tobacco cessation support and treatment available and can provide information on their use, effectiveness and how to access them, including providing support and treatment if possible or referral pathways to local specialist tobacco cessation services if needed. They can give advice on nicotine-containing products on general sale including nicotine replacement therapy and nicotine-containing e-cigarettes and how to use them properly. They give advice on nicotine-containing e-cigarettes that is clear, consistent and up to date.

Commissioners (for example, local authorities and integrated care systems) ensure they commission services that can provide information on and access to a range of tobacco cessation support and treatment. If local needs assessment shows that it is necessary, a range of services should be commissioned to help South Asian people stop using smokeless tobacco. This can be within existing stop-smoking support, part of services offered within a range of healthcare and community settings, or a stand-alone service tailored to local needs.

People who want to stop smoking or using smokeless tobacco are given information on a range of approaches to help them quit. They discuss these and their circumstances and preferences with their healthcare professional to choose the approach that is right for them.

Source guidance

Tobacco: preventing uptake, promoting quitting and treating dependence. NICE guideline NG209 (2021, updated 2022), recommendations 1.12.1, 1.12.2 and 1.13.1

Definitions of terms used in this quality statement

Tobacco

Includes smoked tobacco, such as cigarettes and shisha, and smokeless tobacco.

Smokeless tobacco is any product containing tobacco that is placed in the mouth or nose and not burned. It is typically used in England by people of South Asian family origin. It does not include products that are sucked, like 'snus' or similar oral snuff products (as defined in the European Union 2014 Tobacco Products Directive). The types used vary across the country, but they can be divided into 3 main categories based on their ingredients:

Tobacco with or without flavourants: misri India tobacco (powdered) and qimam (kiman).
Tobacco with various alkaline modifiers: khaini, naswar (niswar, nass) and gul.
Tobacco with slaked lime as an alkaline modifier and areca nut: gutkha, zarda, mawa, manipuri and betel quid (with tobacco).

[Adapted from NICE's guideline on tobacco, terms used in this guideline (smokeless tobacco), final scope (2018) and expert opinion]

Tobacco cessation support and treatment

Support and treatment may include behavioural support, pharmacotherapy, advice on using nicotine-containing e-cigarettes or referral to local tobacco cessation services.

The following should be accessible to adults who smoke:

behavioural interventions:
- behavioural support (individual and group)
- very brief advice
medicinally licensed products:
- bupropion (see BNF information on bupropion hydrochloride)
- nicotine replacement therapy (NRT) – short and long acting
- varenicline (see NICE's technology appraisal guidance on varenicline for smoking cessation and the BNF information on varenicline)
nicotine-containing e-cigarettes
Allen Carr's Easyway in-person group seminar.

In August 2022, varenicline was unavailable in the UK. See the MHRA alert on varenicline.

Consider nicotine replacement therapy alongside behavioural support to help women stop smoking in pregnancy and for young people aged 12 and over who are smoking and dependent on tobacco. Varenicline, when available, and bupropion should not be offered to pregnant or breastfeeding women or people under 18.

People who use smokeless tobacco who want to quit should be referred to local specialist tobacco cessation services, including services specifically for South Asian groups, where they are available. [Adapted from NICE's guideline on tobacco, recommendations 1.12.2, 1.12.3, 1.12.4, 1,16.3, 1.20.6 and 1.20.11]

Key points of contact

Such as:

a consultation with a newly registered patient
a consultation about a condition related to smoking or use of smokeless tobacco
an antenatal appointment
a dental appointment
an NHS health check
an annual review
a preoperative appointment
during an inpatient episode
an outpatient appointment
at presentation at an emergency department
at first contact with social care services
as part of a Care Act assessment
at presentation after not being in regular contact with a health and social care professional.

[Expert opinion]

Healthcare professional

People trained to provide tobacco cessation support. For training requirements see the National Centre for Smoking Cessation and Training (NCSCT) standard for training in smoking cessation treatments. [Adapted from NICE's guideline on tobacco, section 1.12 and expert opinion]

Equality and diversity considerations

People who want to stop smoking should be provided with information during the discussion that they can easily understand themselves, or with support, so they can communicate effectively with healthcare services. Information given should be in a format that suits their needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally appropriate and age appropriate. People should have access to an interpreter or advocate if needed.

For people with additional needs related to a disability, impairment or sensory loss, communication support should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.

People with severe mental health conditions who may need additional support to stop using tobacco should be offered support by a specialist adviser with mental health expertise that is tailored in duration and intensity to the person's needs.

People who are experiencing homelessness should be supported to access services, for example, by providing outreach services, flexible opening and appointment times and drop-in services. [NICE's guideline on integrated health and social care for people experiencing homelessness, recommendations 1.5.1 and 1.5.15]

People who use smokeless tobacco who want to quit should be referred to local specialist tobacco cessation services, including services specifically for South Asian groups, where they are available.