Quality standard


This quality standard covers smoking cessation, which includes support for people to stop smoking and for people accessing smoking cessation services. For more information see the topic overview.

Why this quality standard is needed

Smoking is the main cause of preventable illness and premature death in England. It is the primary reason for the gap in healthy life expectancy between rich and poor.

A wide range of diseases and conditions are caused by smoking, including cancers, respiratory diseases, coronary heart and other circulatory diseases, stomach and duodenal ulcers, erectile dysfunction, infertility, osteoporosis, cataracts, age‑related macular degeneration and periodontitis.

Smoking can cause complications in pregnancy and labour, including ectopic pregnancy, bleeding during pregnancy, premature detachment of the placenta and premature rupture of the membranes. The health risks for babies of mothers who smoke are substantial.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measureable quality improvements within a particular area of health or care. They are derived from high‑quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcome frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2013–14


Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicators

1a Potential Years of Life Lost (PYLL) from causes considered amenable to healthcare

i Adults ii Children and young people

1b Life expectancy at 75

i males ii females

Improvement areas

Reducing premature mortality from the major causes of death

1.1 Under 75 mortality rate from cardiovascular disease*

1.2 Under 75 mortality rate from respiratory disease*

1.4 Under 75 mortality rate from cancer*

i One‑and ii Five‑year survival from all cancers

iii One‑and iv Five‑year survival from breast, lung and colorectal cancer

Reducing premature death in people with serious mental illness

1.5 Excess under 75 mortality rate in adults with serious mental illness*

Reducing deaths in babies and young children

1.6.i Infant mortality*

ii Neonatal mortality and stillbirths

Reducing premature death in people with learning disabilities

1.7 Excess under 60 mortality rate in adults with a learning disability

2 Enhancing quality of life for people with long‑term conditions

Overarching indicator

2 Health‑related quality of life for people with long‑term conditions**

Improvement areas

Ensuring people feel supported to manage their condition

2.1 Proportion of people feeling supported to manage their condition**

Reducing time spent in hospital by people with long‑term conditions

2.3 i Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults)

2.3 ii Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s

Enhancing quality of life for carers

2.4 Health‑related quality of life for carers**

3 Helping people to recover from episodes of ill health or following injury

Overarching indicators

3a Emergency admissions for acute conditions that should not usually require hospital admission

3b Emergency readmissions within 30 days of discharge from hospital* (Placeholder)

Improvement areas

Improving outcomes from planned treatments

3.1 Total health gain as assessed by patients for elective procedures

i Hip replacement

ii Knee replacement

iii Groin hernia

iv Varicose veins

Preventing lower respiratory tract infections (LRTI) in children from becoming serious

3.2 Emergency admissions for children with LRTI

Improving recovery from injuries and trauma

3.3 Proportion of people who recover from major trauma

Improving recovery from stroke

3.4 Proportion of stroke patients reporting an improvement in activity/lifestyle on the Modified Rankin Scale at 6 months

Improving recovery from fragility fractures

3.5 Proportion of patients recovering to their previous levels of mobility / walking ability at i 30 and ii 120 days

Alignment across the health and social care system

* Indicator shared with Public Health Outcomes Framework (PHOF)

** Indicator complementary with Adult Social Care Outcomes Framework (ASCOF)

Table 2 Public health outcomes framework for England, 2013–16


Objectives and indicators

2 Health improvement


People are helped to live healthy lifestyles, make healthy choices and reduce health inequalities


2.1 Low birth weight of term babies

2.3 Smoking status at time of delivery

2.9 Smoking prevalence – 15 year olds (Placeholder)

2.14 Smoking prevalence – adult (over 18s)

4 Healthcare public health and preventing premature mortality


Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities

Reducing deaths in babies and young children

1.6.i Infant mortality*


4.1 Infant mortality*

4.3 Mortality from causes considered preventable**

4.4 Mortality from all cardiovascular diseases (including heart disease and stroke)*

4.5 Mortality from cancer*

4.7 Mortality from respiratory diseases*

4.9 Excess under 75 mortality in adults with serious mental illness* (Placeholder)

4.11 Emergency readmissions within 30 days of discharge from hospital* (Placeholder)

4.12 Preventable sight loss

4.13 Health‑related quality of life for older people (Placeholder)

Alignment across the health and social care system

* Indicator shared with NHS Outcomes Framework

** Indicator complementary with NHS Outcomes Framework

Coordinated services

The quality standard for 'smoking cessation: supporting people to stop smoking' specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole smoking cessation pathway. A person‑centred, integrated approach to providing services is fundamental to delivering high‑quality smoking cessation services.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high‑quality smoking cessation service are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All health and social care practitioners involved in assessing, caring for and treating people who smoke should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard.