Statistics on NHS Stop Smoking Services in England - April 2022 to March 2023 (Q4, Annual)

NHS Stop Smoking Services were first set up in 1999/2000 with the aim of reducing health inequalities and improving health among local populations.

Services were rolled out across England from 2000/2001 and provide free, tailored support to all smokers wishing to stop, offering a combination of recommended stop smoking pharmacotherapies and behavioural support.

The National Centre for Smoking Cessation and Training (NCSCT) supports the delivery of tobacco control programmes and smoking cessation interventions provided by local stop smoking services.

NHS England is responsible for the central collection, validation and analysis of NHS Stop Smoking Services (SSS) data.

Data are collected to assess performance, compare services, identify good practice and target underperforming services. See the “Data” section for details.

Data are submitted by local authorities using a web-based tool which has automated validation to check that submitted data meet data requirements. See “Validation” section for details. 

Data are collected and reported on a quarterly basis. Data submitted in quarters 1 to 3 is provisional but all data submitted in quarter 4 is final for that financial year.

For each local authority (LA)¹ quarterly data are collected for the following:

1. Number of people setting a quit date.
2. Number of successful quitters (self-reported).
3. Number of successful quitters (self-reported) where non-smoking status confirmed by Carbon Monoxide (CO) validation.
4. Number of unsuccessful quitters (self-reported).
5. Number not known/lost to follow up.

See “Data definitions” section for more details.

Additional information is collected on each quitter including demographic data (e.g. gender, age, ethnic category and socio-economic group) and treatment data (e.g. pharmacotherapy, intervention setting and intervention type). These data are used to monitor provision of services to different demographic groups and the efficacy of different treatment approaches.

Self-reported 4-week quitter
A treated smoker who reports not smoking for at least days 15–28 of a quit attempt and is followed up 28 days from their quit date (-3 or +14 days). (Russell Standard).

CO-verified 4-week quitter
A treated smoker who reports not smoking for at least days 15–28 of a quit attempt and whose carbon monoxide (CO) reading is assessed 28 days from their quit date (-3 or +14 days) and is less than 10 ppm (parts per million).

The -3 or +14 day rule allows for cases where it is impossible to carry out a face-to-face follow-up at the normal four-week point (although in most cases it is expected that follow-up will be carried out at 4 weeks from the quit date). This means that follow-up must occur 25 to 42 days from the quit date.

Lost to follow-up (LTFU)
A treated smoker who cannot be contacted face to face, via telephone, email, letter or text following 3 attempts to contact them at different times of day, at 4 weeks from their quit date (or within 25 to 42 days of the quit date). The 4-week outcome for this client is unknown and should therefore be recorded as LTFU on the monitoring form.

Data collection tool
In-built validations occur within the data collection tool (an Excel spreadsheet), with users automatically warned of validation failures and requested to either change their data or enter an explanatory note (an exception reason) where available. It is not possible to submit a file containing validation failures without explanatory notes.

The in-built validations are as follows:

• Completeness – checks that expected quarterly data is present.
• Consistency checks – checks for consistency of totals between different parts of the return, and that the number setting a quit date is not lower than the number successfully quitting in any category.
• Accuracy checks – checks that the success rate of the intervention type and setting is within the range 35% to 70%².
• Financial checks – Check that the cumulative spend on delivery of stop smoking services is less than the total allocation for smoking cessation for the year; Request an exception reason if the cumulative spend on delivery of stop smoking services appears to be too low (<10% of the total allocation for smoking cessation for the year); Request an exception reason where the total cost of pharmacotherapies is £0.
• Format checks – checks for non-numeric entries.

Exception reasons are included in Table 4.3c and should be considered when interpreting the other tables.

In addition, the data collections team checks that submissions have been received from all expected LAs.

Data collection system

Further checks are carried out in the data collection system when the data is submitted. This involves comparing the submitted data with historical data from the same LA. Where breach thresholds are exceeded, the submitter is asked to enter a breach reason into the system. The data will not be accepted until breach reasons are assigned to any breaches that are identified. The breach thresholds are as follows:

• Check that the percentage change between number of people setting a quit date in the current year to date and the previous year to date is within -66.6% and +100%.
• Check that the percentage point change between the proportion of people successfully quitting in the current year to date and the proportion from the previous year to date is within +/- 20 percentage points.
• Check that the proportion with a not known/lost to follow up outcome in the year to date is not higher than 40%.
• Check that the financial allocation is the same as for the previous quarter (quarters 2 to 4 only).
• Check that the cumulative spend on delivery of stop smoking services is greater than the figure for the previous quarter (quarters 2 to 4 only).
• Check that the total cost of pharmacotherapies issued as part of the service is greater than the figure for the previous quarter (quarters 2 to 4 only).
• Check that other monies allocated to smoking cessation are greater than or equal to the figure for the previous quarter (quarters 2 to 4 only).

Breach reasons are included in Table 4.3d and should be considered when interpreting the other tables.

