A72Delivery risk: AmberGate: pending
Make effective smoking treatment reach more people
Existing action A72, assessed at the same scope.
Not stated in the review record; treated as a provisional single-reviewer assessment, not an approved business case.
- Who and where
- Adults aged 18–64 in routine and manual occupations in England who smoke (16.6% smoked in 2025; about 1.2 million people on ONS weighted counts). (from the action record) Jurisdiction: England.
- Result so far
- Range if completed: 21.0–24.0 out of 30 (equal weights; not yet assessed: incremental affordability (Co))
- Funded now (baseline)
- Funded baseline: the 2026–27 public health grant ring-fences £152.8m for smoking cessation (absorbing the extra £70m a year and Swap to Stop); the generational age-of-sale law starts on 1 January 2027; NHS trusts offer tobacco dependence treatment. Targeted outreach to routine and manual workers is a UK Facts proposal, not government policy. (from the action record)
- The change assessed (marginal)
- Expand access to established behavioural support plus suitable cessation treatment for a defined underserved adult group; cardiovascular prevention is a separate, unscored option. (from the 6 October review)
- Domain home: Health
- In the national plan: Wellbeing list
What the evidence supports—and the next decision
Established cessation treatment provides a stronger basis than a generic prevention promise; reach and sustained quits still determine additional benefit.
AI-assisted analytical follow-up · 8 October 2026. Proposed appraisal design; the attributed scores below are unchanged. No funding or delivery agreement is implied.
- Define the change
- Expand access for a defined underserved adult group using suitable NICE-recommended support and treatment beyond current provision.
- Test whether it works
- Sustained quits, relapse and adverse effects by deprivation and other relevant groups; distinguish quit attempts from lasting outcomes.
- Establish the cost
- Adviser time, treatment, referral and follow-up; estimate health gains separately from cashable NHS savings.
- Protect against harm
- Use clinically appropriate choices and informed consent; this assessment does not include an uncosted cardiovascular-prevention package.
Read with the outcome evidence and sources in the full assessment. Monitoring proposals are not existing baseline measurements. A numerical benefit or cost score needs evidence for the defined increment, not just the scale of the problem.
Full assessment of Make effective smoking treatment reach more people: ten criteria, scenarios, delivery, costs and monitoring
The ten criteria (0–3)
Each criterion is scored 0 to 3 by the reviewer. “Not yet assessed” means unknown: it is never counted as zero.
Scale and severity (Sc)3 of 3 — Severe harm across a broad population
Increment beyond baseline (Ad)2 of 3 — Specific material change to existing delivery
Confidence in the proposed action (Ev)2 of 3 — Relevant evaluated evidence with limitations
Expected incremental benefit (Bn)2 of 3 — Material for the target population
Residual harms (Hm)2 of 3 — Manageable harm with specified safeguards
Incremental affordability (Co)Not yet assessed
Delivery capacity (Ca)2 of 3 — Stretched but plausibly obtainable
Distribution (Fa)3 of 3 — Benefits concentrated on disadvantaged people with assessed burdens
Meaningful first outcome (Ti)3 of 3 — Within one year
Readiness (Rd)2 of 3 — Named commissioning/allocation/coordination step
Four weightings
Normalised as 10 × weighted sum ÷ sum of weights, on a 0–30 scale. Where a criterion is not yet assessed, the range is the lowest and highest result if it were later scored 0 or 3 — not a score, a confidence interval or a rank.
- Equal weights: Range if completed: 21.0–24.0 out of 30. Not yet assessed: incremental affordability (Co). Funding gate: not passed.
- Evidence doubled: Range if completed: 20.9–23.6 out of 30. Not yet assessed: incremental affordability (Co). Funding gate: not passed.
- Scale doubled: Range if completed: 21.8–24.5 out of 30. Not yet assessed: incremental affordability (Co). Funding gate: not passed.
