Guidance

Local stop smoking services and support: guidance for local authorities

Published 8 November 2023

Applies to England

This guidance has been endorsed by the Local Government Association.

About this guidance

On 4 October 2023, the government published Stopping the start: our new plan to create a smokefree generation. This included a programme of funding to support current smokers to quit smoking, with £70 million additional funding per year for local stop smoking services and support. This more than doubles existing funding through the public health grant.

This guidance for local authorities provides:

• an overview of the funding aims
• the framework for delivering services and support
• information on the grant agreement process
• information on future reporting mechanisms for the new funding for local stop smoking services and support

However, the guidance is not comprehensive, and the Department of Health and Social Care (DHSC) will be in touch with each local authority with a grant agreement document which will provide additional details. For further enquiries please email [email protected].

This guidance should be read alongside Local stop smoking services and support: funding allocations and methodology. 

Funding aims

The aim of this additional funding is to ensure there is a nationwide comprehensive offer to help people stop smoking across England and to increase the number of smokers engaging with effective interventions to quit smoking. Additional funding will be provided to local authorities with the highest smoking rates to level up the communities who need the support the most and to address health disparities.

We will achieve this aim by:

• stimulating more quit attempts by providing more smokers with advice and swift support
• linking smokers to the most effective interventions to quit
• boosting existing behavioural support schemes designed to encourage smokers to quit (for example the ‘swap to stop’ scheme)
• building capacity in local areas to respond to increased demand
• strengthening partnerships in local healthcare systems

Framework for delivering services and support

This framework outlines the most effective actions that local areas can take to meet the funding objective. These actions are based on our experience and the public health evidence of local stop smoking interventions. The framework mainly focuses on strengthening resources and capacity and enhancing infrastructure. Local authorities can consider which of these options are most appropriate for their local populations. 

We must also build demand for the services. You can do this by promoting the local options available directly to smokers and working with partners in the local system to stimulate quit attempts and refer people swiftly into effective support. 

The framework is intended to help local authorities to make decisions on how they can increase capacity across the system with this spending uplift, building on their existing services and structures. We expect that the majority of funding will be spent on the following activities. Additional activities are permitted but we expect these to demonstrate good evidence of effectiveness.

Building capacity for local stop smoking support and services

Leadership, co-ordination and commissioning

Local authorities need to have increased leadership capacity and oversight, and increased co-ordination and commissioning capacity, to expand their offers to support smokers to quit. We encourage you to use the following resources when considering your options for spending the additional funding.

The National Centre for Smoking Cessation and Training (NCSCT) provides a full range of resources to support commissioners and providers of local stop smoking support. These resources include service and delivery guidance, expected to be published in January 2024.

The National Institute for Health and Care Excellence (NICE) guideline Tobacco: preventing uptake, promoting quitting and treating dependence (NG209) covers smoking cessation support for people aged 12 and above.

The guideline also includes recommendations on nicotine replacement therapy, medicines and vapes (e-cigarettes) for smoking cessation and harm reduction, consolidating previous NICE guidelines on tobacco use, including smokeless tobacco.

The CLeaR self-assessment for tobacco control resource is for local authorities, public health bodies and the NHS to use as ‘deep dive’ self-assessment tools to improve their tobacco control work.

You can engage in local or regional efforts to exchange best practices, for instance through webinars or establishing communities of practice to improve professional links and collaboration. For example, Greater Manchester’s Make Smoking History programme has hosted events for public health leaders to gather and reaffirm their commitment to make smoking history.

A range of further case studies to support planning are available from the Local Government Association at Local action towards a smoke-free future.

Increasing local resources to help people quit

Local authorities can use the funding to increase resources to provide behavioural support and wider availability of stop smoking aids by: 

• recruiting dedicated specialist staff to provide smoking cessation interventions and support to non-specialist advisers
• improving the knowledge and skills of non-specialist staff (other healthcare professionals like nurses and pharmacists) to extend the reach of stop smoking interventions
• providing access to specialist and non-specialist advisers in locations where smokers routinely attend, such as GP surgeries, mental health services and employers
• increasing spend for stop smoking aids for smokers to use in their quit attempts from the full range of products available as recommended by NCSCT and NICE guideline NG209
• enhancing the overall service infrastructure, including:
  • digital and remote support
  • establishing physical presence in prominent locations
  • conducting targeted outreach efforts, especially for local priority populations

Building demand for local stop smoking service support and services

Increased referrals and improved pathways

Local authorities should improve their referral pathways and increase the number of referrals into local stop smoking services and support, using the ‘very brief advice’ on smoking approach.

