Make effective smoking treatment reach more people
Delivery RAG: AmberGate: pendingA72
Not stated in the review record; treated as a provisional single-reviewer assessment, not an approved business case.
What the evidence supports—and the next decision
Established cessation treatment provides a stronger basis than a generic prevention promise; reach and sustained quits still determine additional benefit.
Codex — AI-assisted analytical follow-up · 8 October 2026. Proposed appraisal design; the attributed scores below are unchanged. No funding or delivery agreement is implied.
- Define the change
- Expand access for a defined underserved adult group using suitable NICE-recommended support and treatment beyond current provision.
- Test whether it works
- Sustained quits, relapse and adverse effects by deprivation and other relevant groups; distinguish quit attempts from lasting outcomes.
- Establish the cost
- Adviser time, treatment, referral and follow-up; estimate health gains separately from cashable NHS savings.
- Protect against harm
- Use clinically appropriate choices and informed consent; this assessment does not include an uncosted cardiovascular-prevention package.
Read with the outcome evidence and sources in the full assessment. Monitoring proposals are not existing baseline measurements. A numerical benefit or cost score needs evidence for the defined increment, not just the scale of the problem.
Who and where
Adults aged 18–64 in routine and manual occupations in England who smoke (16.6% smoked in 2025; about 1.2 million people on ONS weighted counts). (from the action record)
Scope assessed: Expand access to established behavioural support plus suitable cessation treatment for a defined underserved adult group; cardiovascular prevention is a separate, unscored option.
Jurisdiction: England. Stop smoking services are devolved: Quit Your Way Scotland, Help Me Quit (Wales) and Stop Smoking NI. The Tobacco and Vapes Act 2026 applies UK-wide.
Scope not yet verified against current delivery.
The problem behind it
Britain is losing healthy years.
Health priority: Increase healthy years and narrow avoidable physical and mental ill-health gaps.
The headline of the Health page, as context: it describes the topic, not necessarily the group this option would reach.
The deep dive
No chapter is recorded for this option; its evidence is on the Health page.
What the evidence supports
NICE supports effective treatment combinations. Evidence is stronger for treatment than for this exact outreach/access increment; no national impact total is claimed.
- NICE, Tobacco: preventing uptake, promoting quitting and treating dependence (NG209), Treating tobacco dependence
- Cochrane Database of Systematic Reviews, Cochrane reviews of smoking cessation: behavioural support added to medication (CD009670.pub4) and nicotine e-cigarettes (CD010216.pub10)
- NHS England, Statistics on Local Stop Smoking Services in England, April 2025 to March 2026
What would need to happen
Verify service gap and current funding; cost adviser time, treatment, referral and follow-up. Measure sustained quits and inequalities, with adverse effects monitored. Proposed owners: public-health commissioners and health providers.
Who would act
public-health commissioners and health providers (proposed, unverified).
Powers: needs a decision or allocation. Capacity: unverified.
- England: Councils (public health duty, Health and Social Care Act 2012 s.12) with integrated care boards and the Department of Health and Social Care
- Scotland: not assessed
- Wales: not assessed
- Northern Ireland: not assessed
How we would know
Measure: Define and baseline the outcome described in delivery requirements before approval.
Source: not yet named. Baseline: not yet established.
- Quit dates set with local stop smoking services: latest 265,502 (2025–26); baseline 238,166 (2024–25).
- Adults aged 18–64 in routine and manual occupations who smoke: latest 16.6% (95% CI 15.9–17.3) (2025); baseline not published.
Measures already on the topic page; not necessarily this option’s own metric.
Timeframe
First meaningful outcome (reviewer’s rating): Within one year.
No first-90-days plan recorded.
One shared assessment · ten criteria, 0–3
- 3ScScale and severity: 3 of 3
- 2AdIncrement beyond baseline: 2 of 3
- 2EvConfidence in the proposed action: 2 of 3
- 2BnExpected incremental benefit: 2 of 3
- 2HmResidual harms: 2 of 3
- ?CoIncremental affordability: Not established
- 2CaDelivery capacity: 2 of 3
- 3FaDistribution: 3 of 3
- 3TiMeaningful first outcome: 3 of 3
- 2RdReadiness: 2 of 3
“?” = not established. An unknown is never counted as 0.
