National guidance and policy

National guidance and policy

This page provides an overview of national guidance and policy relating to smoking in pregnancy

On 22nd July 2019, the Government published a consultation on the Prevention Green Paper: Advancing our health: prevention in the 2020s, asking for responses on how the Government can achieve the ambition of a smokefree England by 2030. 

The Green Paper recognises it will be “extremely challenging” to reduce the inequalities in smoking rates. It highlights that 1 in 4 pregnant women smoke in Blackpool compared to 1 in 50 in Westminster and goes on to state that: “Tackling these inequalities is the core challenge in the years ahead. If we are to achieve this vision of a smoke-free future, we need bold action to both discourage people from starting in the first place, and to support smokers to quit.”

The Green Paper also references the commitment in the NHS Long Term Plan to implement “a new smoke-free pregnancy pathway for expectant mothers and their partners” by 2023/2024.

Challenge Group submission to Advancing our Health: Prevention in the 2020s

In October 2019 the Smoking in Pregnancy Challenge Group responded to the Department of Health and Social Care’s consultation ‘Advancing our health: prevention in the 2020s.’ The response calls for a national incentive scheme to support women in high smoking prevalence communities to quit, and greater support for smoking households and families to reduce pregnant women’s exposure to secondhand smoke.

You can read the submission here

The NHS Long Term Plan, published January 2019,  includes a commitment to deliver an opt-out smokefree pregnancy pathway including focused sessions and treatments for expectant mothers and their partners. Areas with the greatest level of need will be prioritised with a commitment to support 600,000 people to quit over the next five years. 

The Implementation Framework was published in June 2019. Details on smoking and maternity services can be found on p15-16. On the Saving Babies’ Lives Care Bundle (v2) the framework states:

  • Funding will be available on a fair shares basis from 2021/22 to optimise implementation, particularly the new element on reducing pre-term births.

On the smoking components of the LTP, it commits to:

  • Targeted investment to develop NHS-funded smoking cessation services in selected sites in 2020/21;
  • Additional indicative allocations for all STPs and ICSs, from 2021/22, for the phased implementation of NHS smoking cessation services for all inpatients who smoke, pregnant women and users of high-risk outpatient services (as a complement not a substitute for local authority’s own responsibility to fund smoking cessation)

The Implementation Framework is accompanied by a ‘System support offer’ which signposts the national and regional support that local systems can draw on to develop their five-year strategic plans. Information on maternity services can be found on p14-15.

The Maternity Transformation Programme will provide support for the implementation of the maternity commitments by:

  • Publishing further guidance to local maternity systems (LMSs) through the seven regional Maternity Programme Boards during summer 2019
  • Appointing named maternity and neonatal safety champions in every national, regional and local NHS organisation involved in providing safe maternity and neonatal care to support safety initiatives, including the implementation of Saving Babies’ Lives Care Bundle (v2)
  • Producing tools to help systems address and narrow health inequalities, including enabling greater access to the maternity services dataset.

The Saving Babies’ Lives Care Bundle Version 2 (2019) – ‘Element 1: Reducing smoking in pregnancy’ recommends carbon monoxide (CO) testing of all pregnant women at antenatal booking appointment; CO testing a 36 weeks; referral to a stop smoking service/specialist based on an opt out system; and training on CO monitor use and Very Brief Advice (VBA) for all relevant maternity staff. An evaluation of the Care Bundle found that stillbirths fell by a fifth at maternity units where the guidance was implemented, saving more than 160 babies’ lives. You can read the NHS press release here. Version 1 of the Saving Babies’ Lives Care Bundle can be accessed here.

NICE guidance provides the evidence-based model for smoking cessation support within maternity settings:

The 2017 Tobacco control plan for England includes an ambition to reduce rates of smoking in pregnancy to 6% or less by 2022.  The Plan further commits Government to a number of specific actions including commitments to embed CO Screening in Maternity Services Data Set and to take further action via the Maternity Transformation Programme.

Response to inquiry on e-cigarettes

In December 2017 the Smoking in Pregnancy Challenge Group submitted its response to the House of Commons Committee on Science and Technology Inquiry into e-cigarettes. You can read the submission here and learn more about the inquiry here.

CLeaR self-assessment tool for smoking in pregnancy

The CLeaR model for helping local areas to map their current tobacco control activity against evidence-based best practice has been around since 2012, and been used by around two-thirds of localities across England. In 2017, Public Health England developed deep dive CLeaR tools to allow for a more in-depth review of specific topics within tobacco control; one of these is around addressing smoking in pregnancy. This tool builds upon evidence from NICE guidance and allows localities or LMSs to benchmark themselves by working through a series of questions. These questions are grouped around 4 broad themes:

  • Systems (including leadership and commissioning)
  • Training
  • Communications (both internal and external)
  • Treatment (referral pathways and behavioural support)

The CLeaR tool is free to download and use from here. Completing the tool should require input from a range of partners involved in tackling maternal smoking, such as maternity staff, SSS commissioners and providers, CCGs, communications staff, etc. Once completed, it will provide an at-a-glance summary of areas of strength and those requiring further development, which should then inform future action planning.

For further discussion on the CLeaR tool, or for support with your local assessment, please email