1.  EXECUTIVE SUMMARY

  1.1  Smoking is a major factor in health inequalities and the main cause of preventable morbidity and premature death in the UK. By tackling smoking levels, through the promotion of effective smoking cessation techniques and treatments, the NHS can make a significant impact on health inequalities in the UK.

  1.2  The NHS Stop Smoking Service, however, has been found to be both ineffective and cost-inefficient. Although reliable figures are difficult to obtain, the NHS service appears to have a failure rate of around 90% at 12 months, with the cost per smoker who successfully quits being over £2,000.

  1.3  Allen Carr's Easyway To Stop Smoking is the world's most successful smoking cessation method. It has been conservatively estimated that Allen Carr's Easyway clinics and books have helped over 10 million smokers quit. Independent studies conducted by highly respected scientists and published in peer review journals have shown that the clinics have a success rate of over 51% at 12 months. The fee is £220, with a full money back guarantee if the smoker fails to stop for at least 3 months. The clinics have a truly national coverage throughout the UK and offer the consistent quality of service one would expect from a highly successful global company.

  1.4  Regrettably, the Government and NICE have consistently failed to recommend, and now propose specifically to exclude, Allen Carr's Easyway for use by the NHS. This has meant that smokers from the most disadvantaged sectors of society have not been able to benefit from the method on the NHS, and illustrates how the Government has failed to deliver on its commitment to expand the choice of help available in the Choosing Health White Paper. This British-based organisation, a global brand leader in the field of smoking cessation, is in a position to offer a more effective and cost-efficient alternative to the failing and predominantly pharmacological interventions currently provided by the NHS Service.

2.  INTRODUCTION

  2.1  The Department of Health has recognised that smoking is the principal avoidable cause of premature deaths in the UK. Smoking is responsible for an estimated 106,000 deaths in the UK each year, and for a wide range of diseases and conditions including cancers, coronary heart disease, impotence and infertility.

  2.2  It is also widely recognised that smoking is the primary reason for the gap in the life expectancy of the rich and the poor, and is responsible for over half the excess risk of premature death between the social classes. An international study published in 2006, found that there was a two-fold difference between the highest and the lowest social strata in overall risks of dying among men aged 35-69 years (England and Wales: 21% vs 43%). More than half of this difference in mortality between the top and bottom social strata involved differences in risks of being killed at age 35-69 years by smoking (England and Wales: 4% vs 19%).[355]

  2.3  One in four British adults smoke, of which half tried to quit in 2006. Of those, only 2.5% will end up quitting permanently, and only 0.2% because of the NHS Stop Smoking Service. It is therefore vital that the Government provides more effective support and greater choice for those wanting to stop smoking.

3.  NHS STOP SMOKING SERVICE

  3.1  The Government's favoured method of smoking cessation is intensive counselling, coupled with nicotine replacement therapy (NRT). The Government's own figures claim that the NHS Stop Smoking Service has a success rate of 51% at only 4 weeks, based on self-report.[356] According to NICE, only 13-23% of these are still abstinent at 52 weeks.[357] Therefore, according to the Government and NICE, the success rate of all those that use the NHS Stop Smoking Services is 7-12% at one year.

  3.2  Additionally, a recent study has found that the NHS Stop Smoking Service's behavioural support has no effect and that the absolute quit rates achieved are those expected from nicotine replacement alone. The study found that the quit rate at a year is 7.7% for the NHS's basic treatment and 6.6% for the intensive treatment.[358] Yet the Department of Health still proclaims the NHS Stop Smoking Service to be "world leading".

  3.3  Although reliable figures are difficult to obtain, our calculations, based on Government statistics, suggest that the NHS Stop Smoking Service, including NRT products, costs between £1,996 and £3,532 for every smoker who quits for 12 months.

  3.4  In addition to this, many of the NHS Stop Smoking Service's so-called "successes" remain addicted to nicotine via the nicotine products they receive from the NHS and many smokers continue to smoke and use NRT as well, in situations when they are unable to light up. The consequences are multiple dependencies and the prolonging of nicotine addiction, which leads to a decrease in the extensibility of the arteries, diseases of the circulatory system, the kidneys and the retina, as well as stomach and duodenal complaints.[359] It should be noted that insurance companies do not consider policy holders as non-smokers while they continue to take nicotine in any way.

  3.5  Consequently, the pharmaceutical companies are now competing with the tobacco companies for the nicotine addicted market and the tax payer is paying millions of pounds for the provision of nicotine to addicts, which simply perpetuates their addiction. You cannot cure nicotine addiction by giving addicts nicotine. Additionally, the Health Services Journal reports that "stories abound of unscrupulous advisers making up figures and of service users selling their free NHS patches."[360] This may explain why vast quantities of nicotine patches and gum are to be found on sale on eBay.

  3.6  In addition to NRT, in July 2007, NICE issued guidance recommending varenicline (Champix/Chantix) as an effective treatment for helping smokers to quit. In November 2007, the US Food and Drug Administration (FDA) released an early communication on the ongoing safety review of varenicline, in which they stated that they had received reports of suicidal thoughts and aggressive and erratic behaviour in patients who have taken Chantix, and called on healthcare professionals to monitor patients taking Chantix for behaviour and mood changes.[361]

  3.7  With smoking at the top of the agenda, and with many smokers looking to quit, we believe that the NHS should stop throwing good money after bad and stand by their commitment, in the Choosing Health White Paper, to expand the choice of help available and provide more support through alternative routes to meet smokers' needs.[362]

4.  ALLEN CARR'S EASYWAY TO STOP SMOKING

  4.1  Allen Carr's Easyway To Stop Smoking is the most successful smoking cessation method in the UK and around the world, and has been operating for over 20 years. Throughout that time, Allen Carr's Easyway clinics, conducted in groups or on a "one to one" basis, have been offering a genuine money-back guarantee, whereby smokers who do not quit for at least three months, after attending 3 sessions, are entitled to a full refund of their fee.

