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Best and worst places to quit smoking in England

We all know the consequences of smoking can be detrimental – but you may not realise just how damaging it can be from both a health and monetary perspective.

The statistics make for stark reading. Around 78,000 people die from smoking in the UK every year. More than half a million people are admitted to hospital each year due to smoking. Two-thirds of long-term smokers end up dying due to smoking-related illnesses. Smoking is the leading preventable cause of death in the UK.

And it’s not just smokers who are affected. Recent figures from the public health charity Action on Smoking and Health reveal that the cost of smoking to society in England is £17.04bn per year – £5bn higher than previously estimated.

Productivity costs due to smoking have hit £13.2bn and it costs the NHS an additional £2.4bn. In light of these figures, the Government has put together a tobacco control strategy to make the UK 'smoke-free' by 2030, i.e., less than 5% of the population smoking by then.

In devising this strategy, the Government has acknowledged that “we need bold action to both discourage people from starting in the first place, and to support smokers to quit”. It has also just published a review carried out by former Barnardo's chief executive Javed Khan, which has concluded that today's children should never be able to buy tobacco products.

Smoking costs England approx £17 billion per year
The England anti-smoking budget has been cut from £5million to £3.8 million

In his report, Khan has recommended that an extra £70 million needs to be invested into stop smoking services every year.

However, amidst all this, the Government has recently reduced its anti-smoking budget from £5m to £3.8m. This is despite the fact that expert behavioural support, combined with stop smoking aids, makes someone three times more likely to quit

Furthermore, if the current number of stop smoking support services are anything to go by – particularly in some of England’s most deprived areas – hundreds of thousands of smokers lack the support they need to kick their unhealthy habit. And with tobacco dependence being one of the hardest addictions to break, the proportion of the UK population who still smoke is unacceptable.

We know this, having reviewed last year’s data on the number of smokers within each Clinical Commissioning Group (CCG) in England and cross-compared this with the number of dedicated, local stop smoking services available within each area. (For context, Clinical Commissioning Groups account for around 60% of the NHS budget and allocate a wide range of services – including stop smoking support – to local populations.) 

In this report, we outline our full findings and explain what they mean in terms of the current climate and the wider context of the Government's long-term tobacco control plan. 

Before we delve into the numbers we’ve uncovered, let’s analyse the current state of play in terms of how many smokers there are in the country, how many are trying to quit, and how many need to quit for the Government to achieve its target.

How Many People Currently Smoke In England?

There doesn’t appear to be a consistent figure for the number of smokers in England and the rest of the UK – the exact number depends on which article or resource you refer to. 

Based on our below table, which comprises current smokers aged 15 and above across every NHS CCG in England, there are currently just over 8 million smokers in England at the time of writing. 8,040,280, to be exact. 

However, the official numbers from other sources are slightly lower. According to the Government report mentioned above, there are currently around 6 million smokers in England. It should be noted, though, that these figures only take into account smokers aged over 18 – they don’t account for younger smokers who take up the habit before they become an adult. Therefore, the actual number of overall smokers in England is likely to be much higher.

Whichever of these figures is most accurate, what we do know is that the total number of smokers in England is well into the millions. This fact is a major concern given that the Government wants less than 5% of the country to be smokers in just eight years. For this outcome to be achieved, more than 350,000 people would need to quit smoking every year, on average, between now and 2030 - and this stat doesn't take into account anybody smoking over the next eight years.

It will be interesting to see whether or not this happens, given the cuts to the anti-smoking budget, the need for much higher investment into stop smoking services, and the scarcity of local stop smoking support within certain key areas of the country (which we explore in more detail below).

How Many Smokers In England Want To Quit?

With at least 60% wishing to quit the habit, there is amazing potential to reduce the smoking rates in the UK. Any help to stop smoking will considerably enhance a smoker’s chances of success, so smoking cessation services have an important role to play moving forward.

However, smokers must be aware of the help available to take advantage of it. Stop smoking support should be well publicised, and the nature of that support clearly explained. Free help to stop smoking must be highly accessible. Smokers seeking a stop smoking service should not be required to do extensive research or jump through hoops to obtain the help they need.

