Stop smoking services: keep quitters winning

The NHS has rightly recently celebrated the success of its stop smoking services over the past 10 years. But new research from the London Health Observatory shows services are not targeting communities with the highest levels of smoking effectively because they lack crucial data - and to continue the good progress this needs to be addressed.

More routine and manual workers in London smoke than in any other socio-economic group

The Observatory’s findings from the “London Boost” of the annual Health Survey for England show major contrasts in smoking rates between different local authorities and primary care trusts. For example, figures for 2006 show this ranges from 13 per cent in Ealing to 32 per cent in City and Hackney. And more routine and manual workers in London smoke than in any other socio-economic group. They also identified significant ethnic and gender differences in smoking which mean some communities are more at risk and need more help to quit smoking.

However, in the smoking cessation data the Observatory collected, 15 per cent of records did not have a specified ethnicity.

Poor recording

Observatory director Bobbie Jacobson says some of the stop smoking data is poorly and inconsistently recorded and managed.

“This results in major limitation in what we can learn about the delivery and effectiveness of smoking cessation services in London,” says Dr Jacobson.

Observatory analysis found the 24 PCTs in the London sample were effectively targeting stop smoking services at the most deprived communities with high smoking rates. But the proportion of people quitting at four weeks was greatest in wealthier areas (52 per cent compared with 45 per cent in the most deprived areas).

Nearly one in five clients using London’s services did not have a valid postcode, so there is no information on where service users actually live, rather than where they use a service. For example, London stop smoking clinics are often used by commuters who live outside the city. The rates also need to be based on the number of people smoking in a particular area, rather than the whole population. If this information were available it would be possible to calculate accurately the quit rates, and which communities are using stop smoking centres.

The four-week quit rate figures are impressive, between three and 11 per 1,000 of the adult population. However, this underestimates the true impact of smoking cessation services in London because not all adults smoke. Estimates of the size of the smoking population in the 24 London PCTs in this survey suggest that between 13 and 45 people per 1,000 smokers quit at four weeks. But the London Boost, the Observatory’s own measure of smoking prevalence, shows the quit rate is higher at between 15 and 55 people per 1,000 smokers.

52% - Stop smoking service users quitting at four weeks in London’s wealthier areas

45% - Stop smoking service users quitting at four weeks in London’s most deprived areas

8% - Proportion of London stop smoking service clients who are recorded as still not smoking after one year

There is also little information tracking long term quit rates and the success of services - achieving long term quitting at one year was only recorded for 8 per cent of clients across London. The Observatory argues for better monitoring of stop smoking services with a follow-up a year after giving up.

However, several PCTs have demonstrated that long term follow-up is possible. Redbridge followed up 100 per cent of quitters and Brent 70 per cent, while Ealing and Hounslow monitored 59 per cent.

Data warehouse

Dr Jacobson says the creation of a pan-London stop smoking data warehouse “to support London’s PCTs in monitoring London’s stop smoking services could help to form the basis of better data and better informed, equitable commissioning”.

She says: “Alongside the reporting of more meaningful nationally reported data, this could help us greatly to play our part in meeting the national inequalities target for reducing smoking.”

The good news is the analysis has identified some important good practice which PCTs can share. A number of London PCTs are using effective approaches demonstrably targeting communities at risk.

NHS Islington takes a systematic approach to using data and intelligence to identify need, and believes starting from the client’s perspective before developing initiatives. It uses a creative and proactive approach with a focus on deprivation to target specific areas. For example, the PCT has commissioned local community based organisations to work with the Turkish and Somali communities, which are known to have high rates of smoking.

The Observatory’s analysis shows that in south London, NHS Sutton and Merton targeted services effectively to school age smokers. This has resulted in a higher than average proportion of young smokers using local stop smoking services than in the rest of London (12 per cent compared with 2 per cent).

By working in partnership with local secondary schools in Merton the PCT is providing stop smoking support during school time. Its latest data (for 2007) shows it has achieved a 30 per cent four-week quit rate.

Dr Jacobson adds: “Our report demonstrates the benefit of analysing and assessing data from PCT stop smoking services. Better monitoring and targeting means better outcomes - and more people helped to quit.”