Smoking kills, but is entirely preventable. All clinicians encounter smokers in their daily work, and most will have first-hand experience of caring for people whose lives have been destroyed by addiction to smoking tobacco. For nearly six decades, the Royal College of Physicians has led medical opinion on tobacco policy and clinical practice, and with the many other organisations and individuals involved in advocacy for smoking prevention has made a significant contribution to achieving a substantial fall in smoking prevalence in the UK. However, there is one area where policy and practice have singularly failed to achieve their potential, and that is in helping our patients who smoke to quit. Despite the availability of evidence-based clinical guidelines on smoking interventions in the UK for 20 years, smokers who use NHS facilities, and in particular our hospitals, are admitted and discharged without being asked if they are a smoker, or if asked, without being offered help, or if offered help, without that help being delivered at the time of the admission. Our consistent failure to act on the largest avoidable cause of premature death and disability in the UK needs to be remedied.
This report addresses the harms and costs arising from smoking in the patients we see every day, and argues for a new approach to treating their addiction. We argue that existing models of delivering stop smoking services separately from mainstream NHS services, while successful in the past, may now not be the best approach. We argue that responsibility for treating smokers lies with the clinician who sees them, and that our NHS should be delivering default, opt-out, systematic interventions for all smokers at the point of service contact. We demonstrate that clinicians working in almost all areas of medicine will see their patient’s problems improved by quitting smoking, and that systematic intervention is a cost-effective means of both improving health and reducing demand on NHS services. Smoking cessation is not just about prevention. For many diseases, smoking cessation represents effective treatment.
As doctors we must therefore recognise that treating tobacco dependence, effectively and routinely, is our business. Smoking cessation should be incorporated, as a priority, as a systematic and opt-out component of all NHS services, and delivered in smoke-free settings. It is unethical to do otherwise.
Professor Jane Dacre, President, Royal College of Physicians