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Thursday, 29 March 2012

Smoking cessation will be under local authority control

The introduction to this year's UK National Smoking Cessation Conference is brief. It refers to a change of management in the field of smoking cessation:
As well as research updates and clinical innovations we will consider the implications of the shift of responsibility for the delivery of tobacco control and the commissioning of stop smoking services from the NHS to Local Authorities.
I am not too clear on the implications of this. Why are so many public health-related areas being taken out of the NHS remit and being given to local authorities? They are listed here and include mental health and dental services. Some observers fear the new system will mean that these services fall under normal local authority funding arrangements, i.e. means tested.

Although it empowers local authorities to commission public health services, this change doesn't seem to be anything to do with decentralising power. The government has employed MHP as a consultant in public health. Their report on the process can be seen here. Its introduction talks about holding the new public health service (local authorities) to account in meeting objectives that are created centrally, of course with the help of MHP. Its summary of key objectives starts by recommending all local authorities define public health in the same way. If this is decentralisation, it is very much from the top down.

Since smoking cessation is included in the package of services to be handed over to the local authorities, MHP's paragraph on the subject is instructive. It includes the information that 'NHS Walsall currently commissions the Walsall Stop Smoking Service which is achieving quit rates for participants in the scheme of 47.9%'. Information as to how long these people need to have stopped smoking before they are counted as successful is, if anywhere, buried in amongst pages of the Joint Strategic Needs Assessment for Walsall. I would hazard a guess at four weeks, especially as smoking cessation specialist Timothy Coleman has so recently told the world that patches don't work – but however long it is, it's remiss of them not to include this information in their report. However, since MHP's business is public relations, a dearth of vital detail is perhaps not surprising.

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