  4.2  This money back guarantee has been offered to private and corporate clients for over 20 years and is currently offered in more than 38 countries and 100 cities. Less than 10% of clients worldwide find it necessary to claim under the guarantee.

  4.3  In addition, independent studies conducted by highly respected scientists and published in peer review journals have shown that after 12 months, the success rate is still over 51%.[363], [364]

  4.4  Allen Carr's Easyway To Stop Smoking Clinics are currently PruHealth's exclusive smoking cessation service provider in the UK.

  4.5  Despite the weight of both scientific and anecdotal evidence, NICE has repeatedly failed to recognise Allen Carr's Easyway To Stop Smoking Clinics, books and other products for use in the NHS. We find it extraordinary that the Government and the NHS have failed to recognise the success of Allen Carr's Easyway and the millions of people it has helped to stop smoking.

  4.6  Furthermore, the draft guidance on smoking cessation that is currently being developed by NICE, with the final guidance due at the end of February, has specifically not recommended Allen Carr's Easyway for use by the NHS. In contradiction, the draft guidance recommends that group therapies can be recommended.[365] In practice, this means that an established, popular, and phenomenally successful group behaviour therapy is barred, whilst leaving the door open for any new group behavioural therapy to set up and qualify for recommendation for use by the NHS, merely as a result of being a group therapy that is not Allen Carr's Easyway.

  4.7  NICE cites that there is insufficient data available on Allen Carr's Easyway Programme to draw any conclusions. However, the two independent papers represent significant studies into the effectiveness of Allen Carr's Easyway technique and, along with the other supporting evidence that we have presented, including testimonials from thousands of former smokers who have successfully used the method and letters of support from eminent supporters of the method, the commercial success of the method over 20+ years in 38+ countries are more than sufficient for NICE to draw conclusions about the effectiveness of the smoking cessation method. NICE currently requires Allen Carr's Easyway to provide far more onerous and comprehensive scientific evidence of its effectiveness than that which NICE applies to the current NHS Stop Smoking Service.

  4.8  It should also be noted that there is no reason why Allen Carr's Easyway method should be subjected to the same analysis as pharmaceutical interventions. It is not a drug, there are no side effects, it is harmless, and the service is extremely economical compared to other interventions not just with regard to the basic cost but also in terms of the money back guarantee which would be available to NHS clients in the same way as it is currently available to private clients.

5.  CONCLUSION

  5.1  The cutting of smoking prevalence can help to achieve a significant reduction in the levels of health inequality in the UK. Around 75% of smokers state that they would like to quit and, therefore, the NHS has the potential to make significant impact in this area.

  5.2  However, the NHS is currently wasting hundreds of millions of pounds of tax payer's money by failing to recognise Allen Carr's Easyway whilst continuing to fund smoking cessation techniques which are considerably less successful and less cost-effective.

  5.3  Making Allen Carr's Easyway To Stop Smoking Clinics, books, and DVDs available to smokers contacting the NHS Stop Smoking Service would provide smokers who have already been through the existing NHS Service unsuccessfully with a different, successful and hugely popular approach, and also be welcomed by the many smokers who prefer a drug-free method of quitting smoking which frees them from their addiction rather than perpetuates it.

  5.4  Allen Carr's Easyway To Stop Smoking enjoys an excellent media profile, established over many years, and would prove to be a popular and highly effective addition to the NHS Service which could only benefit by association with the brand.

January 2008

356   Statistics on NHS Stop Smoking Services in England, April to December 2006. Back

357   NICE draft guidance on smoking cessation services, May 2007. Back

358   Aveyard P, Brown K, Saunders C, Alexander A, Johnstone E, Munafo M, et al. A randomised controlled trial of weekly versus basic smoking cessation support in primary care, Thorax (2007). Back

359   Ginzel KH, Maritz GS, Marks DF, Neuberger M, Pauly JR, Polito JR, Schulte-Hermann R, Slotkin TA 2007. Journal of Health Psychology 12, 2, 215-224. Back

360   Carlisle D, Will next month's ban fire up PCT stop-smoking services?, Health Service Journal, 14 June 2007. Back

361   FDA, Early Communication About an Ongoing Safety Review Varenicline (marketed as Chantix), 20 November 2007. Back

362   Department of Health, Choosing Health: Making healthy choices easier, November 2004, p.136. Back

363   Moshammer H, Neuberger M, Long term success of short smoking cessation seminars supported by occupational health care, Addictive Behaviors (2006), doi:10.1016/j.addbeh.2006.10.002. Back

364   Hutter H.P, Moshammer H, Neuberger M, Smoking cessation at the workplace: 1 year success of short seminars, Int Arch Occup Environ Health (2006) 79: 42-48, DOI 10.1007/s00420-005-0034-y. Back

365   NICE Public health programme draft guidance-Smoking cessation services, including the use of pharmocotherapies, in primary care, pharmacies, local authorities and workplaces, May 2007. Back