BMA: A Generation of Non-Smokers for UK

The Health Department’s new strategy for giving the UK a generation of non-smokers will put extra pressure on underfunded local authorities, according to Professor Parveen Kumar, the head of the British Medical Association’s science board. Kumar says the aspiration lines up with the association’s own aim of achieving a completely tobacco-free society by 2035 but without proper resources both goals will remain a pipedream.

Local authorities burned out

Steve Brine, the parliamentary under-secretary for public health and primary care, confirmed that the new strategy required more action from local services. “Our vision is nothing less than to create a smoke-free generation,” he said. “To do this we need to shift emphasis from action at the national level – legislation and mandation of services to focused, local action, supporting smokers, particularly in disadvantaged groups, to quit. This vision is ambitious and presents a challenge to local services – local councils, the NHS and civic society – to continue to reduce smoking prevalence, targeting those communities where smoking rates are highest, and providing people who smoke with the tools that they need to quit.”

But the BMA’s Kumar warned that local authorities are already stretched. “If we’re to stop the 79,000 annual deaths in England attributed to smoking, smoking-cessation services and tobacco-control measures must be adequately funded yet local authorities are reducing stop–smoking budgets, merging services into unwieldy departments or cutting services altogether,” she said.

While the plan aimed to end the inequality of smoking as poorer people are more likely to smoke she warned that the reverse could happen, with lower income smokers receiving less support. “Cuts to these highly cost-effective services will only increase health inequalities and demand on tomorrow’s GP surgeries and hospital wards,” she said.

Local authorities are facing deep cuts in their 2017-18 health budgets with the biggest hits lined up for services relating to sexual health, young children, drug misuse and – ironically – quitting smoking, according to the healthcare improvement charity The King’s Fund.

The Savings?

The overall logic of the smoke-free generation report is that smokers impose a huge cost on the UK. The Department of Health estimates that smoking costs the economy more than £11 billion a year. That includes £2.5b from the NHS, £5.3b from employers in sick days and smoking breaks, £4.1b through the burden of people who cannot contribute to the economy through death or illness, and an estimated £760m on adult social care services.

The only trouble with the plan is the long-term investment it requires. The previous Tobacco Control Plan was released in March 2011 and in the six years since then adult smoking rates have dropped by almost 5% to 15.5% of the population. If that sort of progress continued the UK could theoretically be smoke-free in less than 20 years, which would match the BMA’s target date of 2035.

The new plan aims to achieve a drop of 3% in the next five years but it relies heavily on cutting the number of young people who take up smoking, while older smokers will still face the health problems of almost lifelong addiction. The gloomier but more realistic prospect is that the current generation of older smokers will continue to haunt health budgets for decades. In the meantime the pressure of pursuing a smoke-free generation and ultimately a smoke-free UK risks being yet another straw to break the back of vital local authorities if adequate funding is not provided to meet these ambitious new aims.

by Stewart Vickers

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