Statistics on NHS Stop Smoking Services in England April 2019 to March 2020

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 Digital 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 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.

¹From April 2013 responsibility for commissioning these services moved from Primary Care Trusts (PCTs) to Local Authorities (LAs).

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

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 four 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 three attempts to contact them at different times of day, at four weeks from their quit date (or within 25 to 42 days of the quit date). The four-week outcome for this client is unknown and should therefore be recorded as LTFU on the monitoring form.

Initial data collection stage
In-built validations occur at the point of data entry within the data collection tool, with users automatically warned of validation failures and requested to either change their data or enter an explanatory note. 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 (including previous quarters).
• Consistency checks – checks for consistency of totals between 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 per cent to 70 per cent².
• Format checks – checks for non-numeric entries.
• Financial data checks – checks that the cumulative spend is never less than the previous quarter.

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

Post submission checks
Further checks are carried out after the data has been submitted. This involves comparing the submitted data with historical data from the same LA. Where breach thresholds are exceeded, these may be queried with the supplier and resubmissions may then occur. 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 -66²/₃ per cent and +100 per cent
• 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 per cent.

Data is not automatically rejected if it does not pass these validations. They are used as a warning for further investigation and discussion with the LA. Breach reasons are included in table 5.3C and should be considered when interpreting the other tables.

Current Data Quality Reporting
A data quality report is available as table 5.2 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 local authorities 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.

² Note that success rates based on fewer than 20 quit attempts are not checked as rates based on so few attempts can often lie outside this range. E.g. if there is only one quit attempt then the success rate can only be 0 per cent or 100 per cent which will always be queried and this places a burden on LAs to provide an explanation.

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 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 end year report. 

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 levels. 

The Tobacco Control Plan, Towards a Smokefree Generation, was published in July 2017 and set out the following national ambitions for the end of 2022:

• Reduce the prevalence of 15 year olds who regularly smoke from 8% to 3% or less.
• Reduce smoking prevalence amongst adults in England from 15.5% to 12% or less.
• Reduce the inequality gap in smoking prevalence between those in routine and manual occupations and the general population. 
• Reduce the prevalence of smoking in pregnancy from 10.7% to 6% or less.
• Improve data collected on smoking and mental health to help us to support people with mental health conditions to quit smoking.
• Make all mental health inpatient services sites smokefree by 2018.
• Help people to quit smoking by permitting innovative technologies that minimise the risk of harm.
• Maximise the availability of safer alternatives to smoking.

The plan is targeted around four main themes, with a range of actions for each:

1. Prevention first
2. Supporting smokers to quit
3. Eliminating variations in smoking rates
4. Effective enforcement

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

³ E-cigarettes that contain more than 20 mg/ml of nicotine or make medicinal claims will be regulated by the Medicines and Healthcare products Regulatory Agency.

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

Statistics on Smoking
This annual report 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 the NHS Digital.

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 levels.

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 Commissioning Region, Area Team and Clinical Commissioning Group level.

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 is a campaigning public health charity that works to eliminate the harm caused by tobacco. Their website provides a range of resources and publications: http://www.ash.org.uk/.

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
The NCSCT supports the delivery of effective local stop 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 Clinical Excellence
NICE produces public health guidance, for those working in the NHS, local authorities 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 can be found at the below link.

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 Department of Health publishes policies such as the Tobacco Control Plan (18 July 2017) and all policies can be found via this link: 

Public Health England - 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 Digital 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 Digital 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.