Evidence

Surveillance report 2017 – Smoking: harm reduction (2013) NICE guideline PH45 and Smoking: acute, maternity and mental health services (2013) NICE guideline PH48

Previous review decisions for the tobacco guidelines

Previous review decisions for the tobacco guidelines

The following review decisions for the tobacco guidelines have already been made:

  • Smoking: brief interventions and referrals (2006) NICE guideline PH1 and stop smoking services (2008) NICE guideline PH10 are currently in update and merger. This update and merger includes a consideration of the evidence base on electronic cigarettes.

  • Smoking: workplace interventions (2007) NICE guideline PH5. Placed on the static list in September 2014.

  • Smoking: preventing uptake in children and young people (2008) NICE guideline PH14. In November 2014, the review decision was to update the guideline to take account of new evidence relating to the use of new media for changing social norms around smoking, and the impact of smoking cessation campaigns aimed at adults on de-normalising smoking and deterring children from taking up smoking.

  • Smoking prevention in schools (2010) NICE guideline PH23. In April 2013, the review decision was to partially update the guideline in light of new evidence. Additionally a refresh of the guideline was also agreed to update the language and terms used in the guideline on schools, the NHS and local authorities to reflect recent changes in systems, structures, and the changed policy and delivery context.

  • Smoking: stopping in pregnancy and after childbirth (2010) NICE guideline PH26. In August 2015, the review decision was to partially update PH26. This was initially going to be updated within the current update of PH1 and PH10. However, the scope of this update proved to be substantial and resource limitations resulted in the update being postponed.

  • Smokeless tobacco: South Asian communities (2012) NICE guideline PH39. No review of the guideline has been undertaken due to PH39 meeting the criteria to be placed on the static list as it does not have an associated quality standard. However, it would be beneficial to consolidate this product within the proposed tobacco sub-theme.

Implementation

There was no implementation feedback received from within NICE for PH45 and PH48. However, feedback from topic experts on implementaing PH45 and PH48 was provided, see views of topic experts.

Anti-discrimination and equalities considerations

There has been no evidence to indicate that the guidelines do not comply with anti-discrimination and equalities legislation.

However, feedback from topic experts suggested that people who are institutionalised with severe mental health problems, or are serving custodial sentences in particular, tend not to receive adequate levels of help with smoking cessation or harm reduction. It was suggested by topic experts that NICE revisits PH45 and PH48 to ensure that these groups are provided with appropriate and effective levels and types of service commensurate with the particular needs of these individuals.

Feedback from topic experts also noted that whilst PH48 recommends universal delivery of cessation interventions to secondary care service users in reality this is still far from standard practice. This inconsistency tends to "perpetuate smoking among those with socioeconomic disadvantage, and those (in particular) with mental health problems". Additionally a potential inequality was noted in access to varenicline as the topic experts indicated that the majority of secondary care and mental health settings do not stock or provide varenicline.

Views of topic experts

Feedback from experts contacted as part of the surveillance process for PH45 highlighted that workshops and surveys from Action on Smoking and Health (ASH) suggest that the guideline has limited implementation due to the lack of recommendations around consumer e-cigarettes.

Feedback from topic experts on PH48 indicated that there is uncertainty about how to implement PH48 particularly with regard to smoke free policies and the increase in e-cigarette use. One expert also noted that it would be helpful for NICE to reflect on case studies of secondary care organisations that have succeeded in going "smoke free" and use this data to update the guideline using these experiences and the challenges that were faced. Public Health England has published Use of e-cigarettes in public places and workplaces: Advice to inform evidence-based policy making (July 2016).

Implications for other NICE programmes

There are 3 quality standards that are related to the tobacco guidelines that could be influenced by any updates to the guidelines:


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