Quality statement 1: Offering harm‑reduction approaches

Quality statement

People who are unwilling or not ready to stop smoking are offered a harm‑reduction approach to smoking.

Rationale

The best way for a person to reduce illness and mortality associated with smoking is to stop smoking in one step (see the NICE quality standard on smoking cessation: supporting people to stop smoking). However, not everyone who smokes feels able to, or wants to, stop, or they may want to stop but without giving up nicotine. It is important that these people are encouraged to try a harm‑reduction approach to smoking. In addition, it is important to raise the option of harm‑reduction approaches as widely as possible – that is, outside 'stop smoking' services, because people who are unwilling or not ready to stop smoking are less likely to access these services.

Quality measures

Structure

Evidence of local arrangements and written protocols to ensure that people who are unwilling or not ready to stop smoking are offered a harm‑reduction approach to smoking.

Data source: Local data collection.

Process

a) Proportion of people identified as being unwilling or not ready to stop smoking who are offered a harm‑reduction approach to smoking.

Numerator – the number in the denominator who are offered a harm‑reduction approach to smoking.

Denominator – the number of people identified as being unwilling or not ready to stop smoking.

Data source: Local data collection.

b) Proportion of people who decline a referral to a 'stop smoking' service, and who are unwilling or not ready to stop smoking, who are offered a harm‑reduction approach to smoking.

Numerator – the number in the denominator who are offered a harm‑reduction approach to smoking.

Denominator – the number of people who decline a referral to a 'stop smoking' service and who are unwilling or not ready to stop smoking.

Data source: Local data collection.

Outcome

Uptake of smoking harm‑reduction approaches.

Data source: Local data collection.

What the quality statement means for service providers, healthcare and public health practitioners, and commissioners

Service providers (such as primary and secondary healthcare providers, pharmacies, residential and domiciliary care providers, 'stop smoking' services and providers of secure mental health services) ensure that healthcare and public health practitioners are trained to offer and explain harm‑reduction approaches to people who are unwilling or not ready to stop smoking.

Healthcare and public health practitioners (such as pharmacists, GPs, nurses, clinicians in NHS services, mental health care staff, staff in drug and alcohol services, 'stop smoking' advisers, ophthalmic practitioners and dental professionals) who determine whether service users smoke ensure that they understand and are able to explain harm‑reduction approaches, and offer harm‑reduction approaches to people who are unwilling or not ready to stop smoking while still prioritising stopping smoking as the best approach to take.

Commissioners (such as clinical commissioning groups, local authorities and NHS England) ensure that they commission services from providers that train healthcare and public health practitioners to offer and explain harm‑reduction approaches to people who are unwilling or not ready to stop smoking.

What the quality statement means for service users

People who smoke but aren't ready or don't want to quit are offered ways to reduce their harm from smoking that don't necessarily mean having to give up nicotine. These are called 'harm‑reduction approaches', and include things like cutting down, using licensed nicotine‑containing products (such as patches, gum and tablets) and stopping smoking for a while.

Source guidance

Definitions of terms used in this quality statement

Harm‑reduction approach

Harm‑reduction approaches to smoking include:

  • Stopping smoking, but using 1 or more licensed nicotine‑containing products for as long as needed to prevent relapse.

  • Cutting down before stopping smoking ('cutting down to quit'):

    • with the help of 1 or more licensed nicotine‑containing products (which may be used for as long as needed to prevent relapse) or

    • without using licensed nicotine‑containing products.

  • Smoking reduction:

    • with the help of 1 or more licensed nicotine‑containing products (which may be used for as long as needed to prevent relapse) or

    • without using licensed nicotine‑containing products.

  • Temporary abstinence from smoking:

    • with the help of 1 or more licensed nicotine‑containing products or

    • without using licensed nicotine‑containing products.

[Adapted from Tobacco: harm-reduction approaches to smoking (2013) NICE guideline PH45, box 1]

People who are unwilling or not ready to stop smoking

This includes people who:

  • may not be able (or do not want) to stop smoking in one step

  • may want to stop smoking, without necessarily giving up nicotine

  • may not be ready to stop smoking, but want to reduce the amount they smoke.

[Tobacco: harm-reduction approaches to smoking (2013) NICE guideline PH45]

Stop smoking in one step

Stopping smoking in one step is the standard approach to stopping smoking currently offered by most 'stop smoking' services. The person makes a commitment to stop smoking on or before a particular date (the 'quit date'). This may involve the use of nicotine replacement therapy (NRT) products or medication (varenicline or bupropion) in the lead up to the quit date and for a short amount of time afterwards.

[Adapted from Tobacco: harm-reduction approaches to smoking (2013) NICE guideline PH45]

Equality and diversity considerations

Advice should be culturally appropriate and readily available to people with additional needs such as physical, sensory or learning disabilities and people who do not speak or read English, and to people in groups identified as having a higher smoking prevalence. These include lesbian, gay, bisexual and transgender (LGBT) people, people with mental health problems, people in closed institutions (such as secure mental health units and custodial sites), people who are homeless and people from lower socioeconomic groups.