Findings from Action on Smoking and Health (ASH) and Cancer Research UK’s annual national survey of local government stop smoking support [1] show improvements compared to before the pandemic hit.

In 2021, 76 per cent of local authorities were providing some form of dedicated specialist service for smokers, compared to 69 per cent in 2019. However, long term underfunding and forecast growth in demand for services due to new NHS programmes is placing pressure on services, and has increased the urgency to improve local authority public health funding to meet these demands and tackle inequalities in the wake of the pandemic.

Local councils adapted quickly to the challenges posed by the pandemic to make sure services were available for smokers. For example, by delivering these traditionally face-to-face services remotely, reaching out to vulnerable homeless populations being bought into hotels and finding new ways to support access to medications. However, although a third (36 per cent) reported that the emergency context had created positive opportunities for services to be delivered differently and reach more people, a further third (34 per cent) reported that the pandemic had compromised their ability to provide support.

The councils most likely to report negative impacts were those delivering their services through NHS partners in general practice and primary care settings, which were overwhelmed with the frontline pandemic response. Among those delivering through the NHS, 88 per cent reported negative impacts compared to just 25 per cent of local councils with separate dedicated service.

Smoking is a leading cause of health inequality, responsible for half the difference in life expectancy between rich and poor. Stop smoking services are a highly cost-effective part of addressing this inequality, which can triple the chances that poorer smokers will successfully quit. [2]

However, consecutive UK government cuts to the Public Health Grant since 2015/16 mean that local councils can only do so much. The lowest point was reached in 2018 when just 67 per cent of councils were able to provide a dedicated specialist stop smoking service. This year councils still haven’t been told what their budgets will be for public health, making it difficult to plan and undermining the stability of services currently in place.

This underfunding and uncertainty also undermines the ability of local councils to meet new demand for stop smoking support, which is likely to emerge this year. New NHS services will prompt more smokers to make a quit attempt, but many will need support from local authority run services. Unless addressed, pre-existing funding pressures will jeopardise the success of these programmes at a time when both the NHS and Government have prioritised the importance of tackling health disparities.

The report recommends that:

  • National government implement the All Party Parliamentary Group on Smoking and Health recommendations necessary to secure a smokefree country by 2030, including a charge on tobacco companies to fund services
  • Local government embed addressing smoking in their covid recovery plans as part of addressing inequalities
  • New integrated care boards collaborate with local government to ensure joined up plans across local government and the NHS to tackle smoking and maximise the opportunity to support more smokers to stop.

Malcolm Clark, senior policy manager at Cancer Research UK, said, “Smoking is a leading cause of health inequalities, so it’s great to see local authorities engaging with people who have the highest rates of smoking. However, this report also shows the harmful impact of years of funding cuts to public health budgets. To close the inequality gap, everyone who smokes must have access to effective specialist support to help them stop. Increased and sustainable funding for local tobacco control is vital for this to happen.”

David Fothergill, councillor and chairman of the Local Government Association’s Community Wellbeing Board, said, “As this report rightfully highlights, councils’ public health teams have worked hard throughout the pandemic to help smokers quit, adapting services to reach out to residents so they can continue to provide vital support.

“Councils need long-term funding certainty to help the government achieve a smoke-free England by 2030. It is essential the public health grant is published as soon as possible, so they can get on with planning ahead for an expected surge in demand.”

Jim McManus, president of the Association of Directors of Public Health, said, “Astonishing things have been achieved with little funding in public health. However, there are limits. New NHS lung health checks are already creating demand for quit support that areas are struggling to meet, and this is before further new NHS services for smokers get up and running later this year. The funding burden this creates on local authorities needs to be met. This is a time of tremendous opportunity with the NHS stepping up on smoking, but all parts of the system must be equipped to meet it, or we risk failing to help those who need it most.”

Hazel Cheeseman, deputy chief executive of ASH, said, “Now more than ever councils see the value in protecting the public’s health and the benefit of a local population that is fit and healthy. However, funding for services have been cut by a third and is insufficient to cope with the new pressures now looming. A levy on tobacco companies to fund tobacco control is needed or thousands of smokers will fail to get the help they need to quit successfully.”

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