Specifying a smoking cessation service for people having elective surgery
The key components of a smoking cessation service for people having elective surgery are:
- identifying people who smoke
- ensuring appropriate information, referral and intervention
- ensuring a seamless pathway between secondary and primary care
- developing a high-quality smoking cessation service for people having elective surgery.
Identifying people who smoke
NICE public health guidance PH10 on smoking cessation services and NICE public health guidance PH1 on brief interventions and referral for smoking cessation outline the importance of every health professional advising all people who smoke to quit and offering them a referral for additional support.
The guidance on brief interventions (PH1) recommends that:
- Everyone who smokes should be advised to quit, unless there are exceptional circumstances. People who are not ready to quit should be asked to consider the possibility and encouraged to seek help in the future. If an individual who smokes presents with a smoking related disease, the cessation advice may be linked to their medical condition.
- It is important that all patients in hospital have their smoking status identified and recorded.
Commissioners should ensure that people who smoke and who are undergoing elective surgery are asked how interested they are in quitting, and that any advice offered to stop smoking is sensitive to the individual's preferences, needs and circumstances. The topic-specific advisory group suggested that the needs of patients who choose not to make a quit attempt, but who will be subject to enforced abstinence during their inpatient stay, should also be considered.
Ensuring appropriate information, referral and intervention
Ensuring that people are referred for the appropriate level of support and intervention is an important way to increase the number of people who access smoking cessation services.
Smoking cessation interventions described in NICE public health guidance PH10 on smoking cessation services include:
- a brief intervention (opportunistic advice)
- individual behavioural counselling
- group behaviour therapy
- pharmacotherapies or a combination of treatments, and
- other services delivered by NHS Stop Smoking Services.
It is important to identify the particular level of intervention that is suitable for each person in order to ensure appropriate onward referral. This will depend on several factors, including:
- the individual's willingness to quit
- how acceptable they find the intervention on offer
- the previous ways they have tried to quit.
Commissioners may wish to review current practice and consider with clinicians the best time to offer smoking cessation interventions, for example at the point of referral in primary care, during secondary care consultations and/or at preoperative assessment. NICE public health guidance PH1 on brief interventions and referral for smoking cessation recommends that GPs should take the opportunity to advise all patients who smoke to quit when they attend a consultation. Those who want to stop should be offered a referral to an intensive support service (for example, NHS Stop Smoking Services). If they are unwilling or unable to accept this referral they should be offered pharmacotherapy. Smoking cessation advisers and healthcare professionals may recommend and prescribe nicotine replacement therapy, varenicline or bupriopion as an aid to help people quit. This is in line with NICE public health guidance PH10 on smoking cessation services and NICE technology appraisal TA123 on varenicline for smoking cessation. Commissioners will also need to consider how to target services to meet the needs of their local population and in particular minority ethnic and socioeconomically disadvantaged communities. Changing clinical practice is likely to require education and training.
Ensuring a seamless pathway between secondary and primary care
- PCTs should ensure that NHS Stop Smoking Services can provide smoking cessation support to hospitals
- smoking cessation support should include a fast-track referral system after discharge for patients who have tried to quit smoking in hospital
- PCTs should develop a clear referral plan with links between primary and acute trusts.
NICE public health guidance PH1 on brief interventions and referral for smoking cessation recommends that monitoring systems are set up to ensure health professionals have access to information on the current smoking status of their patients.
Developing a high-quality smoking cessation service for people having elective surgery
Every contact with a healthcare professional is an opportunity to deliver a smoking cessation intervention. In order to deliver a high-quality smoking cessation service, NICE public health guidance PH10 on smoking cessation services recommends that:
- all frontline healthcare staff should be trained to offer brief advice on stopping smoking in line with NICE public health guidance PH1 on brief interventions and referral for smoking cessation
- all frontline healthcare staff should also be trained to make referrals where necessary and, if possible, to NHS Stop Smoking Services and other publicly funded smoking cessation services
- training should comply with the Health Development Agency's Standard for training in smoking cessation treatments or its updates
- commissioners should ensure that the NHS Stop Smoking Services provide a good service by maintaining adequate staffing levels,including a full-time coordinator (or the equivalent)
- NHS Stop Smoking Services are easily accessible by people from minority ethnic or socioeconomically disadvantaged groups.
NICE public health guidance PH10 on smoking cessation services provides further information regarding treatments that were not recommended for the NHS to provide.
Commissioners may provide a smoking cessation service for people having elective surgery in different ways. For example, these could include having:
- A smoking cessation adviser from the locally commissioned NHS smoking cessation service who visits the hospital to deliver interventions to inpatients.
- Smoking cessation adviser(s) from the locally commissioned NHS smoking cessation service who are based in the hospital and entirely dedicated to smoking cessation interventions in the hospital.
- A hospital-wide service delivered by specially trained staff as part of their overall role. They would be trained by the locally commissioned NHS smoking cessation service.
Whichever model is chosen, it should be supported and fully integrated within the wider NHS smoking cessation service commissioned for the local population.
Local stakeholders, including people who smoke, should be involved in determining what is needed from a smoking cessation service for people having elective surgery, in order to meet local needs.
The service specification needs to consider:
- the required competencies of, and training for, staff responsible for providing the service, that is, compliance with the standard for training in smoking cessation treatments
- the expected number of patients (this should take into account how quickly any changes in service provision are likely to take place)
- ease of access and service location: commissioners should engage with service users and other relevant individuals and organisations locally
- the generic principles of the NICE public health guidance PH6 on behaviour change
- care and referral pathways that also enable self-referrals from patients and carers and visitors to the hospital
- information and audit requirements, including IT support and infrastructure
- planned service improvement, including redesign, quality, equitable access, and referral-to-treatment times according to the 18 week patient pathway or equitable waiting times locally for those services currently outside 18 weeks
- service monitoring criteria detailed in the NHS Stop Smoking Services: service and monitoring guidance, March 2009/10
Useful sources of information may include:
- The Map of medicine provides an information resource that visually organises the care pathway.
- The NICE shared learning database offers examples of how organisations have implemented NICE guidance locally, including a hospital-based smoking cessation service.
- Heart Disease and South Asians: delivering the national service framework for coronary heart disease.
- NICE implementation advice for Smoking cessation services: implementation advice
- Do once and share (DOAS)-preoperative assessment prior to elective surgery dataset.
This page was last updated: 02 March 2012
- Commissioning a smoking cessation service for people having elective surgery
- Specifying a smoking cessation service for people having elective surgery
- Determining local service levels for a smoking cessation service for people having elective surgery
- Assumptions used in estimating a population benchmark
- The commissioning and benchmarking tool
- Ensuring corporate and quality assurance