- Cost ignored (the funding gate still applies): Range if completed: 23.3–23.3 out of 30. Not yet assessed: incremental affordability (Co). The missing criteria carry no weight here, so the ends meet; the record is still incomplete. Funding gate: not passed.
Funding gate: Not passed — the cost is not yet assessed or no allocation is committed for this scope. Ignoring cost in a weighting never removes the gate.
Delivery risk and gate
Delivery risk shown: AmberReview’s claim: Amber. Best the recorded evidence allows: Amber.
Review’s reason: Verify service gap and current funding; cost adviser time, treatment, referral and follow-up. Measure sustained quits and inequalities, with adverse effects monitored. Proposed owners: public-health commissioners and health providers.
Why it is not Green yet
- Scope (population, place and increment) not verified against the delivery baseline.
- No verified owner with the powers in place.
- Delivery capacity not verified.
- Lifetime incremental costs not complete.
- No credible funding (a committed allocation for the scope).
- Safeguards not specified.
- Monitoring lacks a metric, a data source or a baseline.
Green needs verified scope, a verified owner with the powers, verified capacity, complete lifetime costs with credible funding, specified safeguards and monitoring with a metric, source and baseline. Amber means appraisal gaps remain; Red means a material delivery obstacle. Red does not mean unimportant.
Gate: Pending — appraisal incomplete (review label: “Pending baseline verification, incremental costing and funding; not a rollout approval”).
Why: Scores incomplete; Funding gate not passed (cost unknown or no credible funding).
The gate is separate from national list membership: being listed does not make an option eligible, and an eligible option need not be listed.
Cost and funding
Lifetime costing: Not established. Review: “Not fully costed in this review”.
Still to cost: Verify service gap and current funding; cost adviser time, treatment, referral and follow-up. Measure sustained quits and inequalities, with adverse effects monitored. Proposed owners: public-health commissioners and health providers.
Funding status: not identified.
Owner, powers and capacity
Proposed owner: public-health commissioners and health providers (proposed, unverified).
Powers: needs a decision or allocation. Capacity: unverified.
Powers and capacity read from the review’s Rd and Ca anchors; no proposed owner has agreed to act (the review: “Proposed owners have not agreed to act”).
- England:
- Councils (public health duty, Health and Social Care Act 2012 s.12) with integrated care boards and the Department of Health and Social Care (action record)
- Scotland:
- not assessed
- Wales:
- not assessed
- Northern Ireland:
- not assessed
Stop smoking services are devolved: Quit Your Way Scotland, Help Me Quit (Wales) and Stop Smoking NI. The Tobacco and Vapes Act 2026 applies UK-wide.
Dependencies, safeguards and risks
Depends on: None recorded.
Safeguards
None specified yet.
Monitoring and measured results
Metric: Define and baseline the outcome described in delivery requirements before approval.
Data source: Not yet named. Baseline: Not yet established.
Measures already on the domain page
- Quit dates set with local stop smoking services: latest 265,502 (2025–26); baseline 238,166 (2024–25) (England).
- Adults aged 18–64 in routine and manual occupations who smoke: latest 16.6% (95% CI 15.9–17.3) (2025); baseline not published (England).
A page measure is not necessarily the review’s metric; linking the two is an editorial decision still to be made.
Evidence for the outcome
Outcome: Define and baseline the outcome described in delivery requirements before approval.
NICE supports effective treatment combinations. Evidence is stronger for treatment than for this exact outreach/access increment; no national impact total is claimed.
Sources: nice.org.uk (P-GC-NICE-NG209-TREAT)
SWOT points it addresses
Review record
Assessment status: Not stated in the review record; treated as a provisional single-reviewer assessment, not an approved business case.
Reviewer: Original assessment author (name not supplied). Reviewed: 6 October 2026.
Scored in the working review of 6 October 2026 on the shared ten-criterion scale (one reviewer); not independently calibrated.
An editorial screening framework by one reviewer, not a formal appraisal or business case. Proposed owners have not agreed to act.