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Target to quit could stub out services

A massive hike in smoking cessation targets is putting pressure on primary care trusts to concentrate on richer and easier-to-reach patients, it is claimed.

The new target for England of 800,000 successful ‘four week quitters’ over the next three years is an increase of 170 per cent. But it emphasises numbers at the expense of quality, according to Professor Robert West of the Cancer Research UK Health Behaviour Unit (University College London).

Professor West told healthmatters that people from more affluent backgrounds have greater success with a quit attempt. The new targets would lead many PCTs to abolish core clinics and replace them with a low grade service unable to offer the higher levels of support poorer groups required. ‘Excellent PCT services are getting hammered’, he added.

He called for ‘more realistic [smoking cessation] targets that don’t just focus on the total numbers’, including ones for harder to reach smokers such as Bangladeshi men and manual workers, 12 month quitters, and the percentage of smokers who use services.

In 2000 the NHS Cancer Plan aimed to cut the much higher rates of smoking in manual groups from 32 per cent in 1998 to 26 per cent by 2010. Irish women and some other ethnic minorities also have higher smoking rates. But Professor West said the pressure on PCTs was ‘to deliver high numbers without any social class breakdown’.

Areas such as Nottingham with higher than average numbers of ethnic minorities and low socio-economic conditions were being disadvantaged, said Professor West. A spokesperson for the Directorate of Health Equality in Nottingham City told healthmatters that ‘as smokers from middle class communities tend to have higher quit rates, the [class] gap in smoking prevalence may increase, leading to a higher relative proportion of tobacco-related disease amongst the lower socio-economic groups’.

Addressing both health inequalities and targets for quitters ‘presented a significant challenge on which to deliver’, she added.

Statistics on smoking cessation services in England for last year (April 2002-March 2003) published by the Department of Health in November failed to include a breakdown by social class.

Despite recent signals from the chief medical officer that a ban on smoking in public was imminent, health secretary John Reid favours voluntary codes by restaurants, pub owners and employers.