What is the paramedic's role in smoking cessation?

The Five Year Forward View (NHS England, 2014) argues that the sustainability of the NHS and economic prosperity depends on improving prevention and public health. As smoking is the leading preventable cause of illness and premature death in the UK (NHS England, 2014; Department of Health and Social Care (DHSC), 2017), Public Health England (PHE) (2014) has responded by making smoking cessation a health promotion priority, aiming for a ‘smoke-free’ NHS by 2020 (NHS England, 2017).

The negative impact and cost of smoking in terms of both public health and the economy almost go without saying (Box 1). Smoking cessation interventions are one of the most cost-effective treatments, saving £1000 per life year gained after quitting (National Centre for Smoking Cessation and Training (NCSCT), 2017). In 2006, the National Institute for Health and Care Excellence (NICE) produced guidelines on opportunistic brief interventions for smoking cessation (NICE, 2006). However, the role of the paramedic was not considered in the original report. This meant that the potential impact and scope of influence paramedics may have had in this important area of health promotion was not discussed or realised for more than 10 years. Subsequent guidelines have recognised that paramedics have a role to play in smoking cessation (NICE, 2018) but they contain little practical advice, and no realistic blueprint for quality improvement.