2.8. Smoking rates have fallen significantly, but smoking still accounts for more years of life lost than any other modifiable risk factor. Around 6.1 million people in England still smoke [23]. Smokers see their GP over a third more often than non-smokers, and smoking is linked to nearly half a million hospital admissions each year [24]. Current estimates are that nearly a quarter of women in the UK smoke during pregnancy [25].

Figure 10

Table 3: Impact of smoking in pregnancy.

Maternal smoking Second-hand smoke exposure
Low birth weight Average 250g lighter Average 30-40g lighter
Stillbirth Double the likelihood Increased risk
Miscarriage 24-32% more likely Possible risk
Preterm birth 27% more likely Increased risk
Heart defects 50% more likely Increased risk
Sudden infant death 3 times more likely 45% more likely

Source: Action on Smoking and Health. Smoking in pregnancy challenge group. Review of the Challenge 2018. July 2018.

2.9. First, the NHS will therefore make a significant new contribution to making England a smoke-free society, by supporting people in contact with NHS services to quit based on a proven model implemented in Canada and Manchester [26]. By 2023/24, all people admitted to hospital who smoke will be offered NHS-funded tobacco treatment services.

 2.10. Second, the model will also be adapted for expectant mothers, and their partners, with a new smoke-free pregnancy pathway including focused sessions and treatments.

2.11. Third, a new universal smoking cessation offer will also be available as part of specialist mental health services for long-term users of specialist mental health, and in learning disability services. On the advice of PHE, this will include the option to switch to e-cigarettes while in inpatient settings.

Case study

The Ottawa Model for Smoking Cessation
The Ottawa Model for Smoking Cessation in 120 hospitals across Canada identifies the smoking status of all admitted patients, followed by brief advice, personalised bedside counselling, timely nicotine replacement therapy and/or pharmacotherapy, and follow-up after discharge [27]. It improves long-term quit rates by 11% [28]. The Royal College of Physicians has modelled the impact of implementing the Ottawa Model for Smoking Cessation intervention within the NHS [29], which this Long Term Plan will now be adopting.


23 Office for National Statistics (2018) Adult smoking habits in the UK: 2017. Accessible from:

24. Department of Health (2017) Towards a Smokefree Generation: A Tobacco Control Plan for England.
Available from:

25. Royal College of Paediatrics and Child Health (2018) Child health in England in 2030: comparisons with
other wealthy countries. Available from:

26. Evison, M., Agrawal, S., Conroy, M., Bendel, N., Sewak, N., McWilliams, L., Jerram, J., Shackley, D., Preece, R.,
Brown, L. & Barber, P. (2018) Building the case for comprehensive hospital-based tobacco addiction services:
Applying the Ottawa Model to the City of Manchester. Lung Cancer. 121, 99-100. Available from:

27. Reid, R., Mullen, K., Slovinec D’Angelo, M., Aitken, D., Papadakis, S., Haley, P., McLaughlin, C. & Pipe, A.
(2010) Smoking cessation for hospitalized smokers: An evaluation of the “Ottawa Model”. Nicotine &
Tobacco Research.12 (1), 11-18. Available from:

28. Mullen, K., Manuel, D., Hawken, S., Pipe, A., Coyle, D., Hobler, L., Younger, J. Wells, G. & Reid, R. (2017)
Effectiveness of a hospital-initiated smoking cessation programme: 2-year health and healthcare outcomes.
Tobacco Control. 26 (3), 293-299. Available from:

29. Royal College of Physicians (2018) Hiding in plain sight: Treating tobacco dependency in the NHS. Available