Quality standard

Quality statement 5: Referral for stop-smoking support and treatment

Quality statement 5: Referral for stop-smoking support and treatment

Quality statement

Pregnant women and partners who smoke are referred for stop-smoking support and treatment at routine antenatal appointments. [2012, updated 2023]

Rationale

Stopping smoking in pregnancy is important for the health of the woman and baby. Referring partners who smoke for stop-smoking support and treatment reflects the need to reduce or prevent the mother and baby's exposure to second-hand tobacco smoke as part of their antenatal care. In support of NHS England's Saving Babies' Lives Care Bundle, identifying women and their partners who smoke at routine antenatal appointments enables those who have not engaged with specialist support or who have relapsed to be identified and re-referred for stop-smoking support and treatment.

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.

Process

a) Proportion of booking appointments that included a carbon monoxide (CO) test.

Numerator – the number in the denominator that included a CO test.

Denominator – the number of booking appointments.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from antenatal care records. NHS Digital's Maternity Services Data Set includes data for CO measurement readings at the booking appointment, which supports the NHS England Saving Babies' Lives Care Bundle.

b) Proportion of pregnant women who smoke who were given an opt-out referral for stop-smoking support and treatment at the booking appointment.

Numerator – the number in the denominator who were given an opt-out referral for stop-smoking support and treatment.

Denominator – the number of pregnant women recorded as current smokers at the booking appointment.

Data source: No routinely collected national data has been identified for this measure. Data can be collected from information recorded locally, for example, antenatal care records. NHS Digital's Maternity Services Data Set collects data on smoking status at the booking appointment. The proportion of women who are recorded as smokers at the booking appointment is displayed on the NHS Digital Maternity Services dashboard, enabling data to be compared for services.

c) Proportion of pregnant women whose partner was recorded as a current smoker and was given a referral for stop-smoking support and treatment at the booking appointment.

Numerator – the number in the denominator whose partner was given a referral for stop-smoking support and treatment.

Denominator – the number of pregnant women whose partner was recorded as a current smoker at the booking appointment.

Data source: No routinely collected national data has been identified for this measure. Data can be collected from information recorded locally, for example, antenatal care records.

d) Proportion of 36-week routine antenatal appointments that included a CO test.

Numerator – the number in the denominator that included a CO test.

Denominator – the number of 36-week routine antenatal appointments.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from antenatal care records. NHS Digital's Maternity Services Data Set includes data for CO measurement readings at the 36-week appointment which supports the NHS England Saving Babies' Lives Care Bundle.

e) Proportion of pregnant women who smoke who were given an opt-out referral for stop-smoking support and treatment at the 36-week routine antenatal appointment.

Numerator – The number in the denominator who were given an opt-out referral for stop-smoking support and treatment at the 36-week routine antenatal appointment.

Denominator – The number of pregnant women recorded as current smokers at the 36-week routine antenatal appointment who have not already engaged with stop-smoking support and treatment.

Data source: No routinely collected national data has been identified for this measure. Data can be collected from information recorded locally, for example, antenatal care records.

f) Proportion of pregnant women whose partner was recorded as a current smoker and was given a referral for stop-smoking support and treatment at the 36-week routine antenatal appointment.

Numerator – the number in the denominator whose partner was given a referral for stop-smoking support and treatment.

Denominator – the number of pregnant women whose partner was recorded as a current smoker at the 36-week routine antenatal appointment.

Data source: No routinely collected national data has been identified for this measure. Data can be collected from information recorded locally, for example, antenatal care records.

Outcome

a) The proportion of women who were current smokers at delivery.

Numerator – the number in the denominator who were current smokers at delivery.

Denominator – the number of women who gave birth.

Data source: NHS Digital's Maternity Services Data Set includes smoking status at delivery, and also collects demographic data including index of multiple deprivation. The NHS Digital Maternity Services dashboard can be used to monitor performance and compare services.

b) The proportion of pregnant women with a partner who was a current smoker at delivery.

