Setting up a cessation service

Introduction

In 1998, when the UK government announced the introduction of smoking cessation services throughout the NHS, few such services already existed. In most areas, therefore, the services had to be set up quickly and from scratch. This article reflects on some of the difficulties and challenges experienced in establishing and maintaining a cessation service, the Nottingham “New Leaf” service.

What is the likely demand?

Nottingham has a population of about 650 000—and therefore about 200 000 smokers. If (as expected from national data) 30% of these were to make a quit attempt in the same year, and all sought help from the cessation service, the demand would be overwhelming. In the event, however, initial demand rose fairly slowly. Some of the reasons for this slow start were:

• Smokers were initially suspicious of the new service. Many remarked that they expected to be “told off” about their smoking but were pleasantly surprised when encouraged instead to decide if the time was right for them to quit

• Health professionals were sceptical about the likely effectiveness of the service and had little understanding of what was offered

• There was also general suspicion, in an NHS based largely on a medical model, of services that relied on a health promotion approach, including client empowerment and behaviour change.

As a result, one of the major pressures in the early months was not the level of demand but the political pressure to meet high quit rate targets set by government.

Demand soon rose, however, as a result of various influences, such as the service's feedback of performance results to primary care teams. Although variable, the service currently deals each month with about 200 smokers who agree to set a quit date, of whom half are not smoking four weeks later.