The National Institute for Health and Clinical Excellence (NICE) has published a commissioning guide to help the NHS in England effectively commission evidence-based services to help women who smoke during pregnancy and after childbirth to quit.

The guide, published last month, provides support for the local implementation of NICE guidance through commissioning, and is a resource for people involved in commissioning health and social care services and public health programmes within the NHS and partner organisations in England.

Smoking in pregnancy is a major public health concern imposing a considerable economic burden on society, and increasing risks to both mother and child. It can increase the risk of miscarriage, premature birth, still-birth and sudden unexpected death in infancy.

Exposure to smoke in the womb is also associated with psychological problems in childhood such as attention and hyperactivity problems. Meanwhile, children of parents who smoke tend to suffer from more respiratory problems like asthma or bronchitis and have problems of the ear, nose and throat, compared to children in non-smoking households. It is thought to cost the NHS between £20 million and £87.5 million each year to treat mothers and small infants under 12 months old with problems caused by smoking in pregnancy.

Underpinned by the NICE public health guidance on quitting smoking in pregnancy and following childbirth, the NICE commissioning guide signposts and provides topic-specific information on key clinical and service-related issues to consider during the commissioning process. It also offers an indicative benchmark of activity to help commissioners determine the level of service needed locally. An interactive tool provides data for local comparison against the benchmark and resources to estimate and inform the cost of commissioning intentions.

The potential benefits of commissioning effective services for quitting smoking in pregnancy and following childbirth identified in the guide include:

• Reducing morbidity and infant mortality
• Reducing inequalities and improving access to NHS Stop Smoking Services by increasing referral routes from maternity services and others in the public, community and voluntary sectors
• Improving engagement with NHS Stop Smoking Services by increasing the number of pregnant women receiving specialist support while attempting to stop smoking
• Increasing choice for pregnant women by improving partnership working and offering access to a range of services across a number of settings
• Reducing costs associated with smoking-related complications for mothers during pregnancy and babies following birth
• Increasing clinical and cost effectiveness by making commissioning decisions based on NICE guidance and accredited information from NHS Evidence

Jennifer Field, NICE Associate Director - Costing and Commissioning, said: “We know that the average GP practice will see around 27 pregnant women per year who will be smoking at first maternity booking and referred to an NHS Stop Smoking Service. We also know that smoking during pregnancy is the single most modifiable risk factor for adverse outcomes in pregnancy.

"This commissioning guide shows commissioners how they can reduce morbidity and cost by ensuring that clear and systematic referral pathways are in place for pregnant women who smoke to be referred into appropriate services and to receive help to quit, and by ensuring that service providers are trained and competent to provide evidence-based interventions.”

The NICE commissioning guides are one of a number of products introduced by NICE focusing on helping the NHS as it faces up to arguably its greatest challenge yet - to deliver the QIPP (Quality, Improvement, Productivity and Prevention) agenda, whilst facing a squeeze on finances.

While the commissioning guide draws on existing NICE recommendations, it does not constitute formal NICE guidance and is intended as a tool to help the NHS improve patient care through effective commissioning of services.

NICE