Let’s make every contact count! Reply

The Scottish Tobacco-free Alliance formed a working group this year to address the poor rates of referral to stop smoking services for patients facing hospital treatment. In this post our Partnerships Lead and STA Coordinator, David Robertson, tells us more.

In Scotland there are clear guidelines in place to help build a health-promoting health service that reduces the number of healthcare staff who smoke, creates provision for the training of health professionals at appropriate levels to refer smokers to stop smoking services and builds effective referral pathways.

There are good reasons for creating a blueprint for an effective way to reduce the number of people smoking before they undergo surgery or periods of time in hospital for testing or therapies.

Hospitals do not allow smoking, and patients are apprehensive enough when they arrive without having to undergo nicotine withdrawal as well. Patients who enter hospital can be offered nicotine replacement therapy to control their cravings; you don’t always know you are going to end up in hospital. However, to avoid the worst impacts of smoking on recovery it is better if the patient has been smoke-free for over four weeks.

Why? Because that allows lung and circulatory health to improve, leading to fewer complications during surgery. Quitting smoking may reduce the amount of anaesthetic required during an operation, improves the viscosity of the blood thus reducing clotting risk, and increases oxygen circulation leading to faster wound healing and fewer post-operative infections.

The Royal College of Physicians 2018 report Hiding in plain sight calculated that the total avoidable cost to the NHS from current smoking arising from hospital care, postoperative infections, the higher doses of drugs for mental health problems, and loss of productivity in staff, amounts to around £1 billion a year to the NHS across the UK. Postoperative infections resulting from current smoking cost the NHS in England at least £2.5 million each year.

The benefits of stopping smoking do not just accrue to those patients facing surgery. Since smoking impacts on every system of the body, quitting has a positive impact on treatment for cancer, mental ill-health, diabetes, rheumatoid arthritis, COPD and macular degeneration of the eye to name a few.

The plain fact is, not enough is being done to make the most of existing stop smoking provision. A British Thoracic society survey of hospital cessation published in 2016 found that

  • more than 1 in 4 patients were not asked if they smoke
  • nearly 3 out of 4 smokers were not asked if they would like to quit smoking
  • 50% of frontline healthcare staff were not offered regular smoking cessation training.

Of the smokers who were asked if they would like to quit smoking, only 20% of this group were referred to a hospital stop smoking service and only 7% were referred to a community-based service – which are the services that treat tobacco dependence the most effectively.

So why doesn’t every contact with a smoker by a healthcare professional result in an exploration of a smokers willingness to stop? Hiding in plain sight suggests that greater investment in hospital based services is required along with a presumption that a smoker will accept support to either quit or stop before and during treatment. In addition there needs to be mandatory brief advice training for the entire healthcare profession workforce during qualification and in-service.  Leadership to ensure facilities are smoke-free and referral pathways are attended to is key.

Consequently, the STA and ASH Scotland are calling on all healthcare professionals to ensure that every smoker they meet is aware of the benefits of stopping smoking and that free help is available to support them. Why stop at the NHS? There are many people engaged in charities and community support agencies who provide help to those suffering from long-term illness and battling multiple health issues. Help to stop smoking may be the break they needed.

Creating a positive quitting environment where friendly advice and support is always on offer is the key to ensuring that patients get better quicker or stay healthier longer.

For more information please contact ASH Scotland on 0131 225 4725 or enquiries@ashscotland.org.uk

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