In England around 60% of smokers want to quit
Combining behavioural support with quit aids makes people 3 times as likely to stop smoking

What Stop Smoking Support Services Are Available In England?

Stop smoking support services generally take three forms – signposted, outsourced, and dedicated local services. Here’s a quick lowdown on each:

  • Signposted: A local authority often refers (or ‘signposts’) smokers to independent service providers if it is unable to provide a support network. A signposted stop smoking support service is one that is provided by GPs, pharmacies, NHS helplines and digital resources, and vaping retailers. When you use this type of service, you are unlikely to receive specialist, regular one-to-one support.
  • Outsourced: This type of service works to a more clearly defined framework than the services above. To access this type of service, you generally have to go through a registration process and, as part of this process, you may be required to meet specific eligibility criteria. Outsourced support providers are generally NHS-funded and may also receive funding from the local authority. They are, however, operationally independent of local authorities, and the advisors who work for these types of services usually require some level of NCSCT qualification.
  • Dedicated local: These services are much more comprehensive than signposted and outsourced services. They are staffed by expert advisers who can provide regular, tailored one-to-one support over a longer period of time. These experts use a wide range of proven methods to help you quit smoking and will typically give you advice and support over several months. In some cases, they will offer you continual support for up to a year after you quit, should you need it. These services are so effective that most people who use them will get through the first month after quitting without smoking a cigarette.

 

Below is a map showing every single dedicated local stop smoking support service (that we could find) across England.

What Do The Numbers Reveal?

At the time of writing, there are 129 dedicated local stop smoking support services in England. Referring to the above six million figure, this equates to around one service for every 46,512 smokers. However, the data we’ve collected from all the CCGs across the country yields a slightly higher average number – one service for every 62,328 smokers.

If quit rates are to increase, then it’s likely that the number of services available will need to drastically increase, too. As you’ll see in the below table, many densely populated areas don’t include any dedicated local stop smoking service. 

Below is a summary of the current state of play, but before we dive into the granular details of our research, we want to briefly outline how we've come to the below conclusions.

Our Methodology

Through the Office for Health Improvement & Disparities website, we have investigated the number of current smokers aged 15 and over across England. This data is based on the period of April 2020 to March 2021 and encompasses every CCG in England.

Using this data, we then researched and calculated the number of locally commissioned stop smoking support services in each area (see our definition of this above).

Finally, we divided the total number of smokers within each CCG by the number of services available in each area to get a support service to smoker ratio, i.e., there is one service for every X number of smokers in X. 

The Complete Data

Using the above formula, below is a comprehensive overview of the number of smokers and the support service to smoker ratios within each CCG area in England.

The Headline Stats

As you can see above, a huge amount of data is available on smoking prevalence across the country. We’ve dissected the data to give you this quickfire overview of the most shocking statistics:

  • 12 CCG areas in England that don’t contain any locally commissioned stop smoking support service. These include Ealing, Wolverhampton, Bolton, and North Cumbria. 
  • These 12 areas comprise nearly HALF A MILLION smokers (454,906). That means that around half a million smokers in England don’t have access to dedicated local stop smoking support. 
  • Nearly one in ten CCGs in England are based in an area that doesn’t provide locally commissioned stop smoking support.
  • The Birmingham city region doesn’t contain any locally commissioned stop smoking support service. 
  • The ten ‘worst’ areas of the country don’t contain any locally commissioned stop smoking support service for 454,906 smokers, while the ten ‘best’ areas contain 17 services for 286,747 smokers. That’s 17 more services for 168,159 fewer smokers.
Nearly half a million people in England have no access to local stop smoking support
Map of best and worst areas in England for stop smoking support

The North-South Divide

When we dig deeper into the NHS’s smoking prevalence data and compare this to the number of stop smoking support services in England, we uncover a clear picture of the disparities between north and south.

Of the ten best areas for smoking cessation – i.e., the areas with the lowest smoker-to-support service ratio – eight are in the south and midlands, while only two (West Lancashire and Southport and Formby) are in the north.

