How public health cuts could leave Stop Smoking Services under threat

For many, the New Year offers a fresh chance for a lifestyle overhaul.

And if quitting smoking is on your resolution list, then free NHS Stop Smoking Services should be your first port of call as you’re around three times more likely to quit with their support than going it alone.

But what if they no longer existed?

Yesterday’s headlines prophesise that future. And it all comes down to vital funding coming under threat.

As part of the 2012 Health and Social Care Act, money for Stop Smoking Services – and responsibility for running them – now comes from local public health budgets, rather than the NHS. And following the £200 million cuts from these budgets last summer, and a further £331 million being cut over the next five years following the 2015 Spending Review, the picture’s looking a bit bleak.

We’ve been investigating this worrying trend, and yesterday we published our latest findings.

We’re really worried about the future of Stop Smoking Services. But, crucially, we think there could be a way to get those budgets looking healthy again, helping more people quit smoking.

And it comes from making those who’ve inflicted the damage – the tobacco companies – pay for it.

Funding cuts

Last March, we commissioned Action on Smoking & Health to look into the challenges Stop Smoking Services might face as responsibility for running them was handed over to local authorities.

Overall the impact of the transition was positive, with new relationships across local government enabling public health professionals to create new opportunities. But there were signs of problems developing, particularly around funding and resources.

Yesterday, we launched the second part of this report, which has revealed how drastically the situation has changed since then.

The report surveyed tobacco control staff in local councils across England, and nearly 90 per cent responded.

In response to the cuts to public health budgets, we found around four in every 10 local authorities in England are cutting budgets to Stop Smoking Services and wider tobacco control.

On a positive note, the report also found that many councils acknowledged the potential benefits to shifting the responsibility of tobacco control to local governments, such as improved relationships across local government. But worryingly, three out of four people questioned cited budget pressures as the biggest difficulty arising from this shift in power.

Based on these findings, it’s clear that the generally positive outlook on tobacco control we found in our first report is now being clouded by financial pressures, which undermine not only new initiatives but also established services.

A slowing decline

Since the cuts, we’ve heard high-profile calls to boost England’s approach to preventing cancer. In July, the Independent Cancer Taskforce, supporting the view of the Five Year Forward View for the NHS, recognised the need for a radical update in prevention and public health.

This was a bold and welcome rallying cry. But England would need to buck many of the trends we’ve recently seen in public health for this to happen in practice.

Recent evidence from a survey we help support – the Smoking Toolkit Study – suggests that smoking rates in England have stopped falling for the first time in years. We need a sustainable way to ensure people have the support they need to quit.

And figures released by the Health & Social Care Information Centre (HSCIC) last August show that the number of people using Stop Smoking Services fell by 23 per cent compared with the previous year – the first time the number has fallen for three consecutive years. While the reason for this fall is debated, one issue that can’t be contested is the financial pressure public health services are being forced to deal with.

Ultimately, the budget cuts are leaving local authorities with some tough decisions. If protecting their Stop Smoking Service comes at the cost of other local public health services, then something isn’t right – especially given the need to get serious on problems like obesity, as we highlighted last week.

Slashing funding for public health services represents a false economy, making the Taskforce’s call for a ‘radical upgrade’ impossible. While the reality is that financial pressures exist, cuts to services which are hugely cost-effective in the long-term represent a counter-productive approach.

On top of this, services will need to be run effectively and dynamically. They must be able to respond to changes in how people want to quit – such as the growing popularity of e-cigarettes – and incorporate them into how they operate. Cash-strapped services will obviously find this hard.

So what’s the alternative?

‘You broke it, you pay for it’

We believe that the tobacco industry – which makes eye-watering profits from a product which kills up to two in three long-term smokers and inflicts a massive financial burden on the country – should pay for the damage it has caused.

Tobacco use in England alone costs society approximately £13.8 billion each year, both in direct costs to the NHS, and other costs such as lost work days and productivity due to smoking related illness.

That’s why we are calling for the introduction of a levy on tobacco industry proceeds of £500 million per year: that works out at around one penny per manufactured cigarette sold each year. The money would come directly from the tobacco companies; it’s not an additional tax on the product. And the amount each company paid would be based on its market share.

Crucially, this money would be specifically earmarked to fund essential areas of tobacco control: Stop Smoking Services, mass media campaigns, and targeting illicit tobacco trade.

By holding the tobacco industry to account financially, Stop Smoking Services can be given the investment to ensure they can help more people quit.

Our vision for the future

As things stand, the future for Stop Smoking Services looks grim.

It’s a future where successful tobacco control policies are undermined.

We need to confront the cold hard fact that there is less cold hard cash. And if government fails to find new investment for Stop Smoking Services then smokers risk being left out in the cold.

We have a vision for the future: a tobacco-free UK where, by 2035, fewer than one in 20 adults smoke. If we are to realise this ambition, then it’s vital to help smokers quit by ensuring that the most effective route – through a Stop Smoking Service – receives continued investment.

And we think the Government should support these services by making the tobacco industry cough up, and pay for the damage they cause.

Alyssa Best is a policy adviser in our Cancer Prevention Department

• Find out more about NHS Stop Smoking Services
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