Introduction In 2010, 17% of hospital inpatients in England were current smokers, equating to 1.1 million individuals.¹ In November 2013, NICE published guidance on stopping smoking in secondary care, recommending the routine and systematic delivery of stopping smoking support to all smokers in acute, maternity and mental health settings. Patients who smoke should be offered stop smoking medications, nicotine patches, and counselling as soon as they are admitted, encouraging them to quit. We undertook an audit of secondary care trusts in London to see how much stop smoking medications were being provided.

Methods The London Procurement Partnership has access to drug expenditure data for all Trusts and CCGs within the London area. We calculated the total expenditure for all nicotine replacement products including varenicline and bupropion between April 2016 April 2017 in each trust.

Results There was a 90-fold variation in expenditure on stop smoking products across London secondary care trusts (graph 1). Some of the highest expenditure was in trusts dealing with mental health. Comparing similar sized organisations to correct for bed numbers; within major teaching hospital groups, there was a 3-fold variation (£96 k vs £29 k). There was a 10-fold difference in smaller acute Trusts (£32 k vs £3 k) and specialist trusts (£14 k vs £1.4 k).

Discussion It is important to stress that expenditure does not equate to prescribing or use of these products. Also, this expenditure does not include any products bought in a hospital shop or provided by any on site external stop smoking services. Being unwell and admitted to hospital offers a unique opportunity for sick smokers to stop smoking. Heightened health concerns and being in an environment where smoking is not permitted enhances the motivation to quit. However, it appears that not all secondary care Trusts in London are providing the tools to help sick smokers quit, This may also reflect the lack of skilled advisors to provide support within these trusts. Hopefully, the variation in expenditure will narrow with the introduction of a national CQUIN for offering stop smoking products in secondary care coming into force for 2017–2019.

Reference

1. Szatkowski Let al. Thorax 2015;70:498–500.

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Abstract S5 Figure 1

Secondary care smoking cessation product expenditure 2016/2017.