Tobacco smoking is the leading cause of preventable disease and premature mortality in the UK. As a student nurse I expected to learn about evidence-based tobacco dependence treatments in class and to work in healthcare settings where healthy behaviours flourished.
Instead, I graduated in 2019 without any reference to these much-needed lifesaving interventions, I saw health undermined by poorly implemented smoke-free policies and I routinely witnessed missed opportunities to recognise or treat this most urgent clinical condition.
On my first clinical placement in a respiratory ward, I observed patients come and go from the ward to smoke outside the hospital door, and then return to receive oxygen therapy.
“Every day around 200 people die from smoking-related illness in England”
No one offered smokers nicotine replacement therapy (NRT) or spoke about the benefits of switching to vaping. E-cigarettes or NRT products were not available to purchase in the hospital shop. Nurses spent hours monitoring vital signs but carbon monoxide levels were never checked and multiple chances to motivate change were lost.
When I asked about providing tobacco dependence treatment, staff said it was the responsibility of local authority run smoking cessation services to treat tobacco dependence and not their job.
Every day around 200 people die from smoking-related illness in England and it is estimated that one third of all the daily admissions to acute hospitals are to treat illness associated with smoking.
Given the pressure on the NHS, it seems to me that now is the time to invest in prevention and the best place to start is with low-cost smoking cessation interventions delivered by nurses across all care pathways.
In Advancing Our Health: Prevention in the 2020s, the government announced an ambition to reduce the overall percentage of the population who smoke to 5% or less by 2030. With the current level at 15% it seems unlikely this target will be reached without a fresh approach.
In June, an independent review by Dr Javed Khan, commissioned by former health secretary Sajid Javid, to help government decide on the most impactful options to be taken forward in the new Tobacco Control Plan was published.
It suggested 15 recommendations, including four ‘must dos’ to achieve the smoke-free 2030 target. Top of the list was a call for an extra £125m investment in tobacco control, Dr Khan suggested this can be attained by placing a levy on tobacco industry profits. He proposed following the example of New Zealand by raising the legal age of tobacco product sales by one year every year, to make it harder for young people to start smoking. He recommended active promotion of vaping as a quit smoking tool, in line with the consensus view of Public Health England, The Royal College of Physicians, and National Institute for Health and Care Excellence (NICE).
Crucially for nurses, Dr Khan believes the NHS needs to prioritise prevention, with actions to stop people smoking, provision of support and treatment across all services, particularly in primary care, mental health and maternity services.
In my opinion nurses are best placed to be at the forefront of stamping out smoking. With brief training, minor changes to infrastructure and access to specialist support nurses can be at the centre of re-defining what the vital signs are so that carbon monoxide monitoring for smokers becomes as routine as blood sugar monitoring for people with diabetes.
With the cost-of-living crisis raging through our communities, nurses can help lift smokers out of poverty by integrating support for smokers to quit as soon as possible and for good.
There is no doubt tobacco dependence treatment can yield huge health and social gains for the communities we serve and nurses can make every contact count by weaving tobacco dependence treatment interventions into routine practice. Together we can make smoking obsolete.
Simon Yates is health community engagement officer, Cancer Research UK