Current data quality reporting
A data quality report is available as Table 4.2 within the NHS Stop Smoking Services Excel workbook. It presents a series of LA level data quality indicators based on submitted data. These are as follows:

• Percentage of records where outcome was not known / lost to follow up.
• Percentage of records where ethnic group was not stated.
• Percentage of records with missing socio-economic code.
• Percentage of records where pharmacotherapy was not known.
• Percentage of records categorised as 'other' for intervention setting.
• Percentage of records categorised as 'other' for intervention type.

This comparable data quality information enables LAs to benchmark their performance and target improvements.

Reports are also accompanied by a data quality statement which explains how any missing data have been handled.

If the total cost of pharmacotherapies is zero or not available then total expenditure (excluding pharmacotherapies) and cost per quitter (excluding pharmacotherapies) are shown as not available.

If LAs provide the total cost of pharmacotherapies but do not provide data for the total spend on delivery of stop smoking services or other spend on smoking cessation, (including any underspend carried over from the previous year), then all totals and cost per quitter are shown as not available.

Prescription data is extracted from a data warehouse hosted by NHS Prescription Services, which is part of the NHS Business Services Authority. NHS Prescription Services process prescriptions in order to reimburse dispensers. The data presented in this report includes prescriptions prescribed by GPs, nurses, pharmacists and others in England and dispensed in the community in the UK and prescriptions written in hospitals.

Prescriptions dispensed in hospitals and private prescriptions are not included in this data. Prescriptions are prescribed either by a paper prescription form or via an Electronic Prescription Service (EPS) message. Each single item prescribed is counted as a prescription item. Net Ingredient Cost (NIC) is the basic cost of a drug. It does not take account of discounts, dispensing costs, fees or prescription charges income. 

Prescribing data presented in Statistics on NHS Stop Smoking Services excludes data on drugs supplied direct to patients without prescriptions. Services such as stop smoking services can supply nicotine replacement therapy (NRT), either direct to patients or through vouchers redeemable at pharmacies. In addition, stop smoking prescription medications can be issued on behalf of these services by pharmacists through Patient Group Directions. These supplies are not recorded in national prescriptions datasets and are also excluded.

Reports are published quarterly with a larger report at the end of the financial year. Publication dates of the upcoming reports are available.

The reports include information on the number of people setting a quit date and the number who successfully quit at the 4 week follow-up. They also present in depth analyses of the key measures of the service including pregnant women quitting and breakdowns by age group, gender, ethnic group and type of pharmacotherapy received. Analyses are presented at national, regional and LA level.

The Tobacco Control Plan, Towards a Smokefree Generation, was published in July 2017 and set national ambitions for the end of 2022. An updated version has not yet been released.

In 2019, the government announced the Smokefree 2030 ambition, which aims for the prevalence of smoking in England among adults to be below 5%. Following this, in June 2021, the All Party Parliamentary Group (APPG) on Smoking and Health published a report with 12 recommendations for a new Tobacco Control Plan. These are as follows:

1. Legislate to make tobacco manufacturers pay for a Smokefree 2030 Fund to bring an end to smoking
2. Take our place on the world stage as a global leader in tobacco control.
3. Set interim targets for 2025, and update our strategy if we are not on track to a Smokefree 2030 by then
4. Deliver anti-smoking behaviour change campaigns targeted at routine and manual and unemployed smokers (C2DE).
5. Ensure all smokers are advised to quit at least annually and given opt-out referral to Stop Smoking Services.
6. Target support to give additional help to those living in social housing or with mental health conditions, who have high rates of smoking.
7. Ensure all pregnant smokers are given financial incentives to quit in addition to smoking cessation support.
8. Fund regional programmes to reduce the use of illicit tobacco in deprived communities.
9. Legislate to put health warnings on individual cigarettes, quit messaging on pack inserts and close other loopholes in existing regulations.
10. Reduce the appeal and availability of e-cigarettes and other nicotine products to children.
11. Make the route to medicinal licensing fit for purpose to allow e-cigarettes to be authorised for NHS prescription.
12. Consult on raising the age of sale for tobacco from 18 to 21.

Further recommendations were published in 2022 in the Khan Review: ‘Making smoking obsolete’, an independent review to the progress being made towards the 2030 goal.

Other recent legislation about smoking includes:

1. The Tobacco and Related Products Regulations 2016 came into force in May 2016, implementing the rules set out in the European Union Tobacco Products Directive, which includes many updates to regulations concerning the manufacture, presentation and sale of tobacco and related products including and also sets out new regulations covering e-cigarettes³.
2. New rules on tobacco, e-cigarettes and smoking came into force on 1 October 2015 in England and Wales, including rules about smoking in private vehicles.

Policies and information relating to government action on smoking are available.

NHS England publishes the following reports which include data on smoking in England. 

Statistics on Public Health
This annual report includes statistics on smoking and presents a broad picture of health issues relating to smoking in England, covering topics such as smoking prevalence, habits, behaviours and attitudes among adults and school children, smoking-related ill health and mortality and smoking-related costs. This comes from a variety of sources and includes new analyses carried out by NHS England.