Each rating, its definition and the reviewer’s reason
Scale and severity (Sc): 3 of 3 — Severe harm across a broad population
Scale: 0 No material problem · 1 Limited harm/narrow reach · 2 Serious harm to a defined group or widespread moderate harm · 3 Severe harm across a broad population
Increment beyond baseline (Ad): 2 of 3 — Specific material change to existing delivery
Scale: 0 No increment · 1 Small or poorly supported increment · 2 Specific material change to existing delivery · 3 Substantial clearly distinct increment; not novelty alone
Confidence in the proposed action (Ev): 2 of 3 — Relevant evaluated evidence with limitations
Scale: 0 No effect evaluation · 1 Indirect, mixed, modelled or weak causal support · 2 Relevant evaluated evidence with limitations · 3 Consistent strong evidence for the specified intervention/outcome
Expected incremental benefit (Bn): 2 of 3 — Material for the target population
Scale: 0 Negligible · 1 Small · 2 Material for the target population · 3 Large for the target population; no multi-domain bonus
Residual harms (Hm): 2 of 3 — Manageable harm with specified safeguards
Scale: 0 Unacceptable serious harm · 1 Material harm/unresolved mitigation · 2 Manageable harm with specified safeguards · 3 Low assessed residual harm
Incremental affordability (Co): Not established
Scale: 0 No credible route for a large commitment · 1 Major unfunded commitment · 2 Costed affordable route subject to allocation · 3 Demonstrably small affordable incremental public cost
Delivery capacity (Ca): 2 of 3 — Stretched but plausibly obtainable
Scale: 0 Unavailable within scope · 1 Binding scarce resource · 2 Stretched but plausibly obtainable · 3 Little scarce capacity required
Distribution (Fa): 3 of 3 — Benefits concentrated on disadvantaged people with assessed burdens
Scale: 0 Strongly regressive · 1 Material disadvantage to vulnerable groups · 2 Mixed or broadly neutral with safeguards · 3 Benefits concentrated on disadvantaged people with assessed burdens
Meaningful first outcome (Ti): 3 of 3 — Within one year
Scale: 0 Ten years or more · 1 More than three but less than ten years · 2 More than one and up to three years · 3 Within one year
Readiness (Rd): 2 of 3 — Named commissioning/allocation/coordination step
Scale: 0 Undefined enabling steps · 1 Legislation/external agreement or major enabling work · 2 Named commissioning/allocation/coordination step · 3 Existing owner and route can act operationally
Explore the weighting
Equal weights: possible range 21 to 24 out of 30. Not a final score.
Possible range if the missing rating is later set from 0 to 3 (incremental affordability). Not a final score, a rank or a confidence interval.
Decision gate
Pending appraisal. Review label: “Pending baseline verification, incremental costing and funding; not a rollout approval”.
- Scores incomplete.
- Funding gate not passed (cost unknown or no credible funding).
Eligibility rule: pending appraisal. The working rule (at least 21 of 30 and a meaningful outcome within three years, with evidence, harm, delivery and cost checks) is not yet fully specified in our records, so no option is shown as passing it. A range or a timing rating alone never clears it.
Delivery readiness: Amber
Not yet in place for Green (7 of 7):
- Scope (population, place and increment) not verified against the delivery baseline.
- No verified owner with the powers in place.
- Delivery capacity not verified.
- Lifetime incremental costs not complete.
- No credible funding (a committed allocation for the scope).
- Safeguards not specified.
- Monitoring lacks a metric, a data source or a baseline.
The funding gap
Funding: not identified. Lifetime costing: Not established.
Still to cost: Verify service gap and current funding; cost adviser time, treatment, referral and follow-up. Measure sustained quits and inequalities, with adverse effects monitored. Proposed owners: public-health commissioners and health providers.
Funding gate: not passed — the cost is not yet rated or no allocation is committed for this scope.
Still unknown
- Incremental affordability (Co): not yet rated.
- Scope (who, where and the increment) not yet verified against current delivery.
- The outcome metric is not yet defined.
- No data source named for the outcome measure.
- No baseline for the outcome measure.