Increased partnership working with relevant agencies should form part of local strategies to address and tackle health inequalities and increase overall demand for services through:

• routine identification of smokers
• providing advice on effective methods to quit
• making active referrals to provide swift access to behavioural support referral (not signposting)

Evidence shows that smokers are more likely to engage with a stop smoking service if they have been referred by a healthcare professional. We would like to see increased referrals from local partner agencies including:

• primary care
• NHS talking therapies for anxiety and depression
• community mental health treatment services for people with severe mental illness
• drug and alcohol treatment services
• large and medium sized employers
• Jobcentre Plus
• charities and community organisations
• other locally identified priority partnerships

Increased promotion of local stop smoking support

We encourage local authorities to invest in marketing and promoting local interventions to quit smoking. This can include developing and creating publicity materials.

The government is investing an additional £5 million this financial year and £15 million per year for the following 2 years to support stop smoking campaign activity. This is a substantial uplift on current spend.

These campaigns will be delivered by DHSC’s existing Better Health campaign. These campaigns are intensively researched and tested and can be adapted for local requirements where necessary. DHSC can work with local authorities and who want to use national campaigns locally, including helping them to co-brand and signpost to local services. If you would like to discuss this, please contact [email protected]. 

We also encourage local authorities to use the range of free evidence-based campaign materials available on the DHSC Campaign Resource Centre. New materials will be made available as campaigns evolve.

Working together to fund services

Local areas can jointly fund activity over a greater geographical area, for example by city, county or region, or through an integrated care partnership (a statutory committee formed of NHS integrated care board and local authorities in the integrated care system area), to co-ordinate:

• marketing
• service design and delivery
• wider tobacco control activities geared to stimulate quits

Case studies

Breathe

Yorkshire and Humber has created the Breathe campaign to promote its vision “to make smoking obsolete across Yorkshire and the Humber, by reducing tobacco related health inequalities”.

Through local authority funding, Breathe has developed mass media campaigns on television and radio to promote quitting, including specific promotion of local stop smoking services.

The collaboration maintains a range of campaign resources aimed at a wide number of partner agencies. These resources include videos and promotional materials that can be used to engage smokers. The materials have also earned extensive free media coverage through regional and local news outlets to keep smoking cessation on the news agenda.

This has helped contribute to the biggest reduction in routine and manual smoking rates of any region over the last decade (down from 33.9% in 2012 to 21.7% in 2022).

Fresh

All 12 local authorities across the North East of England jointly fund Fresh, a regional, comprehensive tobacco control programme established in 2005. Their approach to tobacco control includes:

• motivating and supporting smokers to quit
• reducing smoking uptake
• protecting non-smokers from secondhand smoke harm

The North East consistently sees more of its smoking population using stop smoking services to set a quit date than any other region in England. Since the Fresh programme launched, it has also had the biggest drop in overall adult smoking prevalence of any region, with rates more than halved since 2005 (down to 13.1% in 2022). The programme is collaborative, with funding from local authorities and the integrated care board.

Grant agreement process

Local authorities currently receive funding to provide local stop smoking services and support through the public health grant.

This new funding is in addition to that and will be provided through a new section 31 grant on top of the current public health grant allocations.

DHSC will provide the grant.

Payments will be given to local authorities every 6 months. In the first 6 months, local authorities will receive 70% of their allocated financial year’s funding. They will then be expected to provide grant reporting to the DHSC grants team to receive the second payment.

Local authorities will receive the grant agreement in January 2024. This will provide local authorities with the full grant conditions. Once received, local authorities will be asked to read and return a signed copy. The grant agreement will start from 6 April 2024.

Expected reporting mechanisms

The key success indicators for this funding are:

• number of recorded quit dates set per 100,000 smokers
• percentage of people engaging with services who successfully quit smoking (recorded quit rate)
• number of recorded quits per 100,000 smokers

Local authorities will need to report data throughout the life cycle of the grant. This will take place through 2 methods:

1. The Stop Smoking Services Collection is an existing data collection and reporting system used to monitor the delivery of local stop smoking interventions. NHS England collects the data from local authorities and there is a requirement to submit activity for each quarter. NHS England publishes submission dates and local authorities can return activity and outcome data associated with quit support provided. The collection requires local authorities to submit cumulative counts of activity using a template, which you can request from the Strategic Data Collection Service.

2. Starting from the second payment, local authorities will need to complete a statement of grant usage to the DHSC grants team, before they receive the next payment. The statement of grant usage will ask local authorities to provide the funding amount they received, their actual eligible spending, and a reason for any differences.