Evidence Hub

Supporting the NHS Long Term Plan: An evaluation of the implementation and impact of NHS-funded tobacco dependence services. 

Quick-read summary

Researchers interviewed commissioners, tobacco control managers, healthcare staff and local authority public health consultants, to find out what services were available prior to the new NHS-funded tobacco dependence services, what the new service would look like, and how it was being implemented.

The research highlights some barriers and enablers to implementing the new NHS-funded tobacco dependence service, as well as key expectations of the new service.

Who is this evidence useful for?

Commissioners, secondary care providers, healthcare professionals, and policy makers

What is the issue?

• A new NHS-funded tobacco dependence service within secondary care (hospitals) is being introduced across England as part of the NHS ‘Long Term Plan’.
• This new service aims to identify a smoker on admission to hospital (either acute inpatients, mental health inpatients or through maternity services). At that stage, they will be provided with what is known as ‘Very Brief Advice’ (some basic stop-smoking advice) and then given a referral to the in-house Tobacco Dependence Advisors.
• The Tobacco Dependence Advisors will conduct a detailed assessment of the person’s smoking, and provide Nicotine Replacement Therapy and behavioural support to help support a period of abstinence and a potential quit.
• Upon discharge the patient will be referred to community stop smoking services for 12-weeks of support.

Research summary

Interviews were carried out with 23 people including tobacco control managers, respiratory consultants, local authority public health consultants, and 25 documents were collected from NHS trusts and NHS England.

What the research found

The research found four key themes:

• The tobacco cessation services available prior to the implementation of the new services were described as ‘patchy’, and some had regressed during the covid-19 pandemic.
• The systems and infrastructure in place during implementation of the new services was reported as a barrier to implementing the new service, as NHS Trusts needed to update and adapt their systems to collect the new data metrics.
• Transforming the views and culture of NHS Staff was reported as a barrier to implementing the new service, with tobacco dependence advisors struggling to provide Nicotine Replacement Therapy, as they were often staff not qualified to prescribe.
• The importance of framing tobacco dependence as an addiction as opposed to a lifestyle choice.

Why is this important?

The research highlights the context and the barriers to implementing the new NHS-funded tobacco dependence service within three clinical settings.

The work provides recommendations for commissioners, policy makers and frontline healthcare professionals to build upon.

The recommendations will help commissioners and policy makers to find solutions to the barriers identified within this research

How were patients, community groups or public members involved in this work?

This part of the project spoke with frontline healthcare professionals, commissioners and managers. The project also has a Public Advisory Group made up of four public members, who work closely with the research team throughout the project, providing feedback and guidance.

What’s next?

The next stage of this research project is ongoing. The research team are currently interviewing healthcare professionals working within the tobacco dependency teams, and patients who have accessed and utilised the new service. They are also accessing routinely collected patient level data to determine the effectiveness and cost-effectiveness of the new service.

Get in touch about this research

[email protected]

Link to full paper

A research abstract has been published in Lancet Public Health – November 2022