I smoke… really, I started today!!

James Gubb, 25 April 2007

Today the National Institute for Health and Clinical Excellence (NICE) released guidance that calls on firms to help smokers quit, particularly in the run up to the public ban on smoking that comes into force in England on 1 July. This includes more uncontroversial advice such as employers providing information on where staff can go for help in quitting, and the possibility of NHS ‘stop smoking’ services being held on large firms’ premises if there is the demand. Evidence suggests that 3 in 4 smokers want to quit – if this is the case then making services to help them more accessible should probably help. One criticism also often loaded at the NHS is that it is too heavily focused on treating illness rather than helping to prevent them in the first place. There is little doubt that smoking is linked to any number of different, and serious conditions, that cost the NHS huge sums of public money. So, if such measures do help to prevent illness by stopping people smoking, then we may justifiably support them. Industry would also be glad – smoking is estimated to cost them £5bn in lost productivity, absenteeism and fire damage. Incredibly, evidence suggests that smokers have, on average, 8 days more off work sick than non-smokers.
But this does not justify NICE’s more radical proposal – that employers allow smokers to attend anti-smoking clinics during work time.

This raises all manner of complicated issues. For one, it is highly questionable whether it is right for employers to intervene to such an extent in people’s private lives. Secondly, why exactly would it not be possible for smokers to attend after-work or lunch time clinics? And thirdly, what about all the non-smokers that don’t get the time off to attend such clinics when, statistically, they spend more time at work that smokers anyway? This doesn’t exactly sound fair and also smacks somewhat of the positive discrimination that New Labour seems quite keen on across the board. We can point to the fact that if the smoker did as a result quit, industry should recoup the cost of letting that person off work to attend the clinic via less absenteeism and NHS costs would probably fall. But will they actually quit? People are surely much more likely to if they decide to do so off their own accord rather than if they decide to attend clinics (heaven forbid…) to get some time off work. Moreover, government statistics relating to this are not exactly encouraging. The overall number of people smoking is declining—and roughly in line with the government target of a reduction to 24% by 2010—but while the government has aimed to help 800,000 smokers successfully quit at a four-week stage between 2003/4 and 2005/6, there have only been 350,000 successes thus far.
So what’s the solution? Yes, make facilities to help people quit more readily available – but letting people off work to go is a step too far. Far more effective in the long-run would be to follow the logic of economics – if healthcare was not on tap and people had to pay for a part of it, through insurance or otherwise, they may very well take measures, like quitting smoking, that reduces the bills.
See also the BBC’s ‘Have your say’ column: http://newsforums.bbc.co.uk/nol/thread.jspa?threadID=6192&&&edition=1&ttl=20070425170650