Smoke-free Scotland - Guidance on smoking policies for the NHS, local authorities and care service providers

6 Smoking Cessation

The legislation does not require the provision of support to smokers who want to stop smoking. The provision of such support is however recognised good practice and as such is an essential component of the Scotland's Health At Work bronze award. Some of the most significant health benefits to be gained when premises become smoke-free will only be realised if smokers see the move to smoke-free status as an opportunity or trigger to stop smoking, and are provided with support and encouragement to help them do so.

Encouraging people to quit the habit, by raising awareness of the health and other benefits linked to cessation, is something that all employers and service providers can do. They can also raise awareness of the cessation services available in their locality and encourage people to access them. Employers may consider offering cessation services. The benefits of stopping smoking include a direct benefit to the health of the individual, as their risk of developing tobacco related disease reduces.

The following table indicates the reduction in risk once someone has quit smoking: ²⁵

This reduction in risk should result over time with a fall in sickness rates, and in these days of an ageing workforce should reduce the impact of tobacco related disease on the workforce, especially when measured in terms of the premature retirement and the premature death of experienced and valuable workers.

Responsible organisations can offer valuable support to staff, patients, clients, residents and visitors by publicising smoking cessation services and encouraging staff to access them.

Managers should contact the local NHS providers of cessation services and information on the benefits of stopping and how to stop should be made widely available.

Similarly the 0800 84 84 84 Smokeline number should be widely publicised.

Smoking cessation and hospitals - in-patients

In September 2004 new guidelines for smoking cessation services were published by NHS Health Scotland and ASH Scotland. The guidelines highlight the importance of hospital patients being given the opportunity to quit smoking, as well as the importance of cessation services being available to workplaces. "All health professionals should have access to information on the smoking status of their patients and should ensure that smokers have been advised to stop. All smokers making an attempt to stop should be strongly encouraged to use specialist smoking cessation services (which offer group or individual counselling with Nicotine Replacement Therapy - NRT). Patient groups such as hospital in-patients and pregnant smokers should be offered smoking cessation treatment appropriate to their circumstances at locations and schedules to suit them. Where practicable, smoking cessation services should offer outreach services to non- NHS locations such as workplaces and prisons" ²⁶.

In preparing prospective in-patients for their stay in hospital, the best option is to encourage smokers to give up the habit. Steps can be taken to help them give up the habit before, during and after their stay in hospital. Patients being admitted for elective procedures should be advised that the hospital operates a smoke-free policy and should be provided with information about the benefits of stopping smoking as far in advance of their stay as possible. They should be given the contact details for the local NHS cessation services and the Smokeline number (freephone 0800 84 84 84) or encouraged to see their GP for help.

Where possible all hospitals should be able to offer a cessation service to in-patients.

On discharge patients, who have either tried to stop smoking during their stay in hospital or have expressed an interest in quitting the habit should be referred on to the community based cessation services

Out-patients. Out-patient departments should promote smoking cessation via signs, notice boards and the referral of patients to smoking cessation programmes either in the hospital or via the NHS cessation services.

Adolescent smokers (under the age of 16). Adolescents who are regular smokers should be encouraged to quit the habit either via their outpatient clinic or prior to or during their stay in hospital. The NHS cessation services and the Smokeline are able to provide tailored advice for this age group.

Cessation issues for local authorities and care service providers

So far as staff is concerned, anyone who wishes to stop smoking should be encouraged to do so. Some employers, recognising the benefit which cessation brings, offer to support the individuals by giving them time off to attend a cessation group - as an example, employees may give fifty percent of their own time to attend a cessation group and this contribution is matched by the employer.

It is important to promote local NHS services and they may be able to come into the organisation, if demand is sufficient and a group would be of a viable size.

For residential client groups, including young people, cessation is very important. Young people should be put in contact with the NHS cessation service. Older people may feel that as they have smoked for many years, the health benefits of quitting will be lost to them. However smoking later in life has been associated with higher rates of physical disability, poorer self-perceived health status, higher levels of depressive symptoms and lower levels of physical function, bone mineral density, pulmonary function and muscle strength ²⁷. Consequently smoking cessation for older people can bring about major improvements in their general health and wellbeing.

A note on cessation methods - traditional or alternative?

Our understanding of what works so far as smoking cessation is concerned is based on many years of experience and a wide variety of studies. The move towards evidence-based practice is particularly pertinent for smoking cessation where many purprted remedies are available - often expensive and with little evidence to support their efficacy.

We know that the cold turkey approach will result in around 5 in 100 quitters being successful, and advice from a health professional, plus the use of pharmacological products, could see more than 20% of quit attempts being successful ²⁶. Research by the Cochrane collaboration is recognised as being an excellent, up to date source of reliable information on treatment outcomes. Reviewing the evidence reveals that, "Hypnotherapy is recognized as being popular but has not been found to have a specific effect above simple counselling. Acupuncture has been studied and found not to have any specific effect. St John's Wort - there are no published trials showing a benefit in aiding permanent smoking cessation." ²⁵

In essence organisations wanting to help staff or clients quit smoking should be wary of purchasing alternative sources of treatment.

Two key questions which might be asked before purchasing a smoking cessation product or service are therefore:

• How much will this cost? NHS cessation services are free and if they recommend the use of NRT or other pharmacological cessation aids then these are available on prescription
• Is there clear, objective evidence to support any claims made by the potential supplier that their service / product is effective, and if claims are being made, have they been reviewed independently? NHS cessation services have been evaluated and have been shown to be effective in increasing the chances of successfully stopping smoking.