Quality standard

Quality statement 1: Identifying people who use tobacco

Quality statement

People are asked if they use tobacco at key points of contact with a health or social care professional. [2013, updated 2022]


Identifying people who smoke or use smokeless tobacco offers an opportunity to receive advice or support about quitting, or a referral to a tobacco cessation service if needed. Routinely asking people about tobacco use at key points of contact with health or social care services also offers opportunities to re-engage with people who previously did not want to stop or who may have relapsed following a period of abstinence.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly. Some localities may want to focus on equality of care depending on local needs, for example, by assessing care for particular socioeconomic or ethnic groups.


The following process measure denominator uses a key point of contact for measurement purposes only.

Proportion of people who are asked if they smoke or use smokeless tobacco at a key point of contact with a health or social care professional.

Numerator – the number in the denominator who are asked if they smoke or use smokeless tobacco.

Denominator – the number of people attending a key point of contact with a health or social care professional.

Data source: Data on smoking and use of smokeless tobacco can be collected from information recorded locally by health or social care professionals and provider organisations, for example from patient records.

NHS Digital's indicators no longer in QOF (INLIQ) indicator SMOK001 reports the percentage of patients aged 15 or over whose notes record smoking status in the preceding 24 months. The British Thoracic Society's national smoking cessation audit collects data on documentation of smoking status in inpatient medical records.

What the quality statement means for different audiences

Service providers (for example, primary care services, secondary care services and social care services) ensure that service specifications include asking people at key points of contact if they smoke or use smokeless tobacco and recording this.

Health and social care professionals (such as GPs, nurses, doctors, allied health professionals, healthcare support workers, maternity support workers and social workers) ask people if they smoke or use smokeless tobacco at key points of contact and record this in patient records.

Commissioners (for example, local authorities and integrated care systems) ensure that they commission services in which people are asked if they smoke or use smokeless tobacco at key points of contact with a health or social care service.

People using a health or social care service are asked if they smoke or use smokeless tobacco at key points of contact with a health or social care professional, for example, after newly registering with a GP, at an NHS health check, before or during admission to hospital, at a first appointment with a social worker or as part of a Care Act assessment.

Source guidance

Tobacco: preventing uptake, promoting quitting and treating dependence. NICE guideline NG209 (2021, updated 2022), recommendations 1.11.1 and 1.16.1

Definitions of terms used in this quality statement


Includes smoked tobacco, such as cigarettes and shisha, and smokeless tobacco.

Smokeless tobacco is any product containing tobacco that is placed in the mouth or nose and not burned. It is typically used in England by people of South Asian family origin. It does not include products that are sucked, like 'snus' or similar oral snuff products (as defined in the European Union 2014 Tobacco Products Directive). The types used vary across the country, but they can be divided into 3 main categories based on their ingredients:

  • Tobacco with or without flavourants: misri India tobacco (powdered) and qimam (kiman).

  • Tobacco with various alkaline modifiers: khaini, naswar (niswar, nass) and gul.

  • Tobacco with slaked lime as an alkaline modifier and areca nut: gutkha, zarda, mawa, manipuri and betel quid (with tobacco).

[Adapted from NICE's guideline on tobacco, terms used in this guideline (smokeless tobacco), final scope (2018) and expert opinion]

Key points of contact

Such as:

  • a consultation with a newly registered patient

  • a consultation about a condition related to smoking or use of smokeless tobacco

  • an antenatal appointment

  • a dental appointment

  • an NHS health check

  • an annual review

  • a preoperative appointment

  • during an inpatient episode

  • an outpatient appointment

  • at presentation at an emergency department

  • at first contact with social care services

  • as part of a Care Act assessment

  • at presentation after not being in regular contact with a health and social care professional.

[Expert opinion]

Equality and diversity considerations

People should be asked about tobacco use in a way that suits their needs and preferences. People should have access to an interpreter or advocate if needed.

Smokeless tobacco is predominantly used by people from a South Asian family background. People should be asked if they use smokeless tobacco using the names that the various products are known by locally. If necessary, use visual aids to show them what the products look like.

For people with additional needs related to a disability, impairment or sensory loss, communication support should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.