Numerator – the number in the denominator whose partner was a current smoker at delivery.

Denominator – the number of pregnant women who gave birth who have a partner.

Data source: No routinely collected national data has been identified for this measure. Data can be collected from information recorded locally, for example, antenatal care records.

What the quality statement means for different audiences

Service providers (maternity services) ensure that equipment is available to monitor CO levels in pregnant women. They provide training to midwives on assessing the smoking status of pregnant women and partners. They ensure that local pathways are in place to refer pregnant women and partners who smoke for stop-smoking support and treatment.

Healthcare professionals (midwives) assess the smoking status of pregnant women and partners. At routine antenatal appointments, they provide information about the hazards of smoking when pregnant and of exposure to second-hand smoke for both the pregnant woman and her baby. They provide pregnant women who smoke with an opt-out referral for stop-smoking support and treatment and offer a referral to partners who smoke. They monitor CO levels in pregnant women at the booking and other routine antenatal appointments.

Commissioners (integrated care systems) ensure that they commission maternity services that provide pregnant women who smoke with opt-out referrals for stop-smoking support and treatment and offer partners who smoke a referral for stop-smoking support and treatment. They monitor rates of referrals, quit rates and smoking at delivery. They commission services which monitor CO levels in pregnant women at the booking and other routine antenatal appointments.

Pregnant women who smoke are given an automatic referral (which can be declined) for stop-smoking support and treatment at their antenatal appointments so that they can have support to reduce or stop smoking. If they have a partner who smokes, they are also offered a referral for stop-smoking support and treatment.

Source guidance

Tobacco: preventing uptake, promoting quitting and treating dependence. NICE guideline NG209 (2021, updated 2023), recommendations 1.18.1 and 1.18.2

Antenatal care. NICE guideline NG201 (2021), recommendations 1.2.4 and 1.3.9

Definitions of terms used in this quality statement

Pregnant women who smoke

All pregnant women who:

  • say they smoke or have stopped smoking in the past 2 weeks or

  • have a CO reading of 4 parts per million (ppm) or above or

  • have previously been provided with an opt-out referral but have not yet engaged with stop-smoking support and treatment.

[NICE's guideline on tobacco: preventing uptake, promoting quitting and treating dependence, recommendation 1.18.2]

Partners who smoke

Partners of pregnant women who say they smoke or have stopped smoking in the past 2 weeks. [NICE's guideline on antenatal care, recommendation 1.2.4]

Referral

When a pregnant woman who smokes is identified, an automatic referral is made for specialist stop-smoking support and treatment via an opt-out referral system. This is known as an 'opt-out referral'. The referral can be refused by the pregnant woman. [Adapted from NICE's guideline on tobacco: preventing uptake, promoting quitting and treating dependence, evidence review H].

Partners of pregnant women who smoke are offered referral to a hospital or local stop-smoking support and treatment (using local arrangements) if they want to stop or cut down their smoking. If they are not present, the pregnant woman should be asked to suggest that their partner contacts stop-smoking support and treatment using contact details provided by the healthcare professional. [Adapted from NICE's guideline on tobacco: preventing uptake, promoting quitting and treating dependence, recommendation 1.11.10]

Stop-smoking support and treatment

For pregnant women

Please see NICE's guideline on tobacco: preventing uptake, promoting quitting and treating dependence, recommendations 1.20.1 to 1.20.17.

For their partners

Please see NICE's guideline on tobacco: preventing uptake, promoting quitting and treating dependence, section 1.12 and recommendation 1.20.18.

Routine antenatal appointments

All pregnant women are offered the booking appointment (by 10 weeks), and appointments at 16, 28, 34, 36 and 38 weeks, and 41 weeks (for those who have not yet given birth). Pregnant women who have not given birth before have 3 additional appointments, at 25, 31 and 40 weeks. [Adapted from NICE's guideline on antenatal care, recommendations 1.1.7 and 1.1.8 and schedule of antenatal appointments]