Health Survey for England
The Health Survey for England (HSE) was designed to monitor trends in the nation’s health, to estimate the proportion of people in England who have specified health conditions, and to estimate the prevalence of risk factors associated with these conditions. The surveys provide regular information that cannot be obtained from other sources on a range of aspects concerning the public’s health. Since 1991, the HSE has included questions related to smoking.

Smoking, Drinking and Drug Use among young people
This report presents information from a survey of secondary school pupils in England (mostly aged 11 to 15) and includes data on: smoking prevalence; attitudes towards smoking; relationships between smoking and other factors such as age, gender, ethnicity and previous truancy or exclusion.

Statistics on NHS Stop Smoking Services
These quarterly reports include information on the number of people setting a quit date and the number who successfully quit at the 4 week follow-up. They also present in depth analyses of the key measures of the service including pregnant women quitting and breakdowns by age group, gender, ethnic group and type of pharmacotherapy received. Analyses are presented at national, regional and LA level.

Statistics on Women's Smoking Status at time of delivery
These quarterly reports present the latest results and trends from the women's smoking status at time of delivery (SATOD) data collection in England. They provide a measure of the prevalence of smoking among pregnant women at Clinical Commissioning Group (CCG), Clinical Commissioning Region, Sustainability and Transformation Partnership (STP), and national levels.

Maternity Services Data Set

This data set captures information about activity carried out by Maternity Services relating to a mother and baby(s), from the point of the first booking appointment until mother and baby(s) are discharged from maternity services. Data on smoking at point of booking (CQIMSmokingBooking) and smoking at point of delivery (CQIMSmokingDelivery) is published monthly and can be found in the measures file of the Maternity Services Monthly Statistics publication.

What about YOUth?
What About YOUth? is a postal survey of 15 year-olds and was run in 2014. It collected robust LA level data on a range of health behaviours including data on smoking.

Infant Feeding Survey
The Infant Feeding Survey includes statistics on smoking behaviour among women before and during pregnancy. It was last carried out in 2010 and is now discontinued.

Readers may find the following external organisations and publications useful resources for further information on smoking. A list of additional resources can be found in appendix A of the latest Statistics on Smoking report.

Action on Smoking and Health (ASH)
ASH is a campaigning public health charity that works to eliminate the harm caused by tobacco. Their website provides a range of resources and publications.

Local Tobacco Control Profiles for England
The Local Tobacco Control Profiles for England provide a snapshot of the extent of tobacco use, tobacco related harm, and measures being taken to reduce this harm at a local level.

National Centre for Smoking Cessation and Training (NCSCT)
The NCSCT supports the delivery of effective local sop smoking services by delivering training and assessment programmes, providing support services for local and national providers and conducting research into behavioural support for smoking cessation.

National Institute for Health and Care Excellence (NICE)
NICE produces public health guidance, for those working in the NHS, LAs and the wider public and voluntary sectors, on the promotion of good health and the prevention of ill health.

Smokefree Action Coalition
This group of organisations is committed to promoting public health and came together initially to lobby for smoke free workplaces. It is now committed to reducing the harm caused by tobacco more generally.

Smokefree campaign
The Smokefree campaign provides information, tools and video content for smokers who want to be smoke free. Smokers can also look up their local stop smoking service provider.

The Smokefree Resource Centre
The Smokefree Resource Centre supports the marketing of local services by providing resources such as Smokefree literature, brand materials and guidance and also has the latest news about the national campaign.

From our engagement with customers we know there are many users of this report. There are also many users of these statistics who we do not know about. We are continually aiming to improve our understanding of who our users are in order to enhance our knowledge on what the uses of these data are via recent consultations and feedback forms available online.

In 2016 a consultation was implemented to gain feedback on how to make the report more user-friendly and accessible while also producing it in the most cost-effective way. The results of this consultation are available. 

Below is listed our current understanding of the known users and uses of these statistics. Also included are the methods we use to attempt to engage with the current unknown users.

Department of Health and Social Care (DHSC) - frequently use these statistics to inform policy and planning. The Public Health Outcomes Framework was published in January 2012 which sets out the desired outcomes for public health and how these will be measured. The DHSC publishes policies such as the Tobacco Control Plan (18 July 2017).

Office for Health Improvement and Disparities - frequently use these data for secondary analysis and for inclusion in their Local Tobacco Control Profiles.

Media - these data are used to underpin articles in newspapers, journals and other articles.

Public - all information is accessible for general public use for any particular purpose.

NHS - Use the reports and tables for analyses, benchmarking and to inform decision making.

Public Health Campaign Groups - data are used to inform policy and decision making and to examine trends and behaviours.

Ad-hoc requests – the statistics are used by NHS England to answer Parliamentary Questions (PQs), Freedom of Information (FOI) request and ad-hoc queries. Ad-hoc requests are received from health professionals; research companies; public sector organisations, and members of the public, showing the statistics are widely used and not solely within the profession.

This publication is free to access via the NHS England website, and consequently the majority of users will access the report without being known to us. Therefore, it is important to put mechanisms in place to try to understand how these additional users are using the statistics and to gain feedback on how we can make these data more useful to them. On the webpage where the publication appears there is a “Contact us” link at the bottom of the page. Any responses are passed to the team responsible for the report to consider.