Wednesday 21 August 2013

The jewel in the crown?

From the BBC...

NHS stop-smoking service 'a success'

Tell me more.

The first decade of NHS stop-smoking services in England has been hailed a success by researchers.

The team said the service was the "jewel in the NHS crown" after it helped nearly 146,000 people to quit between 2001 and 2011.

I knew the NHS was in bad shape but I didn't think that things were so dire that being able to help a mere 14,600 people give up smoking each year was enough to become "the jewel in the crown" at the world's third biggest employer. There are about 10 million smokers in England. That means the service helped less than 0.15 per cent of them to quit, and some of them would have quit anyway. Trebles all round!

How much does this thing cost?

And in terms of cost - an estimated £84m a year...

£84 million a year?! That's nearly £5,753 per quitter. We could buy 200 e-cigarette starter kits for that. It would be a hell of a lot more effective than dishing out nicotine replacement therapy and telling people to take one day at a time.

But who are these impartial researchers that have painstakingly assessed whether the service provides value for money?

Prof Robert West, who led the team, said stop-smoking services could be considered the "jewel in the NHS crown".

Well he would, wouldn't he, considering his conflict of interest...

Robert West undertakes research and consultancy for companies that develop and manufacture smoking cessation medications. He has a share of a patent for a novel nicotine delivery device. He is a trustee of QUIT.

West continues...

"It has been a real success. These services are important because the people who are using them are the heaviest smokers who are the least likely to give up.

Actually, the people who contact smoking cessation services are more likely to give up than average. It's the ones who don't have any desire to give up and never seek assistance who are the least likely to do so.

Despite the headline saying that this service is "a success", the outcomes are so obviously feeble that the BBC's number one public health brown-noser, Nick Triggle, has written one of his little editorials to paint it in a more positive light.

It is easy to look at the study produced on the performance of the NHS stop smoking service in its first decade of existence and conclude money has been wasted.

Indeed it is. The best part of a billion pounds, in fact.

The unofficial target for the service is to get half of the people who turn to it for help to quit in the short-term - that is to say to give up for at least four weeks.

Over all the NHS failed to achieve this in any of the years from 2001 to 2011.

Never mind. Let's throw some more money at it, eh?

In fact, the data published on the British Medical Journal website shows if anything performance deteriorated slightly.

Great. Close it down and spend the money more effectively on something else.

But that would do the service an injustice.

Here comes the toadying...

In terms of providing value for money, stop smoking is among one of the most "cost-effective" treatments adopted by the NHS in the past decade, according to...

Go on. According to whom? Which economist have you contacted? Which disinterested third party has been on the phone?

...Martin Dockrell, of the Action on Smoking and Health campaign group.


According to the figures for the year up to March 2011, the service made contact with about 8% of the nation's smokers.

And only 0.15% of the nation's smokers gave up as a result, so that makes a 98.1 per cent failure amongst people who actively bothered to get in touch. That's even worse than the standard unassisted quit rate.

Of course, only a minority end up quitting in the long term.

You can say that again.

Since the mid 1990s the numbers of smokers have been hovering stubbornly above the 20% mark.

That's not quite true, is it? The smoking rate was falling quite nicely from the mid-1990s until 2007 when it reached 21 per cent. Then we had the smoking ban, graphic warnings, a ban on sales from vending machines, anti-smoking adverts with hooks in people's faces and a series of large tax hikes. The result is that the smoking rate fell by a mere one percentage point in four years, whereas before anti-tobacco extremism took hold it was falling at a rate of one percentage point per year. So it's now 20 per cent. Great success!

Trick Niggle says all of this in the most delicate terms...

In recent years the numbers have come down by less than 1% a year.

That is, I suppose, a technically true way of describing the pathetic failure of tobacco control in recent years.

Some of that is down to smokers dying and the success of health campaigns in discouraging a new generation of smokers from taking up the habit.

But some of it is undoubtedly linked to the success of the NHS stop smoking service - and that is why experts are hailing it as the "jewel in the NHS crown".

Pass the sick bag.


Ivan D said...

I knew that Triggle is an awful journalist and a public health groupie but even by his low standards, this is dreadful stuff. The BBC should not be indulging in propaganda on behalf of the public health industry. Isn't there something in its charter about that sort of thing?

