Nick Summerton: NHS cash up in smoke on pointless scheme

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A FEW years ago, the Australian Government commissioned an advertising campaign designed to persuade people to stop smoking.

In one particularly memorable TV commercial, a pregnant lady was filmed sorting through packets of cigarettes emblazoned with the caption “Smoking Can Be Harmful In Pregnancy”.

Eventually she found a packet bearing the alternative wording ‘“Smoking Is Dangerous To People With Asthma”, which she promptly purchased.

The strap line at the end of the advert read: “You don’t have to be stupid to smoke, but it helps.”

In much the same vein, the National Institute for Health and Care Excellence’s call for the NHS to become smoke-free proves you don’t have to be stupid to spend money on writing blindingly obvious guidance and coming up with initiatives that are not supported by the evidence, but it certainly helps.

Claiming that the NHS has turned a blind eye to smoking for far too long, NICE wants to see smoking shelters scrapped and all hospitals to have an on-site stop smoking service, with patients who smoke offered help to quit.

NHS staff will also be allowed to attend stop smoking services during working hours without loss of pay.

It is further recommended that smoking-related information and advice should be provided for carers, relatives and other hospital visitors, together with the development of a policy for smoke-free hospital grounds.

According to NICE, the policy will need to be promoted as part of a communications strategy with “consistent” and “positive” messages.

Aside from stating the obvious that NHS staff should set an example by not smoking and that patients should not have to step over piles of discarded cigarette butts at the entrance to a hospital, what is particularly intriguing about this guidance is that it skirts around the fact that the NHS actually has a pretty dismal record when it comes to helping smokers to quit.

Each year since 2001, only about one-third of those who use its specialist smoking cessation services have given up. Of these, 80 per cent will relapse at some point. Since the mid-1990s, the numbers of smokers within the UK has hovered stubbornly around the 20 per cent mark.

One of the reasons we are keen to stop people smoking is that it increases their risks for conditions such as lung cancer.

It is important, however, not to focus solely on smoking, which could mean ignoring the potential for screening or earlier diagnosis in seeking to reduce death rates from cancer.

Although a reliable screening test for lung cancer is not yet available, the Department of Health has been encouraging individuals (especially if they are smokers) to come and see GPs, such as myself, if they have a persistent cough, as this can be a feature of early lung cancer.

Intriguingly, although NICE has now published no fewer than seven public health guidelines on various aspects of smoking cessation, its guidelines for referring suspected cancer cases still recommend a chest X-ray in patients with a persistent cough.

Moreover, they fail to tell us that the results of this X-ray can be “normal” in about a quarter of patients who are subsequently diagnosed with lung cancer.

Several studies have now demonstrated that low-dose chest CT scanning is actually much more effective in picking up curable lung cancers, but you will not find any NICE guidance on this as it is costly and, as yet, not widely available throughout the NHS.

Another issue is that NICE guidance is very expensive to develop and implement.

This new public health guidance on smoking will no doubt lead to a plethora of meetings and training events which will see NHS staff being taken away from delivering frontline services to patients.

I already struggle to get timely discharge letters and results from 
my local hospitals – and thanks to NICE I now expect this problem to get even worse.

Moreover, as a GP, I will now also be expected to provide specific written information to patients I might refer to one of my three local hospitals about their particular smoke-free policies.

I used to be employed by NICE as 
their consultant clinical and public health adviser. What I would now say to my former colleagues is that 
in circumstances where NHS resources are very tight, they would do well to choose their battles a little more carefully.

*Dr Nick Summerton is a GP in East Yorkshire.