Quality statement 4: Integrating harm‑reduction approaches into 'stop smoking' services

Quality statement

'Stop smoking' services offer harm‑reduction approaches alongside existing approaches to stopping smoking in one step.

Rationale

Stopping smoking in one step is the standard approach currently offered by 'stop smoking' services, with harm‑reduction approaches to smoking being a relatively underused approach. The integration of harm‑reduction approaches to smoking into current services will ensure that they are available as an option to people who use these services and who are unwilling or not ready to stop smoking in one step. While it is important that 'stop smoking' services offer harm‑reduction approaches to smoking, this should not be the only place where these approaches are offered. As set out in quality statement 1, healthcare and public health practitioners outside 'stop smoking' services should also offer harm‑reduction approaches (when appropriate) to reach people who do not use these services.

Quality measures

Structure

Evidence of local arrangements that 'stop smoking' services offer harm‑reduction approaches to smoking alongside existing approaches to stopping smoking in one step.

Data source: Local data collection.

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

Service providers ('stop smoking' services) train healthcare and public health practitioners to offer harm‑reduction approaches to people who are unwilling or not ready to stop smoking.

Healthcare and public health practitioners working in 'stop smoking' services ensure that they offer harm‑reduction approaches to people who are unwilling or not ready to stop smoking.

Commissioners (local authorities) ensure that service specifications include a requirement that providers of 'stop smoking' services offer harm‑reduction approaches to smoking to people who are unwilling or not ready to stop smoking.

What the quality statement means for service users

People who use 'stop smoking' services have the option of harm‑reduction approaches if they don't think they can quit smoking in one step or don't want to quit.

Source guidance

Definitions of terms used in this quality statement

Harm‑reduction approaches

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]

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]

'Stop smoking' services

'Stop smoking' services provide a combination of behavioural support and pharmacotherapy to help people to stop smoking. The behavioural support is free but pharmacotherapy may have a standard prescription charge. The evidence‑based treatment is based on the National Centre for Smoking Cessation and Training (NCSCT) standard programme and involves practitioners trained to its standards or equivalent.

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

Equality and diversity considerations

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 have higher smoking prevalence rates than the general population. 'Stop smoking' services should be promoted, accessible and commissioned to address this need.