We know smoking kills more people than road accidents, murder, suicide and HIV combined and costs the NHS £5.2 billion, but smoking rates over the last 7 years have stayed about the same.
People are more likely to stop smoking if they use smoking cessation services. NHS West Midlands wanted especially to target groups who generally have worse health outcomes, so they designed a new way of commissioning smoking cessation services using a modified payment by results approach.
They welcomed new providers in regional commissioning rounds and started paying for every ‘quit’, with some groups attracting a higher payment. More providers meant more services available, trying different things. This meant commissioners had to change their behaviour as well, to manage the open market.
It was challenging to set appropriate payment tariffs, but it had an exciting effect: since it put the responsibility on providers to engage with smokers and convince them to use the services, they started experimenting with what worked for different places and people. Because of the higher payments for some groups, providers were motivated to work hard to reach disadvantaged groups, helping reduce health inequalities. After each attempt providers could learn, and alter their behaviour for next time.
This bit-by-bit testing led to more nuanced and successful targeting. Numbers of smokers using the services and ultimately quitting have grown, particularly manual workers, pregnant women, smokers, and black, minority and ethnic groups. NHS West Midlands are considering whether to extend the approach to other lifestyle behaviours like weight management, sexual health, and substance abuse.