New NICE commissioning guide set to improve services to help mothers quit smoking

The National Institute for Health and Care Excellence (NICE) has published a commissioning guide to help the NHS in England effectively commission evidence-based services to help women who smoke during pregnancy and after childbirth to quit. The guide, published last month, provides support for the local implementation of NICE guidance through commissioning, and is a resource for people involved in commissioning health and social care services and public health programmes within the NHS and partner organisations in England.

Smoking in pregnancy is a major public health concern imposing a considerable economic burden on society, and increasing risks to both mother and child. It can increase the risk of miscarriage, premature birth, still-birth and sudden unexpected death in infancy. Exposure to smoke in the womb is also associated with psychological problems in childhood such as attention and hyperactivity problems. Meanwhile, children of parents who smoke tend to suffer from more respiratory problems like asthma or bronchitis and have problems of the ear, nose and throat, compared to children in non-smoking households. It is thought to cost the NHS between £20 million and £87.5 million each year to treat mothers and small infants under 12 months old with problems caused by smoking in pregnancy.

Underpinned by the NICE public health guidance on quitting smoking in pregnancy and following childbirth, the NICE commissioning guide signposts and provides topic-specific information on key clinical and service-related issues to consider during the commissioning process. It also offers an indicative benchmark of activity to help commissioners determine the level of service needed locally. An interactive tool provides data for local comparison against the benchmark and resources to estimate and inform the cost of commissioning intentions.

The potential benefits of commissioning effective services for quitting smoking in pregnancy and following childbirth identified in the guide include:

  • Reducing morbidity and infant mortality
  • Reducing inequalities and improving accessto NHS Stop Smoking Services by increasing referral routes from maternity services and others in the public, community and voluntary sectors
  • Improving engagement with NHS Stop Smoking Servicesby increasing the number of pregnant women receiving specialist support while attempting to stop smoking
  • Increasing choice for pregnant womenby improving partnership working and offering access to a range of services across a number of settings
  • Reducing costs associated with smoking-related complications for mothers during pregnancy and babies following birth
  • Increasing clinical and cost effectiveness by making commissioning decisions based on NICE guidance and accredited information from NHS Evidence

Jennifer Field, NICE Associate Director - Costing and Commissioning, said: “We know that the average GP practice will see around 27 pregnant women per year who will be smoking at first maternity booking and referred to an NHS Stop Smoking Service. We also know that smoking during pregnancy is the single most modifiable risk factor for adverse outcomes in pregnancy. This commissioning guide shows commissioners how they can reduce morbidity and cost by ensuring that clear and systematic referral pathways are in place for pregnant women who smoke to be referred into appropriate services and to receive help to quit, and by ensuring that service providers are trained and competent to provide evidence-based interventions.”

The NICE commissioning guides are one of a number of products introduced by NICE focussing on helping the NHS as it faces up to arguably its greatest challenge yet - to deliver the QIPP (Quality, Improvement, Productivity and Prevention) agenda, whilst facing a squeeze on finances.

While the commissioning guide draws on existing NICE recommendations, it does not constitute formal NICE guidance and is intended as a tool to help the NHS improve patient care through effective commissioning of services.


Notes to editors

About NICE commissioning guides

1. These guides are designed as a resource for people involved in healthcare commissioning. They are underpinned by, and support the implementation of, recommendations in NICE guidance. Each guide is splitinto five sections, as follows:

  • Why commission this service?

This explains how to ‘make the case' locally. It highlights the benefits and the key clinical issues. It also links the commissioning process to national targets, the Healthcare Commission's standards and its inspection process.

  • What service elements need to be considered in order to commission effective clinical care?

This offers advice on a range of issues including: referral criteria, the accessibility of services, service models, and service specification content. It also provides links to relevant NICE guidance and other sources of useful information.

  • What level of service do I need locally?

A benchmark figure for a standard, defined population is provided, along with an explanation of the assumptions on which it is based.

  • What resources will be required locally?

The commissioning guides allow individual practices, groups of practices or primary care trusts (PCTs), and strategic health authorities (SHAs) in England to highlight the local resources needed and any opportunities for disinvestment. The models can also be used to determine whether a service should be provided by a PCT or commissioned from secondary care. ‘Activity' data - on how much a current service or intervention is being used - is also provided where available.

  • What mechanisms are available for quality and corporate assurance?

This includes suggestions for audit and monitoring arrangements and how to meet local clinical governance and corporate assurance requirements, signposting useful information including competence frameworks and audit criteria.

About the NICE commissioning guide on quitting smoking in pregnancy and following childbirth

2. The NICE guide on quitting smoking in pregnancy and following childbirth is available on the NICE website at

3. The guide is the fifth commissioning guide published by NICE in the last 6-months - the others being:


4. Details of all the 35 NICE commissioning guides published to date can be found on the NICE website at

About NICE

5. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.

6. NICE produces guidance in three areas of health:

  • public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
  • clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS

7. NICE produces standards for patient care:

  • quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
  • Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

8. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.

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This page was last updated: 19 January 2011

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Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.