Support for smokers and action against illicit tobacco in Medway

The Medway Stop Smoking Service offers behavioural support and stop smoking medicines to all adult smokers in the local population.

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The challenge

Medway Council is a unitary authority within the ceremonial county of Kent. Medway has a long coastline on the Thames estuary and a population concentrated in the urban area around Rochester, Gillingham, Chatham and Strood on the River Medway. In 2021, adult smoking prevalence in Medway was 14.5 per cent, higher than the region rate (11.9 per cent) and the England average (13 per cent) [i].

There is significant income deprivation within Medway, especially in Gillingham, Chatham and south Strood. This presents a key challenge for the local stop smoking service as 28.6 per cent of adults in routine and manual occupations in Medway smoke, as do 31.2 per cent of social housing tenants. Both rates are above the national average. Smoking prevalence is also known to be high among the central and eastern European communities in Medway.

The cost to society of smoking in Medway is estimated to be £92 million per year in lost productivity, health and social care costs and fire costs[ii].

Support and motivate quitting

The Medway Stop Smoking Service offers behavioural support and stop smoking medicines to all adult smokers in the local population. This tailored support is delivered face-to-face, by phone or by video link depending on client needs and preferences. The service responded to COVID-19 by introducing new forms of remote support which have subsequently been retained to offer maximum flexibility.

Face-to-face support is offered at three well-known community centres in Chatham, Gillingham and Strood. The innovative Smoke-free Advice Centre in Chatham was established in 2015 in the town centre and has had a clear visual presence in the community ever since. Its success has led to an expansion of its services to include NHS Health Checks, weight management services, advice on breastfeeding and pregnancy, and mental health clinics.

Treatment and referral pathways are all designed to address the stark local inequalities:

  • The three advice hubs are all based within the more deprived communities of Medway.
  • Local GPs and pharmacists offer accessible community-based Level 2 advice and support.
  • The Council employs an Outreach Project Officer with a brief to engage smokers in areas of high deprivation and from minority ethnic groups. They work with voluntary and community organisations as well as in workplaces to reach smokers who do not usually engage with services.
  • The high smoking prevalence among social housing residents is being addressed through the Council’s ‘Swap to Stop’ pilot which offers tenants a free vaping starter pack alongside seven weeks of behavioural support.
  • The Healthy Pregnancy Team offers a range of support for all pregnant people, partners and significant others attempting to quit smoking.

Smokers from more deprived areas in Medway (deciles 1-3) are twice as likely to access the Medway Stop Smoking Service compared to smokers from more affluent areas (deciles 7-10), but their quit rate is lower than their more affluent peers (32 per cent vs. 41 per cent) [i] so every effort is needed to engage them and maintain their motivation to quit.

Raising the price of tobacco is known to be the single most effective way of motivating smokers to quit, so preventing illicit sales of cheap tobacco is recognised by Medway Council to be vital to the task of bringing down smoking prevalence across all communities. The appointment of a Trading Standards Officer for Illicit Tobacco has helped to sustain action against illicit tobacco as a priority.

Medway, like many other local authorities in England, has seen a new trend of organised criminal activity in creating illegal ‘pop-up shops’ with, for example, tiled walls that conceal hidden chambers for tobacco to be dropped into from the floor above. In a two-and-a-half-day operation in Medway, 82,000 cigarettes were seized from one retail premises but within hours the shop had returned to selling illegal tobacco. Kent Police Community Safety Unit have been the first force to successfully serve a six-month closure order to a retailer in Medway.


  • In the ten years from 2011 to 2021, adult smoking prevalence in Medway fell from 24.2 per cent to 14.5 per cent, equivalent to a 40 per cent contraction in the size of the local population of smokers.
  • Smoking status at time of delivery (SATOD) in Medway decreased from 19.9 per cent in 2010/11 to 10.8 per cent in 2021/22, a faster rate of decline than the national rate.
  • Since 2015, Medway Stop Smoking Service has supported more than 16,600 local residents through a quit attempt, with 8,680 successfully quitting. In 2020/21, the service supported over 2,000 more people per 100,000 compared to the England average.

How the work is sustained

Medway Tobacco Control Alliance has championed collaborative working since 2011 and continues to develop locally responsive approaches to reducing the burden of tobacco on individuals and the community. Working alongside Medway Council’s Public Health team, Health and Wellbeing Board and elected members are Kent Fire & Rescue Service, Kent Police, Medway Taskforce, HM Revenue & Customs, Medway Community Healthcare, Home Office Border & Immigration Agency, the Military, and Medway NHS Foundation Trust.

Lessons learned

During the COVID-19 pandemic, the Stop Smoking Service adapted quickly to client needs. All stop smoking support transitioned to a remote offer and medications were posted to clients to ensure they could continue with their quit attempts. Now, as we live with COVID-19, Medway have maintained many of the flexible treatment options which proved successful for many local people.


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