Reducing health inequalities in England: does the demise of NHS Stop Smoking Services matter? Analysis of mandatory monitoring data

Background
Tobacco smoking is a key cause of mortality, morbidity and health inequalities. The unprecedented English health inequalities strategy (1999–2010) sought to reduce health inequalities, by, in part, instigating NHS Stop Smoking Services (SSS), initially targeted in deprived ‘Spearhead’ localities. Performance of SSS is assessed here in light of its role supporting the strategy, which evidence suggests achieved a reduction in health inequalities.

Methods
SSS enrolment and four-week quits in Spearhead and non-Spearhead localities were compared during and after the strategy period, using regression models and routine monitoring data. Changes in SSS expenditure were estimated.

Results
After similar increases in enrolment and quits between Spearhead and other localities between 2003/4 and 2008/9, SSS in Spearhead localities experienced a 2-fold better rate of improvement in enrolment and quit performance over the 4 years to 2011/12. Since 2011/12, SSS have dramatically reduced, and expenditure had fallen by half in Spearhead localities by 2016/17.

Conclusions
SSS, particularly in Spearhead localities, were expanded up to 2011/12, and this broadly coincides with the reduction in health inequalities. This suggests that although SSS did not achieve the scale anticipated, they have important potential, and the current demise of SSS should not be tolerated.