When we compare some of the north’s major cities to London, the contrast becomes even clearer. For example, Liverpool and Leeds contain two dedicated local stop smoking support services between them, and these two support services cater to a total of 219,195 smokers. That’s the same number of services as in the area covered by the Central London (Westminster) CCG, which contains 30,659 smokers – 7x lower than the combined total for Liverpool and Leeds.

In fact, the areas covered by the West and Central London CCGs contain four dedicated local stop smoking support services for 68,371 smokers between them, whereas the area covered by NHS Manchester – which comprises more than 100,000 smokers – contains two. This is yet another example of the inequalities between two prominent, densely populated areas in terms of support provision. 

Another notable finding is that West Sussex contains six dedicated local stop smoking support services for 108,569 smokers. When we compare this to Leeds, which has five fewer despite being home to 20,000 more smokers, it’s clear, again, that there’s a disproportionate difference between these two areas.

Even when we compare different parts of the south, it becomes apparent that some areas have a far more favourable setup than others. 

For example, South East London contains the same number of stop smoking services as Central and West London, despite having nearly four times as many smokers (268,163 compared to 68,371). 

Meanwhile, the area of Norfolk and Waveney only includes one dedicated local stop smoking service for 153,321 smokers – more than 10x the number of smokers as Surrey Heath, which also contains one. 

Kent and Medway doesn’t fare much better – the area has 260,859 smokers, yet two dedicated local stop smoking services – the same number as Central London, which has 8.5x fewer smokers. 

The Major Cities

What constitutes a ‘major city’ is up for debate, but we’ve chosen England’s best-known and most densely populated cities and analysed the smoker and support service data for each CCG that serves these areas. 

Best & worst major cities for stop smoking support

Unsurprisingly, given our example in the above section of our report, Central and West London come out on top, with support service to smoker ratios of 15,330 and 18,856, respectively. 


Liverpool, Leeds, and Birmingham and Solihull are the worst areas, with the latter having a support service to smoker ratio of 173,743 – and this is only due to the fact that there’s a support service in Solihull. A damning statistic, given that Birmingham is often labelled the UK’s ‘second city’.


The statistics, once again, portray a clear disparity in stop smoking service provision between the north and south. Of the five worst-performing areas, all of them are in the north and midlands, while of the five best-performing areas, only one of these – Newcastle and Gateshead – falls under a CCG in the north. Three of the five best-performing areas are in London.

Why Is There Such A Difference In Stop Smoking Support Between Different Parts Of The Country?

This is a difficult question to answer since the support service to smoker ratios hinge on both the number of smokers themselves and the number of support services available.


However, if we were to try and surmise what the reasons are behind some of the huge ratios in some parts of the country compared to others, we could arrive at one or all of these three conclusions:


  • Smokers in some of the more deprived and/or more northern parts of the country aren’t considered as urgent a priority as in certain other areas. 
  • Smokers in certain areas of the country, particularly some major cities, aren’t being given the information or support they need in order to quit smoking.
  • Smokers in certain areas of the country are less inclined to quit smoking than smokers in other areas.

Which of these conclusions is most accurate is up for debate, but common logic tells us that the second bullet point is perhaps the best explanation of the clear disparity in dedicated local stop smoking support between different areas of England. 


The first conclusion is, of course, quite speculative. It’s a claim that not every politician would publicly support or comment on – but the numbers speak for themselves.


As for the third conclusion, there is some evidence to suggest that a person’s likelihood of smoking increased in line with the level of deprivation in their neighbourhood. Again, this conclusion is speculative, but inclination likely plays a key role in determining whether people within these communities continue to smoke or not. Long-term smokers, for instance, are much less likely to engage with local support services than casual smokers. 


Outreach may be another obstacle here – a more proactive approach is needed for some service providers to be able to keep up with the number of people taking up and quitting smoking, where the volumes are high in both cases. This, again, comes down to budget and how much funding is allocated to certain areas in order for healthcare professionals to carry out due diligence. 


Whether you agree with any of these conclusions or not is your prerogative, but one conclusion you can’t dispute is that there are disproportionate levels of local stop smoking support between some of the major cities within England – and these disparities need to be urgently addressed.


Only by bridging this gap and drastically increasing quit rates can the Government realistically expect to achieve its 2030 smoke-free target. Otherwise, this target is simply a pipe dream.

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