On the plus side, the bleating may be a result of the righteous hearing that someone is considering turning off the free money tap.

Chris Price said...

The NHS SSS is the most egregious use of public funds possible. It is a complete failure in every respect, so much so that its operation has to be cloaked in lies at every stage in order to make it appear anything other than criminal fraud (which in my opinion is what it is).

For example, the target figures have always been based on a 4-week quit success rate. No, I'm not joking. Christpher, you may need to check the timepoint for non-smoking status here as (you will probably agree) anything less than 20 months is of no real use; a 12-month figure is at least a topic for discussion if not the best guide.

As regards costs, the NHS always hides the drug costs (for some reason), and these are usually 40% - 50% of the total, so that they
can present a final cost that looks good value (especially as it is at a uselessly early timepoint, in this case). So you'll probably find the 'cost' they quote is minus drugs, i.e. you need to multiply it by two to get the honest answer. This is why the usual cost of the NHS SSS is normally quoted as around £200m a year.

It's very close to criminal fraud in numerous areas; anyone praising it who knows the full details is implicated in the fraud. I think a far more accurate estimate is that the NHS SSS reduces smoking prevalence by about 0.001% at a cost of £200m annually. It is fraudulent in its criminal waste of taxpayers' funds, the enormously over-rated success rate, the way the real success rate is hidden, the way the real cost is hidden, and probably other ways in addition.

When you add in the fact we have an option that is proven about 1,000 times more successful (THR), at zero cost to the taxpayer, and the NHS is implicated in iatrogenesis to the tune of hundreds of thousands of deaths by not using it, then I'm sure that many will agree with me that people should be in jail over this. This is murderous incompetence and criminal fraud, and there is no other way to describe it.

Rursus said...

£84 million a year for 14,600 quitters?

One simple truth: To much money for too little results!

NielsR said...

What utter bollocks. Even for the short term quitters, you can't argue that £300 for a 4week quit is good value, and then go on to point out that 80% relapse. To get close to a 50% quit rate you're spending £900 already, and that's assuming repeated goes give the same chance of quitting long-term. But it's more likely that first 20% is the low-hanging fruit.

as for the service 'making inroads into hardened smokers' - as you say it's really only helping 0.015% of all smokers, per year. How can anyone say the service is significant against a 1-2% 'natural' annual decline? Quite aside from your point about the rate of decline having dropped since these clowns started really throwing their weight around.

a.welch said...

which number is it? "help a mere 14,600 people" or "helped nearly 146,000 people"

a.welch said...
This comment has been removed by the author.
Christopher Snowdon said...

14,600 a year. 146,000 over ten years.

proglodyte said...

They've hitherto deliberately tried to bury the real quit stats for years (98%+ failure and £5000+ cost/each long term quitter. So why the sudden turnaround? Are they really that stupid?

Ivan D said...


They are not stupid. Thanks to the BBC, the only numbers that most people (including politicians) will see are those that ASH wants them to see. They are not good numbers but they are not as bad as those that a more objective analysis might reveal. ASH has the BBC on board so can effectively spin success from failure in the eyes of the majority.

proglodyte said...

@ Ivan

I suppose..but we often hear about patients being denied life saving drugs/care because of limited NHS resources. The reality is that TC is little more than a self serving unelected political movement. But I still don't understand why they released these figures that, as Chris easily demonstrated, are proof that smoking cessation services are hugely non cost effective. On the one hand they talk about hundreds of thousands signing up, on the other admitting that the vast majority are not helped long term. It's been a betrayal of those who genuinely seek help from the NHS.

Unknown said...

It should be noted that Robert West's research is strongly focused on those who are very dependent on nicotine.

With respect to e-cigarettes, he has spoken out strongly in favour of light touch regulation, as can be witnessed on his blog:
(no permalink - scroll down to January 20)

You fall into the same trap as tobacco control when you assume that Robert West's interests undermine his credibility.

Christopher Snowdon said...


You're right. It was a low blow. Robert West is pretty sound on e-cigarettes and (I think) snus. I've said before that I really don't care about Pharma funding the anti-tobacco lobby (, but these people are so quick to accuse everyone else of being in the pay of industry that's it's fun to point out the hypocrisy every now and then.