Smokers trying to quit hit by postcode lottery as GPs ration help

Smokers in England wanting to quit face a postcode lottery as cash-strapped councils and GPs restrict access to services that can help them.

The revelation has alarmed health experts and charities who claim that lives are being put at risk as a result of the fragmented provision.

Evidence obtained under the Freedom of Information Act shows that an increasing number of clinical commissioning groups – the 200 or so organisations that deliver NHS services in England – have been instructing GPs to stop providing the services. Many of the groups argue that it is no longer their responsibility.

In 2012, local authorities were made responsible for improving public health and given £2.8bn of ring-fenced grants to pay for it. But, as the grants have been pared back, councils have pulled their funding for stop smoking services.

This has led to a rationing of treatments – such as nicotine replacement therapies, bupropion (brand name Zyban) or varenicline (Champix) – in many areas. When used in conjunction with counselling, studies suggest the chances of a smoker quitting can be substantial.

Almost a quarter of a million people stopped smoking in the 12 months to April 2015 as a result of using the services, a quit rate of 51%. The services are said to have a high success rate in helping smokers in poorer communities stop.

“We are increasingly concerned that cuts in council spending, NHS cost pressures and a lack of joined-up thinking by central government are combining to block progress on cutting smoking, still the No 1 public health challenge facing the country,” said Deborah Arnott, chief executive of Action on Smoking and Health (Ash).

A briefing last year to clinical commissioning groups in Worcestershire said: “Worcestershire county council will only fund a smoking cessation service for pregnant women. The CCGs have considered the implications of this decision and due to the current financial challenges are unable to commit local funding to smoking cessation services or prescribing of products to support stop smoking attempts.

“GPs are therefore advised that no prescriptions for nicotine replacement therapy, bupropion or varenicline should be written for new patients from 1 April 2016.”

It added: “The CCGs appreciate that GPs will be in the difficult position of having to explain to patients that this service is no longer available.”

For every £1 invested in help to quit smoking, £2.37 is saved in treatment and lost productivity. Photograph: Matt Cardy/Getty Images

Restrictions have also been imposed in East Kent, York and Somerset. Windsor, Ascot and Maidenhead CCG told GPs last May: “The royal borough has commissioned a new smoking cessation service. From April 2016 Solutions4Health are commissioned to support only three groups: pregnant smokers, smokers with mental health issues and young people. The bottom line is that GPs are not commissioned to provide smoking cessation services.”

But local authorities are failing to plug the gap created by GPs discontinuing the service. A survey by Ash and Cancer Research UK has found that smoking cessation budgets have been cut in almost three in five authorities. Health organisations claim this is a false economy.

At least £1.4bn a year is spent on social care because of smoking-related illness, Ash says. Access to services for patients needing surgery – known as “Stop before the Op” – is considered particularly important.

Smokers are 38% more likely to die after surgery than non-smokers due to higher risks associated with lung and heart complications; higher risks of post-operative infection; impaired wound healing and the need for longer hospital stays and higher drug doses.

The National Institute for Health and Care Excellence estimates that for every £1 invested in quit smoking services, £2.37 will be saved on treating smoking-related diseases and lost productivity.

But the service is not considered a priority. A report by the British Thoracic Society, published in December, shows that NHS hospitals are falling “woefully short” of national standards when it comes to helping patients quit.

It found that 72% of hospital patients who smoked were not asked if they would like help in stopping.

Since last May, all cigarettes must be sold in plain packs that carry the message “get help to stop smoking at www.nhs.uk/quit”. But the fragmented nature of stop smoking provision means some people are being told to contact services miles out of their local authority area.

For example, the site directs smokers in Worcester to a service in Solihull some 35 miles away – for which they do not qualify.

“It’s alarming that a pre-operative patient advised to stop smoking will only get NHS help if they live in the right place – a postcode lottery that will damage patients’ health and certainly cost the health service money in the long run,” Arnott said.

A Department of Health spokesman said smoking rates in England were the lowest they have ever been as a result of its policies. “The needs of individual communities vary significantly across the country, and local areas are best placed to understand local needs,” the spokesman said.

Smokers trying to quit hit by postcode lottery as GPs ration help

Does the NHS need to have to ration cancer treatments? | Zara Aziz

Finite resources: Britain is struggling to keep pace with suggestions that are coming by way of the perform of cancer analysis. Photograph: Christopher Thomond for the Guardian

Cancer forms a big part of my functioning lifestyle. Each day I make a single or two suspected cancer referrals (usually for breast cancer), and stick to up people beneath oncology or palliative care. It is an emotive and intensive area to work in – far more so than almost something else that I have seasoned.

With cancer, the emphasis is usually on early diagnosis, attaining full cure or symptom-cost-free longevity. It is the professionals who make a decision on the suitability of remedies this kind of as surgical procedure, radiotherapy or chemotherapy.

These selections are based mostly on the kind of cancer, the stage the ailment has reached, and different suggestions. For instance, the Nationwide Institute for Wellness and Care Excellence (Good) requires a robust proof-based mostly approach just before it approves drugs.

In addition, NHS England’s Cancer Drug Fund was founded in 2010 to ensure a more equitable allocation of costly cancer medication, which have been not Great accepted but suggested by medical professionals. This has assisted to reduce nationwide variations in the availability of cancer medication. A patient’s specialist can apply to the fund if they really feel there are potential advantages.

But there have been concerns that this fund has been politically motivated and not proof primarily based, with most of the newer medication extending existence expectancy only modestly. And what is worrying is that medication are commencing to be rationed, as the fund runs out of money.

There is also talk among authorities of possible costs for some cancer treatments, for individuals who can afford to pay. We can debate the ethics of an personal having to pay for their own £65,000 experimental cancer therapy that prolongs life-expectancy by six months. But when we begin speaking of introducing expenses, the place do we draw the line as to what need to or should not be paid for?

It is fair that there need to be no nationwide variations on how medicines are allotted. It is appropriate that cancer funds for specialist medicines ought to be held at nationwide ranges as opposed to resting with neighborhood commissioning groups. I accept that there is a finite quantity of income in the NHS, which has to be relatively distributed to a lot of essential regions of the well being support, including psychological wellness, dementia, children’s providers and disease prevention (such as cancer prevention).

Would it really be prudent to spend tens of 1000′s on a cancer drug whose efficacy had not been proven, or that offered only a small likelihood of prolonging daily life expectancy, and only by a couple of months? But most of us would want that tiny hope if it were for ourselves or for a loved one particular.

The 1st time I looked soon after a little one with cancer, his oncologist had told his parents that nothing additional could be accomplished. They cashed in all their cost savings and took him abroad for a 2nd viewpoint. He did not make it, but his dad and mom knew that they had experimented with their greatest for him.

We, as a nation, are struggling to keep tempo with suggestions that are coming by way of cancer research. We lag behind Europe when it comes to cancer survival charges. Our emphasis should also consist of cancer prevention and eliminating waste elsewhere inside of the NHS.

There are numerous missed appointments, delayed hospital discharges through inadequacies in social care, and inappropriate polypharmacy, all of which pile on the expense. If we can decrease these inefficiencies, then we can realistically know regardless of whether we can spend for what really issues in the NHS.

It is up to the people to choose what is crucial to them in the NHS and how the money must be allocated inside of distinct regions. We need a public debate on the topic to set up priorities. I suspect most will decide on timely and large specifications of clinical care over all else. I believe men and women could be in favour of some form of rationing if they understood that there is a genuine proof base and if they could be confident that funds had been being utilised reasonably.

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Does the NHS need to have to ration cancer treatments? | Zara Aziz